Looking through the different therapies available to help you or someone you love break free of an addiction, can be quite challenging and overwhelming. With so many options available, how do you really know which one will work best? A lot of people have never heard about dialectical behavioral therapy, or DBT, until they’re on the search for an effective and proven avenue for addiction treatment.
DBT is a type of psychotherapy comprised of four main treatment modes; as such, it is unique because most psychotherapy options only provide one. At the heart of DBT is helping patients learn new skills to better manage their emotions and minimize relationship conflicts. As you can guess, both of these issues are highly prevalent for those in addiction treatment.
What Does Dialectical Behavioral Therapy Mean?
DBT’s name comes from the term “dialectic,” which means two people with opposing views coming together to understand the truth. In the case of this treatment, these two people are the patient and the therapist. The goal is to help the addict acquire better skills for a healthy, sober life.
The four elements of DBT include:
1.Mindfulness. You’ve probably heard the term “mindfulness” used increasingly in recent years, and it’s a popular goal in yoga class. At its core, mindfulness means a person is present in the moment.
This is important for everyone, but especially addicts who have a tendency to live in the past. They might struggle to continue to live sober or reflect on past events that were embarrassing, harmful, or destroyed relationships.
It’s not easy to live in the moment. Everyone struggles with it. However, since it is one of the four modes of DBT, anyone can get better at mindfulness with the right guidance and regular practice. Living in the moment is rare, but it can provide a lightness and joy never experienced before. Most people tend to reside either in the past or worrying about the future.
2. Distress tolerance. You can’t get rid of negative influences in your life entirely. It’s not realistic to build or expect to live in a life that’s always positive. Instead, every person can benefit from increasing their tolerance towards negativities, and negative emotions in particular.
We all have negative emotions, but addicts tend to have them more than others. It’s a fallout from what could have been a debilitating addiction. For a lot of people, their instinct is to run away from negative emotions. However, DBT helps you work towards building up your tolerance towards these emotions.
This doesn’t mean you’ll become apathetic or lose your feelings in a negative way. Instead, it means your resiliency will increase. Resiliency is vital for a healthy life, particularly for those in recovery.
3. Emotion regulation. This might sound similar to “distress tolerance,” but there are some big differences. Negative emotions can include a number of examples including fear, embarrassment, and hatred. However, these aren’t the only emotions that need to be regulated, or “managed.”
It’s important that everyone learn to regulate their emotions. Otherwise, they can become sensitive to a harmful degree. It’s exhausting to feel every emotion to the maximum degree, and for an addict this exhaustion can lead them wanting for a familiar vice to numb or disregard that pain.
Emotion regulation isn’t something people are taught in school, and it usually isn’t taught well in family environments. That’s unfortunate, but it’s never too late to learn new skills for a healthier life. DBT focuses on emotion regulation so addicts have a healthy, safe avenue that doesn’t have them tempted to use drugs or alcohol for regulation.
4. Interpersonal effectiveness. Most people, whether they’re an addict or not, don’t communicate with others in the best way possible at all times. Miscommunication is a common cause of all kinds of trouble, from intimate relationships to relationships at work.
It’s important that every person know how to be assertive in communication while maintaining respect. Having tools that allow you to be clearer in your communication can help strengthen any relationship.
Many addicts depend on drugs or alcohol to help them “communicate better.” Consider the so-called social drinker. Alcohol has been used to lubricate conversations and high-stress social situations for centuries. Think about the instant “bond” of the smoker’s break or the instant—but false—camaraderie felt when using ecstasy.
It’s common for people to start experimenting with drugs and alcohol when they’re teenagers. At this age, nobody has the experience or maturity to be able to communicate clearly. Drugs and alcohol provide what is perceived as a shortcut. This isn’t true, of course, but it’s easy, accessible, and can easily make a person dependent on drugs and alcohol.
Not everyone becomes an addict or uses drugs in order to feel more social or like a better communicator. However, it’s still important to learn interpersonal skills so that there’s no temptation to depend on drugs or alcohol in the future.
DBT was first developed by Dr. Marsha Linehan to help treat patients with borderline personality disorder (BPD) in the 1980s, but research quickly revealed that the approach could be extrapolated to a number of disorders and diseases. These include eating disorders, PTSD, depression, and of course, substance abuse.
How Does DBT Work?
DBT uses individual therapy sessions with a mental health expert trained in this specific approach. A typical session includes practice drills. A lot of DBT patients also enjoy benefits from adding a group element to their DBT therapy. It’s much easier and more enjoyable to practice these skills with more people, especially since fellow patients truly understand what an addict is experiencing.
Sessions will also focus on pinpointing common scenarios that DBT can help address. Homework is often assigned, which can include experiential tasks such as practicing a certain approach to mindfulness.
In many cases, sessions are weekly for about six months. However, these sessions might be shorter or longer depending on the addict’s needs and goals.
Difference Between Cognitive Behavior Therapy and Dialectical Behavior Therapy?
Cognitive Behavioral Therapy, or CBT, is a psychological treatment centered on a number of ideas, but at the core is the principle that psychological problems (including addiction) are founded on negative or unhelpful thinking. For example, a person might think, “Getting high is the only way I’ll feel better” or “I really need to drink to be social at the office party.”
Negative self-talk such as telling oneself that they’re a failure, unattractive, never good enough, etc. can lead to dangerous habits like addiction to numb the pain. The brain does a really good job at making whatever a person thinks come true.
With negative thinking comes negative behavior. These negative coping mechanisms are used because other more effective and healthier mechanisms have not been learned. With CBT, negative thinking and behaviors are identified while healthy thinking and behaviors are learned and encouraged.
This isn’t always easy. It requires a person to want to change, to learn new skills, and to face their fears. Simultaneously, it’s important to learn self-calming techniques—this might sound a bit like mindfulness, and it can include that element.
You’ve probably noticed there are some things missing from CBT that are at the heart of DBT. These include:
- Distress tolerance. Organically, a person in CBT will likely increase their distress tolerance. However, this is more of a healthy side effect of CBT rather than a foundational goal. Not focusing explicitly on distress intolerance can mean an addict won’t increase their tolerance to the necessary level.
- Interpersonal effectiveness. Again, learning to communicate better with others is a common side effect of CBT. However, the focus of CBT is placed more toward communication with one’s self rather than others. Both are important, and it is simply a distinction to be made.
Dialectical behavioral therapy (DBT) isn’t necessarily “better” or “worse” than CBT. A person might benefit more from dialectical behavioral therapy, CBT, a combination of both, or different approaches at different stages of their recovery.
DBT for Substance Abusers
Dialectical behavioral therapy has shown to be highly effective for substance abusers and addicts because of the wide range of principles it teaches. The therapy specifically focuses on four key, achievable principles that affect the vast majority of substance abusers.
When working with an individual therapist, substance abusers can benefit from finding an expert who specializes in dialectical behavioral therapy within the substance abuse realm. There may also be group sessions of dialectical behavioral therapy that intersect with addiction.
Getting Help for Addiction
If you think dialectical behavioral therapy is for you or someone you know suffering from addiction, it’s time to get help. One interesting facet of DBT is that therapists usually practice it themselves.
You’ll want to look for a therapist who lists dialectical behavioral therapy as their specialty. A detox or rehab treatment center has comprehensive lists of local therapists, and can help connect you with a dialectical behavioral therapy expert.
A quality DBT therapist will have the standard certifications, degrees, and licenses. Ideally, they will have specialized in dialectical behavioral therapy for many years and work within the substance abuse field.
Bear in mind that insurance policies may cover part or all of the dialectical behavioral therapy sessions. Always check with your provider first.