What is Dialectical Behaviour Therapy (DBT)?
Dialectical behavioral therapy (DBT) is an acceptance-based counseling approach used to treat various substance use and mental health issues. DBT is a type of therapy that was developed by Dr. Marsha Linehan in the 1980s. It was originally developed for borderline personality disorder (BPD) treatment. It takes inspiration from CBT, or cognitive behavioral therapy, which is also used to treat drug and alcohol addiction, with the added focus on teaching acceptance skills.
Now, individual and group treatments commonly employ dialectical behavioral therapy (DBT) for conditions such as depression, anxiety disorders, and substance use disorders (SUD), a medical condition defined by the uncontrollable use of substances despite the negative consequences. Multiple studies show that this updated approach, called DBT-SUD, can reduce drug use in people with borderline personality disorder, a mental disorder characterized by unstable relationships, distorted self-image, and impulsiveness.
The term “dialectical” means the interaction of conflicting ideas. Within DBT, “dialectical” refers to the integration of both acceptance and change as necessities for improvement. Dialectical behavior therapy aims to address the symptoms of the disorder by replacing maladaptive behaviors with healthier coping skills, such as mindfulness, interpersonal effectiveness, emotion regulation, and distress tolerance.
Dialectical Behavior Therapy Techniques
DBT uses three types of therapy approaches to teaching the four core skills of mindfulness, interpersonal effectiveness, distress tolerance, and emotional regulation. Some believe this combination of techniques is part of what makes DBT so effective.
DBT usually involves an hour of one-on-one therapy each week. In these sessions, you’ll talk with your therapist about whatever you’re working on or trying to manage. Your therapist will also use this time to build up your skills and help you navigate specific challenges.
DBT involves a skills training group, which is similar to a group therapy session. Skills groups usually meet once a week for two to three hours. The meetings generally last for 24 weeks, but many DBT programs repeat the skills training so the program lasts a full year. During skills group, you’ll learn about and practice each skill, talking through scenarios with other people in your group. This is one of the key components of DBT.
Some therapists also offer phone coaching for extra support between your one-on-one appointments. This might be a good thing to have in your back pocket if you often find yourself feeling overwhelmed or just need a bit of extra support. Over the phone, your therapist will guide you through how to use your DBT skills to tackle the challenge at hand.
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How Does DBT Work?
DBT incorporates four skills intended to help individuals overcome their unhealthy behaviors and distressing thoughts. Each set of skills has its own unique characteristics that help clients better understand their emotions.
Mindfulness is a mental state characterized by being aware and accepting of the present moment, including our feelings, thoughts, and environment. Mindful individuals focus on the moment without judgment. Mindfulness is a skill that teaches clients to control their thoughts and to avoid letting their minds control their lives. They can use this skill and knowledge to better understand their emotions, maintain a positive state of mind, and effectively accept stress rather than push it away.
Interpersonal effectiveness teaches individuals to deal with others in effective and healthy ways. People develop an understanding of how to ask for something and say no when necessary. In doing so, clients learn how to handle difficult situations and improve communication and relationships.
People who control or regulate their feelings and thoughts during tough times often make wise decisions. Others react to highly stressful situations in a hostile manner, which may lead to regrettable choices. Distress tolerance teaches a person to make sound decisions in stressful moments.
Through this module, therapists teach crisis survival skills to clients. This information helps distressed people avoid showing antagonistic behaviors that could worsen the problems. They learn to tolerate stress rather than change it.
Emotion regulation helps individuals understand and regulate their emotions. This set of skills teaches individuals to better understand and express their feelings in order to alleviate psychological pain. The approach allows clients to avoid feeling overwhelmed by their thoughts.
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Benefits of Dialectical Behavior Therapy
In DBT, the client and therapist work to resolve the obvious contradiction between self-acceptance and change to bring about positive results in the individual in treatment. Part of the DBT process involves offering validation, which helps individuals become more likely to cooperate and less likely to experience distress at the notion of change.
In practice, the therapist validates that an individual’s actions “make sense” within the context of their personal experiences without necessarily agreeing that the actions are the best approach to solving a problem.
Each therapeutic setting has its own goals and structure, but the characteristics of DBT can be found in individual psychotherapy, and phone coaching.
- Acceptance and change: You’ll learn strategies to accept and tolerate your life circumstances, emotions, and yourself. You will also develop skills that can help you make positive changes in your behaviors and interactions with others.
- Behavioral: You’ll learn to analyze problems or destructive behavior patterns and replace them with more healthy and effective ones.
- Cognitive: You’ll focus on changing thoughts and beliefs that are not effective or helpful.
- Collaboration: You’ll learn to communicate effectively and work together as a team (therapist, group therapist, psychiatrist).
- Skill sets: You’ll learn new skills to enhance your capabilities.
- Support: You’ll be encouraged to recognize your positive strengths and attributes and develop and use them.
Dialectical Behavior Therapy Benefits in Addiction Treatment
DBT is beneficial in addiction treatment because it addresses harmful behaviors that act as barriers to improving people’s lives. Within addiction treatment programs, DBT focuses on substance use and how it affects the quality of life, while also promoting target behaviors essential for overcoming addiction.
These behavioral targets include:
- Alleviating physical discomfort associated with withdrawal
- Avoiding triggers and cues related to substance use
- Community reinforcement of positive behaviors
- Decreasing substance use
- Reducing behaviors conducive to drug use, like momentarily giving up the goal to stop using drugs or alcohol, and instead functioning as if drug use can’t be avoided
- Reducing cravings and urges to use substances
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9 Cognitive Behavioral Therapy Techniques
The fundamental principle behind cognitive behavioral therapy is that your thought patterns affect your emotions, which, in turn, can affect your behaviors. For example, cognitive behavioral therapy emphasizes how negative thoughts can lead to negative feelings and actions. But, if you reframe your thoughts in a more positive way, it can lead to more positive feelings and helpful behaviors.
Some of the techniques that are most often used with cognitive behavioral therapy include the following 9 strategies:
1. Cognitive Reframing or Restructuring
This involves taking a hard look at negative thought patterns. Perhaps you tend to over-generalize, assume the worst will happen or place far too much importance on minor details. Thinking this way can affect what you do, and it can even become a self-fulfilling prophecy.
Your therapist will ask about your thought process in certain situations so you can identify negative patterns. Once you’re aware of them, you can learn how to reframe those thoughts, so they’re more positive and productive.
2. Guided Discovery
In guided discovery, the therapist will familiarize themselves with your perspective. Then they’ll ask questions designed to challenge your beliefs and broaden your thinking.
You might be asked to give evidence that supports your beliefs, as well as proof that does not.
In the process, you’ll learn to see things from other viewpoints, especially ones that you may not have considered before. This can help you choose a more helpful path.
3. Exposure Therapy
Exposure therapy can be used to confront phobias and fears. The therapist will slowly expose you to the things that provoke anxiety or fear while guiding how to cope with them at the moment. This can be done in small steps. Eventually, exposure can make you feel more confident and less vulnerable in your coping abilities.
4. Thought Records and Journaling
This technique is journaling your thoughts and moods, which includes the time of the mood, the source of it, the intensity of the mood, and how you react to it. It helps you to understand your thought pattern and emotional tendencies. Putting it in writing can help you see how far you’ve come.
5. Behavior Activation and Activity Scheduling
If there’s an activity you tend to avoid or put off because of fear or anxiety, getting it on your calendar can help. Once the burden of a decision is gone, you may be more likely to follow through. In addition, activity scheduling can help establish good habits and allow you to put what you’ve learned into practice.
6. Behavioral Experiments
Behavioral experiments are often used for anxiety disorders that involve catastrophic thinking. Before undertaking a task that usually makes you anxious, you’ll be asked to predict what will happen. Later, you’ll talk about whether the prediction came true. Over time, you may see that the expected catastrophe is not very likely to happen. You’ll likely start with lower-anxiety tasks and build up from there.
7. Relaxation and Stress Reduction Techniques
In cognitive behavioral therapy, you may be taught some progressive relaxation techniques, such as:
- Deep breathing exercises. This technique is all about relaxing and bringing regularity to your breath. It will allow your mind to approach balanced thinking facilitating rational and more effective decisions. In addition, it will reveal you from various kinds of mental illness.
- Muscle relaxation. If you have ever practiced yoga for addiction recovery, then it will be familiar to you. This technique teaches you to relax a group of body muscles at a time. Thus it makes you relax your whole body muscle. It will calm your nerves and soothe your busy mind.
- Imagery. This technique will be helpful for you if you are suffering from anxiety and fear. You will go through a sort of experiment in which you will imagine the outcome of the worst case. This scenario will make you stronger by perceiving that if the fear comes out, it will be manageable.
Role-playing can help you work through different behaviors in potentially tricky situations. Playing out possible scenarios can lessen fear and can be used for:
- Improving problem-solving skills
- Improving communication skills
- Practicing social skills
- Gaining familiarity and confidence in certain situations
- Assertiveness training
9. Successive Approximation
This involves taking tasks that seem overwhelming and breaking them into smaller, more achievable steps. Each successive step builds upon the previous steps so you gain confidence as you go, bit by bit.
Benefits and Limitations of Cognitive Behavioral Therapy Treatment
The chief strength of cognitive behavioral therapy (CBT) lies in the fact that it not only helps the individual to overcome the symptoms of issues currently being experienced but also equips them with new skills and strategies which can be used with future difficulties or issues.
Other benefits and strengths of this therapeutic technique include:
- The focus on the individual’s thoughts: Psychological disorders in many people have been found to display maladaptive assumptions and thoughts.
- Testing and measuring: The theories and methods used in cognitive behavioral therapy can be tested.
- Address the root of the problem: The thoughts of a person are the reason for both accomplishments and problems, especially behavior problems.
- Evidence-based: Cognitive behavioral therapy has been proven to be effective for the treatment of depression and anxiety-related issues.
- Cost-Effective: Cognitive behavioral therapy is also viewed as a cost-effective treatment method because it tends to result in the change occurring quickly when used with some types of problems.
At the same time, there are also some limitations or weaknesses with this technique. For instance:
- The exact role cognitive processes play is yet to be determined.
- The cognitive model or theories are very narrow in scope. Our thoughts are just one part of being human – there are more issues that need to be addressed.
- Cognitive behavioral therapy is classified as a directive therapy that aims to change beliefs and thoughts. However, this is sometimes done more forcefully. There are even those who argue that this method can be unethical.
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Dialectical Behavior Therapy vs Cognitive Behavioral Therapy
Many addiction treatment services focus on therapies like Dialectical Behavior Therapy (DBT) and Cognitive Behavioral Therapy CBT. Normally, clients will choose between dialectical behavior therapy vs cognitive behavioral therapy with the help of their therapist or counselor. Cognitive Behavioral Therapy is often the first line of response to depression because it is so effective. Meanwhile, Dialectical Behavior Therapy is generally the top choice for borderline personality disorder.
Cognitive behavioral therapy (CBT) is also a top therapy for treating panic disorder, sleep problems, phobias, obsessive-compulsive disorder, and post-traumatic stress disorder (PTSD). Doctors use DBT for sexual trauma, self-harm behaviors, and suicidal ideation. While DBT focuses on mindfulness and emotional regulation, cognitive behavioral therapy centers around how feelings, thoughts, and behaviors impact each other. Both techniques are useful in treating mental disorders, so the right choice depends entirely on the individual’s unique situation and needs.
Ultimately, DBT and CBT are both effective ways to treat addiction and mental illnesses. Choosing between DBT vs CBT depends entirely on your personal needs. When you enter a treatment program, an intake specialist will perform an initial assessment to figure out the kinds of addiction therapy services you need. Then, you can begin your personalized treatment process.
Difference Between Cognitive and Dialectical Behavior Therapy
Dialectical Behavior Therapy is simply a modified form of Cognitive Behavioral Therapy that uses traditional cognitive-behavioral techniques, but also implements other skills like acceptance, mindfulness, and tolerating distress.
Cognitive Behavioral Therapy
- Emphasis: Focuses on redirecting negative thoughts
- Time: Short interval
- Setting: One-in-one setting along with homework
- Aim: Focuses on changing the thought pattern
Dialectical Behavior Therapy
- Emphasis: Focuses on the relationship between change, acceptance, and balance
- Time: More extended sessions
- Setting: One-in-one and group settings
- Aim: Focuses on changing the thought pattern
Dual Diagnosis Treatment Programs
Many people struggling with addiction also have another underlying mental health condition. When someone is diagnosed with other disorders along with addiction, is it referred to as dual diagnosis or co-occurring disorders. Addiction along with mental health conditions must be treated simultaneously. If the underlying condition leads to substance abuse and is left untreated, the person will go back to drugs or alcohol because the original trigger was not handled.
Finding success in sobriety can be more difficult for those with a dual diagnosis, but suitable therapies can help get them on that path. Learning about dialectical behavior therapy vs cognitive behavioral therapy will help you choose which better suits your condition as both provide the skills and methods to sustain long-term recovery.
We Level Up rehab centers use individualized treatment plans for each client to ensure they can find success in recovery. We know there is no one-size-fits-all recovery method. Treatment plans take into account the substance that was abused, co-occurring disorders, past traumas, past treatments, and future planning that may be needed. We Level Up dual diagnosis treatment centers has medical detox, MAT, residential or inpatient rehab treatment, and aftercare planning programs for those struggling with drug and alcohol addiction. If you or a loved one are struggling with addiction call our 24/7 admissions team.
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 NCBI – https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2797106/
 NIAAA – https://pubs.niaaa.nih.gov/publications/ProjectMatch/match03.pdf
 NCBI – https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2963469/
 NIDA – https://www.drugabuse.gov/publications/principles-drug-addiction-treatment-research-based-guide-third-edition/evidence-based-approaches-to-drug-addiction-treatment/behavioral-therapies/cognitive-behavioral-therapy
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