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Dialectical Behavior Therapy (DBT) for Treating Addictions

What Is DBT?

DBT stands for “Dialectical Behavior Therapy.” It is a type of psychotherapy that was developed to treat individuals with borderline personality disorder (BPD) and other related mental health conditions. The therapy is based on the idea that people with BPD have difficulty regulating their emotions, thoughts, and behaviors, and that these difficulties are caused by a lack of skills in these areas. DBT aims to teach these skills and help individuals improve their ability to cope with difficult situations and emotions. It combines elements of cognitive-behavioral therapy with mindfulness and acceptance-based techniques. Keep reading to learn how DBT is used to treat addictions.

Purpose of DBT

The purpose of DBT is to help individuals with BPD and other related mental health conditions improve their ability to regulate their emotions, thoughts, and behaviors. This is achieved by teaching a set of skills that are broken down into four main categories: mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness. These skills are taught through both individual therapy sessions and group skills training.

DBT for Mental Health Diseases

The goal of DBT is to help individuals reduce their symptoms of BPD and other related conditions, such as self-harm, suicidal behavior, and intense and unstable relationships. Additionally, it aims to improve overall functioning, including the ability to form healthy relationships, hold down a job, and manage symptoms of depression and anxiety. DBT has also been adapted to treat other mental health conditions, such as substance use disorder, eating disorder, Post Traumatic Stress Disorder (PTSD) and other conditions.

DBT for Addiction

DBT has been adapted for the treatment of addiction and substance use disorders. It is based on the idea that individuals with addiction have difficulty regulating their emotions, thoughts, and behaviors, and that these difficulties are caused by a lack of skills in these areas. DBT for addiction is similar to traditional DBT, but with a focus on addressing the specific challenges that individuals with addiction face, such as triggers, cravings, and the emotional pain that often underlies addiction.

In DBT for addiction, individuals learn skills to increase their ability to tolerate distress and cravings, manage negative emotions, improve interpersonal relationships, and increase motivation to change their behavior. The therapy also includes strategies for managing triggers and reducing the risk of relapse, such as learning to identify high-risk situations, developing a plan to cope with cravings, and learning to recognize and change maladaptive thoughts.

DBT for Dual Diagnoses

DBT for addiction is usually administered in an outpatient setting, but it can also be used in inpatient or residential settings. Studies have found that DBT for addiction can be effective in reducing substance use, improving overall functioning, and decreasing the risk of relapse. It’s especially useful for people who have co-occurring disorders like PTSD, depression and anxiety. Co-occurring disorders are also known as dual diagnosis. 

In DBT for dual diagnosis, the therapist addresses both the substance use disorder and the co-occurring mental health condition. The therapy includes the standard DBT skills training, such as mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness, as well as strategies for managing triggers and reducing the risk of relapse. Additionally, the therapist may incorporate specific techniques to address the co-occurring mental health condition, such as cognitive-behavioral therapy (CBT) for PTSD or schema-focused therapy for BPD.

DBT for dual diagnosis can be effective in reducing substance use and improving overall functioning. It also addresses the underlying emotional pain and maladaptive coping mechanisms that often drive addiction, which can increase the chances of long-term recovery. It’s important to note that DBT for dual diagnosis is usually administered in a team-based approach, with a therapist who is trained in DBT, and often a psychiatrist who can address the medication management aspect of the treatment.

How Is DBT Carried Out?

DBT is typically carried out in an outpatient setting, although it can also be used in inpatient or residential settings. It typically involves both individual therapy sessions and group skills training.

Individual Therapy

Individual therapy sessions are typically held once a week and are focused on addressing the specific problems and challenges that the individual is facing. The therapist and the client work together to develop a treatment plan and set goals for therapy. The therapist uses a combination of cognitive-behavioral therapy (CBT) and acceptance and commitment therapy (ACT) techniques to teach the client new skills and help them apply them to their daily life.

Group therapy

Group skills training is typically held once a week and is focused on teaching the client the DBT skills, which are broken down into four main categories: mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness. These skills are taught through a combination of didactic teaching, role-playing, and homework assignments. The group skills training sessions provide an opportunity for clients to practice and get feedback on the skills they are learning.

Virtual Therapy Sessions

In addition to individual therapy and group skills training, DBT also includes virtual coaching. Virtual therapy sessions can also be done via phone, tablet, laptop or an iPad. Virtual coaching is an opportunity for clients to contact their therapist between therapy sessions to get support and help with applying the skills they are learning to real-life situations. This can be particularly helpful for clients who are struggling to manage intense emotions or who are at risk of self-harm or suicide. 

Overall, DBT is a structured, evidence-based treatment that requires a significant commitment from both the therapist and the client. It is usually administered over several months, and the therapist and client work together to track progress and adjust the treatment plan as needed.

DBT: What to Expect from DBT session

During a DBT session, the therapist and client will work together to address the specific problems and challenges that the client is facing. The session may include a variety of different activities, such as:

Reviewing the client’s diary card: The client may be asked to keep a diary card, which is a record of their daily moods, behaviors, and skills used. The therapist will review the diary card with the client to identify patterns and problem areas to be addressed in the session.

Skills training: The therapist will teach the client new skills and strategies to help them cope with difficult emotions, manage impulsive behaviors, and improve relationships. The therapist will also help the client to practice these skills and receive feedback.

Problem-solving: The therapist will work with the client to identify specific problems and develop a plan to solve them. The therapist will help the client to identify the underlying causes of the problem, brainstorm potential solutions, and develop a plan of action.

Emotion regulation: The therapist will help the client to learn how to identify and label their emotions, and develop strategies to manage intense emotions in a healthy way.

Mindfulness: The therapist will teach the client mindfulness techniques, such as meditation and breathing exercises, to help them stay present in the moment and reduce stress.

Interpersonal effectiveness: The therapist will teach the client skills to improve their relationships, such as assertiveness, effective communication and boundary setting.

Reviewing progress: The therapist will review the client’s progress and adjust the treatment plan as needed.

Overall, DBT sessions are a combination of teaching, coaching, and problem-solving, and are tailored to the specific needs and goals of the individual client. The therapist will use a supportive and collaborative approach, and the client will be encouraged to take an active role in their treatment.

Benefits of DBT

DBT is a well-established and effective treatment for individuals with borderline personality disorder (BPD), addiction, and other related mental health conditions. Some of the benefits of DBT include:

Reducing symptoms of BPD

DBT has been shown to significantly reduce symptoms of these issues, such as self-harm, suicidal behavior, and intense and unstable relationships.

Improving overall functioning

DBT can improve overall functioning, including the ability to form healthy relationships, hold down a job, and manage symptoms of depression and anxiety.

Reducing substance use

DBT has been adapted for the treatment of addiction and substance use disorders, and it has been found to be effective in reducing substance use and decreasing the risk of relapse.

Address underlying emotional pain

DBT addresses the underlying emotional pain and maladaptive coping mechanisms that often drive addiction and mental health conditions, which can increase the chances of long-term recovery.

Skills training

DBT teaches a set of skills that can be used to improve the ability to regulate emotions, thoughts, and behaviors, which can be useful not only for the specific condition being treated but also in other areas of life.

Team-based approach

DBT is usually administered in a team-based approach, with a therapist who is trained in DBT and often a psychiatrist who can address the medication management aspect of the treatment.

Adaptability

DBT has been adapted to treat other mental health conditions, such as substance use disorder, eating disorder, Post Traumatic Stress Disorder (PTSD) and other conditions.

Final Thoughts on DBT for Addiction Treatment

Thank you for reading our resource on DBT for addiction treatment. It’s important to note that DBT requires a significant commitment from both the therapist and the client, and it is usually administered over several months. But with consistent effort and dedication, DBT can provide a powerful tool for individuals to manage their symptoms, improve overall functioning, and achieve lasting change in their lives.

Need help? Find mental health professionals that use DBT.

Jordyn Mastrodomenico LPC, LCADC CTP
Author: Jordyn Mastrodomenico LPC, LCADC CTP

Jordyn is a Licensed Professional Counselor (LPC), Licensed Clinical Alcohol and Drug Counselor (LCADC) and Certified Trauma Professional (CTP). She holds a Master's degree in Mental Health Counseling, from Caldwell University, Jordyn has extensive experience in Outpatient and Intensive Outpatient settings and is skilled at guiding clients through the recovery process in individual and group therapy sessions.

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