Though originally developed to treat individuals with borderline personality disorder and suicidal thoughts, Dialectical Behavioral Therapy (DBT) is now used to treat a wide variety of mental health issues and is used in addiction recovery.
The term dialectical refers to ideas and opinions that are opposing, and DBT focuses on the concept that a person suffering from an addiction needs two opposing forces to heal: change and acceptance. The core focus of DBT is to help individuals build their confidence and coping skills to effectively handle stressful situations.
Many addiction treatment centers use DBT in their programs because aspects of DBT are extremely effective at helping individuals reach sobriety . The function of DBT involves enhancing the capabilities of the addict, improving motivation and decreasing maladaptive behaviors, boosting motivation, and structuring the individual’s environment.
DBT can help an addict learn mindfulness, distress tolerance, interpersonal effectiveness, and emotional regulation [1, 3].
Common DBT strategies include helping individuals find environments and peers that are recovery-focused. It also encourages a person to remove triggers to avoid relapse. DBT can also increase self-esteem and confidence in an individual’s coping strategies to overcome stressful or distressing situations.
DBT works to help individuals understand why they want to act in certain ways, and realize that everything is connected and change is constant. This helps people use opposing situations or emotions to find a balance. This, in turn, helps them accept that they need to make choices and changes .
DBT for Substance Abuse and Addiction Recovery
Substance abuse and addiction are types of self-harming behavior, according to DBT founder Dr. Marsha Linehan . Many addicts experiences social, financial, personal, legal, and health-related issues due to their addiction. The first step in DBT is to acknowledge their emotional, mental, and possible past pain that the addiction is numbing out.
Addiction recovery begins with encouraging the person to accept him/herself and their life as it is, rather than the way it is supposed to be.
Following is being able to recognize that change is needed in order to survive, and that the self-harming behaviors are destructive. DBT helps a person confront their addiction, accept self, and realize the importance of changing their behavior.
DBT is based on four skill sets for behavior change . Mindfulness, interpersonal relationships, emotional regulation, and distress tolerance. Mindfulness is about living in the present moment and not thinking about your past or future.
Distress tolerance is being able to accept a difficult situation and not relying on substances to escape. Interpersonal skills can help a person focus on their relationships, and resolving conflicts through communication. Emotional regulation is learning how to identify and change negative feelings.
One approach to applying DBT skills to overcome triggers in addiction recovery is to change the way you think .
Thoughts play an essential role in how a person responds to a situation or emotion. It can be helpful to identify and notice our thoughts, as well as learn how to think differently about them.
Specific DBT Skills for Addiction
For addiction recovery, the first mindfulness DBT skill is the S-T-O-P method. This stands for stop, take a deep breath, observe, and proceed.
You can also use color as a way to promote mindfulness . As you sit in a quiet, relaxed place, begin to breathe in a slow, rhythmic pattern. As you settle into your breathing pattern, ask yourself what is the most calming color for you and what color might your think of when you think about tension and distress.
As you breathe in, imagine breathing in your calming color, and as your breathe you, push out your color and feelings of tension and distress. You might imagine the calming color spreading throughout your body spreading warmth and relaxation. Another part of mindfulness is to be mindful of your emotions, to step away from a situation, understand it and accept it.
Another useful tool in DBT is the Helicopter method. Often when something is distressing, we are close to the situation or event and possibly emotionally involved or connected. It is similar to to being able to see things at a close focus, but we have difficulty seeing the bigger picture.
As we pull back from emotional situations, as though flying away in a helicopter, we can start to see things more clearly and rationally.
Image manipulation means that we all have distressing, intrusive images that coming into our minds and we struggle to dismiss them . These can be based on a real memory, or a random image we saw. Images can trigger strong physical sensations and intense emotions.
We can learn to manipulate the images in our head to reduce distressing feelings through effective visualization exercises.
Thought changing is another useful tool in applying DBT skills. This is where the individual writes or records what the trigger was, their automatic thoughts about the situation, any emotions ,if the automatic thoughts are fact or opinion, and what a realistic thought would be.
This can be done in therapy and at home to work through a challenging negative thought pattern.
In conclusion, there are numerous tools within DBT to develop skills for mindfulness, emotion regulation, distress tolerance, and interpersonal effectiveness. It can be a rewarding and therapeutic practice to apply skills learned into everyday life to maintain recovery.
About the Author: Libby Lyons is a Licensed Clinical Social Worker and Certified Eating Disorder Specialist (CEDS). Libby has been practicing in the field of eating disorders, addictions, depression, anxiety and other comorbid issues in various agencies. Libby has previously worked as a contractor for the United States Air Force Domestic Violence Program, Saint Louis University Student Health and Counseling, Saint Louis Behavioral Medicine Institute Eating Disorders Program, and has been in Private Practice.
Libby currently works as a counselor at Fontbonne University and is a Adjunct Professor at Saint Louis University, and is a contributing author for Addiction Hope and Eating Disorder Hope. Libby lives in the St. Louis area with her husband and two daughters. She enjoys spending time with her family, running, and watching movies.
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 Walker, R. (2015, June 15). DBT in the Treatment of Addiction. Retrieved April 15, 2017, from https://www.thefix.com/content/dbt-treatment-addiction
 (n.d.) Retrieved April 15, 2017 http://www.drug-rehab-experts.org/treatment-information/what-types-of-addiction-can-dbt-treat/
(n.d.) Retrieved April 15, 2017, from https://executiverecoverycenter.com/dialectical-behavior-therapy/
 (n.d.) Retrieved May 9, 2017, from https://www.getselfhelp.co.uk/emotionregulation.htm
The opinions and views of our guest contributors are shared to provide a broad perspective of addictions. These are not necessarily the views of Addiction Hope, but an effort to offer discussion of various issues by different concerned individuals.
We at Addiction Hope understand that addictions result from a combination of environmental and genetic factors. If you or a loved one are suffering from an addiction, please know that there is hope for you, and seek immediate professional help.
Published June 17, 2017
Reviewed By: Jacquelyn Ekern, MS, LPC on June 8, 2017.
Published on AddictionHope.com