What is Dialectical Behavioral Therapy?
Dialectical behavior therapy is a sub-category of cognitive-behavioral therapy (CBT.) Standard CBT tends to focus on large-scale change in a patient’s life perspective, as well as improving the ways in which one deals with stress and crisis.
Dialectical behavior therapy, on the other hand, is a more specific approach that focuses on a cumulative effort that builds from one therapy session to the next. The following skills are addressed:
- Emotional regulation – the ability to cope with mood changes and control harmful impulses.
- Distress tolerance – skills used to cope and survive during a crisis, and helps tolerate short-term or long-term pain.
- Mindfulness – self-awareness of how a situation is, rather than how you believe it should be.
- Interpersonal effectiveness – skills that help increase attendance to relationships, balance priorities versus demands, and build a sense of mastery and self-respect.
These skills are required to navigate one’s life without engaging in substance abuse as a coping mechanism.
What to Expect in Treatment
Behavioral therapy during alcohol or drug rehabilitation treatment takes place in either a classroom environment or one-on-one.
Therapists and patients discuss factors that led up to the harmful behavior, and patients are expected to understand that change is desirable and needed.
Many rehab centers that use dialectical behavior therapy for addiction treatment build upon previous sessions. Patients who have a problem during one session, for example, alternative methods of approaching the situation will be addressed at the next.
DBT offers a balance between acceptance and change. Moreover, CBT is some viewed by some as undesirable due to rapidly forced changes, leading patients to cease treatment. DBT, however, places an equal burden on both the patient and therapist.
For patients dependent on a substance, this condition is the highest priority DBT target among all behaviors that potentially interfere with life quality.
DBT’s substance abuse behavioral targets include:
- Decreasing substance abuse, including illicit drugs and legally prescribed drugs.
- Mitigating physical discomfort associated with abstinence or withdrawal.
- Reducing urges, cravings, and temptations to abuse.
- Avoidance of opportunities and triggers/cues to abuse.
- Reducing behaviors conducive to drug abuse.
- Increasing community reinforcement of healthy behaviors.
Working Between Sessions
Centers that employ dialectical behavior therapy for addiction treatment will usually assign patients homework between sessions.
Patients keep a diary of their thoughts and feelings and record (1) thoughts about a specific situation, (2) how they behaved in response to it, and (3) how they could have approached it better.
These diary entries are discussed during sessions, and those patients in group sessions usually compare and share notes. Patients who engage in therapy in a group session often feel a sense of both belonging and accountability with peers, which can expedite recovery and improve the effectiveness of treatment.
The DBT Approach to Abstinence
DBT urges immediate and permanent abstinence, and yet instills the belief that the desired result can still be achieved (acceptance) even in the event of a relapse.
This approach thus combines insistence on complete abstinence with non-judgmental, problem-solving responses that include techniques intended to reduce the dangers of an overdose or other negative consequences.
Establishing Abstinence By Promoting Change
The therapist begins to stress the expectation of abstinence during the first DBT session by requesting that the patient agree to cease substance use immediately.
But rather than a lifetime of sobriety, the therapist encourages the patient to commit to a specific length of abstinence.
This interval can be as short as just a few minutes – but regardless, at the period’s end, the patient is asked to renew the commitment. The goal is to achieve long-term abstinence by combining consecutive substance-free time periods.
Another strategy instructs patients how to “cope ahead,” in which the patient learns the skill of anticipating possible cues/triggers in upcoming minutes, hours, and days. The patient then proactively prepares responses to high-risk situations that may derail abstinence.
The patient is also encouraged to burn the bridges, so to speak, to his or her substance-abusing past. Moreover, obtain a new telephone number, inform others of his or her sobriety, and throw out or destroy drug paraphernalia.
Transforming the Addict Mind
Patients with a substance use disorder often begin DBT in a mental/behavioral state that may be referred to as “addict mind.”
That is, their thoughts, actions, and emotions are under the control of substances.
As they achieve long-term abstinence, their state of mind transforms into what is known as a “clean mind.”
During this time, they are off substances, but do not accurately gauge personal susceptibility to future problems – an overconfident outlook can lead to a relapse. Eventually, an alternation between these two states results in a philosophy that fosters the emergence of the “clear mind.”
At this point, the patient now enjoys abstinence, yet remains completely aware of the near dangers of the addict mind. He or she is thus free to take measures to avoid or cope with situations that can lead to relapse, or in other words, “restore” the addict mind.
Dialectical behavior therapy, although initially developed for the treatment of personality disorders has displayed effectiveness in the treatment of substance use disorders, as well, and now is often used instead of standard CBT.
It’s slower paced, skills- and accountability-based approach often works well with individuals who are very independent, highly willful, or more easily antagonized under standard CBT.
Treatment at Just Believe Recovery combines holistic healing with evidence-based practices. Techniques include cognitive behavioral therapy (CBT), dialectical behavior therapy (DBT), and eye movement desensitization and reprocessing (EMDR).
Psychoeducational groups, in addition to the Center’s individual and group therapy, strive to build clients’ confidence, improve self-awareness, and inspire positive choices in recovery. Recreational and social activities include kayaking, swimming, volleyball, yoga, and fishing. Residents also attend off-site 12-step meetings.
~ G. Nathalee Serrels, M.A., Psychology