Dialectical Behavioural Therapy in Addiction Treatment

Dialectical behavioural therapy is becoming an increasingly popular form of psychological treatment both, within addiction treatment and other contexts of therapeutic intervention.

This page will give you some information on what to expect from DBT, giving an overview on the different ways that the therapy promotes the development of skills, and how this type of support can help you to achieve and maintain a successful recovery.

What is Dialectical Behavioural Therapy?

DBT: Some Background

Dialectical Behavioural Therapy was developed in the 1980s by Dr Marsha Linehan.

Dr Linehan describes DBT as working to help people develop the skills to combat difficult symptoms associated with mental health conditions and ultimately live a ‘life worth living.’

Dr Linehan wrote a DBT Skills Training Manual that can be accessed by both therapists and patients.

The manual is made up of information that gives some handy context for how DBT works and what it can be used for, as well as providing some exercises that are associated with developing specific skills that make up the core of DBT practice.

CBT vs DBT

DBT is a form of talking therapy.

It is an offshoot of another form of treatment known as Cognitive Behavioural Therapy (CBT).

CBT believes that your thoughts, feelings, and actions are linked and that by acting on one, you can start to affect the others.

This can help you to feel in control of stressful situations and learn appropriate coping mechanisms.

So What Actually Is DBT?

DBT is an extension of or a ‘new version’ of CBT.

It still works on the basis that the ways that we think, feel and behave are all connected, but it also puts a big emphasis on acceptance.

This is because, often when we feel negative emotions, deal with suicidal ideation or difficult situations that can very intense, it can be very easy to begin to practice negative self-talk.

This means we can begin to think and feel badly about ourselves, which in turn can increase our intense emotions and put us at greater risk of engaging in things that can harm us, like self-harm or substance abuse.

DBT is centred around a few core elements:

1. Observing and analysing behaviour
2. Mindfulness skills
3. Interpersonal effectiveness skills
4. Emotional regulation skills
5. Distress tolerance skills

These basic principles can help you to learn how to manage extreme emotions in day-to-day life without relying on dangerous behaviours such as risky drinking or drug abuse.

What Conditions Can DBT Help Treat?

Initially, DBT was developed to help treat individuals dealing with borderline personality disorder.

Since the 80s though, it has become clear that DBT is a helpful tool for risk management and emotion regulation for individuals struggling with lots of kinds of mental health disorders.

Today, DBT is used to treat the following:

• Mood disorders such as anxiety and depression
• Eating disorders (such as anorexia, bulimia, and overeating disorder)
• Post-Traumatic Stress Disorder (PTSD)
• Suicidal ideation
• Substance use disorders

How Does DBT Tackle Addiction?

At its core, DBT is designed to help individuals who are struggling with difficult emotions that can lead to what is known by psychologists as ‘maladaptive behaviours.’

Maladaptive behaviours are things that we do that can cause harm to ourselves, such as:

• Self-harm
• Suicidal ideation
• Eating disorder
• Overspending
• Binge drinking or developing alcohol dependency
• Substance abuse
• Fighting with loved ones

This means that DBT can be very helpful in the treatment of addiction as it can increase your ability to keep a more stable emotional response when you encounter difficult situations.

This can ultimately decrease the urge to turn to drinking or self-medicate with drugs.

What Other Forms of Therapy Does DBT Complement?

Whilst DBT is very helpful in dealing with some of the difficult emotions associated with addiction, and hopefully, will work to decrease your likelihood to turn to drinking or self-medicating with drugs when things get tough, addiction is still a complicated disease.

This means that, whilst DBT is a very valid form of addiction treatment, a more thorough treatment programme will include a course of DBT alongside other therapies.

Some of the other types of therapeutic support offered at our partner rehab centres include:

• Alcohol addiction counselling
• Cognitive Behavioural Therapy (CBT)
• Equine Therapy
• Family Therapy
• Intensive Outpatient Treatments
• Interventions
• Self-Help Groups
• Individual Therapy
• Group Therapy

Tackling addiction from different angles can give you the best chance possible in controlling the urges to drink and moving forward to live a future life of sobriety.

What Skills does DBT teach?

There are five key fundamental principles that DBT revolves around.

Together, these core components can offer varying methods of keeping difficult thoughts or negative behaviours in check.

Self Observation Techniques

The first thing you will learn in DBT is about analysing your own thoughts, feelings and behaviours.

This is the basis for effective therapy.

In order to know how to change something, we first need to know how we may usually react to things.

You might do this in DBT by being given a scenario and thinking about how you might respond.

Or, you may be able to give examples from your own daily life that can cause you anxiety and stress, or may make you feel angry.

This is useful for you to understand lots of different things, including:

• Triggering or upsetting situations
• Your usual ‘natural’ responses
• How situations can spiral into harmful behaviours
• Potential new ways to approach and respond to certain situations

Once you have spent some time thinking about your own situations and have accepted what might be your ‘risky’ or unhealthy behaviours, you can begin to apply practical skills that can help you avoid these.

The next four steps offer different levels of skills training that you can use both inside and outside of a DBT session.

Skill 1: Practicing Mindfulness

One of the first ‘management’ skills you will learn during your sessions is how to practice mindfulness.

Mindfulness is a way of trying to be ‘in the moment.’

When we’re feeling things very intensely, it’s easy for our emotions to begin to run away from us and take control.

By trying to use mindfulness grounding techniques, it can be a way of keeping our feelings in check and allowing ourselves some breathing space until we feel able to calm down and react more appropriately.

A common mindfulness tool in DBT is the teaching of the ‘three states of mind.’

These are the reasonable mind, the emotional mind, and the smart mind.

The idea is that the reasonable mind and the emotional mind exist on a scale on opposite ends to each other.

Reasonable mind is the mind that thinks carefully, is always logical, weighs up options before reacting, and responds appropriately.

Emotional mind is the mind that is driven by feelings and acts on instinct, usually in response to intense emotions and energy running high. This is usually the mind that takes over in distressed individuals.

In the middle of these two, is the smart mind.

DBT teaches that just relying on an emotional mind can often mean we end up in prickly situations.

Equally though, it can be tough to always function through a reasonable mind.

Smart mind meets the reasonable and emotional mind in the middle.

It suggests that whilst we should acknowledge and accept our feelings, we should also try and look at situations through a rational lens to make sure we respond in a manner that both honours our feelings and does not cause ourselves or others any harm.

Skill 2: Learning Skills for Emotional Regulation

Emotional regulation is the opposite of engaging in potentially harmful behaviours.

The skills associated with emotional regulation are there to help you manage your feelings as a replacement for using substances that can lead to alcohol or drug addiction.

Part of emotional regulation is learning to identify emotions.

This can be surprisingly tricky.

Often, we know when we’re feeling good and when we’re feeling bad.

But usually, it can be harder to go much further than that.

Research suggests that being able to identify our own emotions can help us to deal with them in safer, more effective ways.

After developing the tools to identify the emotions, you will begin to learn ways of ‘changing’ the feelings, as well as finding methods of managing very extreme emotions.

In this section, you will also learn skills on how to develop good sleep hygiene and find other ways to keep yourself feeling in control.

Skill 3: Improving Relationships with Others (interpersonal relationships)

The third step addressed in DBT is all about building healthy relationships.

Whilst learning how to keep ourselves feeling safe and in control on an individual level is helpful, we also need to know how to engage with others outside of the therapy session context.

There are times when a tricky situation can involve another person, or when we may want to approach someone about how we are feeling.

To do this, we need to know how to keep both ourselves and others around us safe, and to make sure that we both give respect and feel respected.

It’s not uncommon for strong or heightened emotions to cause conflict. Usually, the fear of this is what can stop us from reaching out to others.

More often than not, though, keeping things to ourselves can make things feel worse.

This means that making sure we have the skills to communicate our feelings to another person in a measured and controlled way can help us keep our healthy relationships running and allow us to get the support we need.

Some of the interpersonal effectiveness skills you might learn include:

• Knowing what can impact or make relationships more difficult
• Learning how to build new relationships
• Learning how to end relationships that can be harmful to us or others
• Learning how to be mindful of other people
• Learning assertiveness skills

Skill 4: Building Distress Tolerance

What distress tolerance combats is your ability to experience difficult situations that can sometimes occur in everyday life with reduced risk.

There are many ways to build distress tolerance that will be discussed during your DBT sessions, your therapist will also be able to tailor these skills to you and your specific needs.

Generally, the following skills to build distress tolerance are used in DBT:

• Learning crisis survival skills
• Practising radical acceptance
• Self-soothing practices
• Finding ways to ‘improve the moment’
• Establishing people and places that allow you to feel calm and in control
• Identifying alternative, non-maladaptive behaviours

Life can be rocky.

We can’t always be sure when a difficult situation that may affect our emotional well-being may raise its head.

The role of distress tolerance techniques is to allow us to feel prepared and to develop a bit of a toolkit for how to act in these moments before our emotions get the chance to overpower us.

DBT Session Structure

DBT can be delivered in many different ways.

You may access dialectical behavioural therapy through:

• Individual sessions
• Group sessions
• Family sessions
• Remote sessions (over the phone, or via video call)
• Independently, by following the DBT skills training manual

Before Sessions Start

Typically, you will have an established course of sessions.

Before sessions start, you will first meet with a DBT therapist.

During this meeting, you will discuss your current situation and they will ask you some specific questions.

This works to see if they think that DBT would be a good fit for you and your current needs.

It also works to assess any risks and ensure that you are safe and feel as though you are currently comfortable enough to engage in therapy.

During Sessions

When the sessions begin, you will be given a handbook. This will involve some information on the different parts of the therapy, as well as some exercises you will work on in the sessions.

A big part of DBT is practising techniques outside of the therapy room.

For this reason, you may be asked to complete some exercises in your workbook between sessions or to make notes of things that you would like to bring up in the next meeting.

This helps you to practice how to apply the techniques to everyday life and allows you to get better at understanding how the therapy might work for you in the long term.

Research into the usefulness of DBT suggests that individuals who engage with the therapy material outside of sessions are most likely to see positive results than those who do not.

Once Sessions are Over

Sessions will typically be delivered in blocks.

Once a course of DBT is over, you will be able to take the skills you have learnt and put them into practice day-to-day to keep yourself healthy and safe.

If you feel you need it, there may be opportunities to have a refresher course in DBT to ensure you are confident and capable of applying the skills you have learnt and feel you are starting to struggle again.

Identifying that things have gotten tricky again doesn’t mean that you’ve failed.

It means that you’ve gained the skills to know when things are hard, and are beginning to take the steps you need to make to ensure that you stay safe.

Contact Us Today

Experiencing an addiction can feel like being on an island.

We can feel lonely and trapped, and not know where or who to turn to.

At Rehab 4 Alcoholism we know that addiction is not a choice.

We also know that everyone struggling with controlling their drinking or drug use deserves a helping hand to get back on the right track to sober living.

If you are ready to access support for addiction or believe that a loved one would benefit from beginning formal support with us, we are more than happy to speak with you and learn more about how we can help you with your current situation.

We are a confidential service, and all our contact with you is designed to help offer you relief, peace of mind and genuine opportunities for long-term recovery.

Contact our team today on 0800 111 4108 to seek advice and to learn more about the kinds of services we offer.