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  • For those who suffer from a substance use disorder, change is difficult. 

    Cognitive-behavioral therapy (CBT) is a form of psychotherapy that helps people change behaviors. CBT works with patients to identify unhelpful thoughts and feelings and make intentional changes in how they act and react in different situations.

    There are a number of different forms of CBT, including dialectical behavioral therapy or DBT. DBT is an ideal option for participants who have difficulty with emotional regulation, or experiencing intense reactions in response to negative feelings of pain or rejection.

    What Is Dialectical Behavior Therapy?

    DBT was developed by Marsha M. Linehan, Ph.D., in the 1980s. This healthcare provider specialized in treating borderline personality disorder, a form of mental illness marked by intense emotional reactions to normal life circumstances and difficulty maintaining stable relationships. 

    Borderline personality disorder is strongly associated with self-harm, substance abuse, and a high risk of suicide.

    Since then, the therapy has been found to be effective for treating a wider range of conditions, including suicidal tendencies, eating disorders, and substance use disorder.

    Acceptance & Change

    The term dialectics refers to the discussion of opposite beliefs, bringing them together to discover truth. As a dialectical therapy, DBT’s unique element has to do with helping individuals bring together two opposite concepts:

    • radical acceptance, or the idea that one should face situations, good and bad, without judgment
    • change, which is subdivided into five specific states of change (precontemplation, contemplation, preparation, action, and maintenance) as therapy continues

    Working from this foundation, DBT aims to help participants feel fully understood and accepted as they gain perspective and improve their problem-solving and self-regulation skills.

    DBT Skills Training

    Dialectical behavior therapy skills are broken down into four categories that are covered over the course of the therapy.

    Mindfulness Skills

    Within DBT, mindfulness is considered the capacity to pay attention to the present moment and to experience and fully understand emotions and senses.

    Distress Tolerance

    This is the ability to calmly accept negative situations without being overwhelmed, trying to get away from them, or having other destructive emotional reactions.

    Emotion Regulation

    This is the ability to identify your own emotions, including intense emotions, and control them with coping skills instead of letting them control you.

    Interpersonal Effectiveness

    This helps you develop effective strategies for asking what you need from others, saying no to others, and coping with conflict without sacrificing self-respect.

    How DBT Sessions Work

    DBT treatment typically involves individual therapy sessions, group meetings, and phone coaching focused on developing new skills.

    Individual Therapy

    Individual therapy sessions are weekly one-on-one talk therapy events where the participants work closely with an individual therapist. Participants discuss their quality of life and any issues that came up during the week (recorded on diary cards) for care, motivation, and support.

    Group Therapy

    Group therapy sessions are held weekly for around two hours. In the skills group, participants learn to use specific DBT skills which, like homework assignments, are put into practice during daily life.

    Phone Coaching

    Phone coaching is also often available, and consultation teams made up of DBT therapists typically meet weekly to evaluate the treatment’s progress.

    When Is Dialectical Behavioral Therapy Useful?

    Behavioral therapy is all about changing behavior for the better.

    Unfortunately, too much pressure to change the way someone thinks or acts, or to change who they are and how they feel, can put emotionally volatile individuals in a stressful position or make them feel misunderstood or invalidated in their current situation. 

    Oftentimes, the pressure can be enough to drive participants away from therapy altogether, taking the blame for their self-destructive behavior on the way out.

    However, DBT can balance the drive to change one’s behavior with the concept of validation. This concept accepts sensitive participants for who they are while also giving them the tools they need to be better.

    Research suggests that DBT is useful in treating many individuals experiencing:

    • depression
    • complex post-traumatic stress disorder
    • bipolar disorder
    • suicidal behaviors
    • self-injury
    • binge eating or bulimia
    • substance use disorders
    • borderline personality disorder

    DBT programs are not considered to be an effective treatment for those with intellectual disabilities or uncontrolled schizophrenia. Some participants have also been reported to prefer other types of therapies due to simple personal preference.

    If you or a loved one struggles with substance abuse or co-occurring mental health issues, help is available. To learn about our mental health and addiction treatment programs, please connect with us today.

    Written by Ark Behavioral Health Editorial Team
    ©2024 Ark National Holdings, LLC. | All Rights Reserved.
    This page does not provide medical advice.

    Addiction Science & Clinical Practice - Dialectical Behavior Therapy for Substance Abusers
    Behavioral Tech - What is Dialectical Behavior Therapy (DBT)?
    Psychology Today - Dialectical Behavior Therapy

    Medically Reviewed by
    Kimberly Langdon M.D.
    on May 25, 2022
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