Have you been recommended Dialectical Behavior Therapy (DBT)? Perhaps you’ve heard of DBT and are wondering if it’s right for you. Perhaps you are a parent looking for the most effective treatment for your loved one. Let’s explore a few ways in which DBT for substance abuse could help you and your loved ones.
Substance use disorders (SUDs) are known to have profound mental and behavioral effects that only specific types of therapy could treat. Dialectical behavior therapy (DBT) has proven to be one of the more successful approaches ever used during addiction treatment alone.
Dialectical behavior therapy is such an effective tool that it is also used in other concerns where there is a need for a focused approach to mental and behavioral issues, such as suicide and other forms of self-harm.
While it does necessarily point out the potential root of the mental or behavioral issue(s), it does not affix the blame squarely on the person, but rather, on the situation itself, thus presenting a scenario where the person could improve and get well, instead of apportioning the blame on the person, which many tend to remember more than the solution.
WHAT IS DIALECTICAL BEHAVIOR THERAPY (DBT)?
Dialectical behavior therapy otherwise referred to as DBT is an evidence-based psychotherapeutic approach used to treat substance abuse and a variety of mental health conditions. This approach was developed by psychologist Dr. Marsha Linehan and a few of her colleagues in the 1980s and was largely based on the cognitive-behavioral therapy approach.
DBT is commonly used in individual and group therapy situations in the treatment of conditions such as substance use disorders, anxiety disorders, depressive disorders, eating disorders, borderline personality disorder, etc. Therapists attribute the success of this approach to the fact that it comes with the addition of acceptance skills.
The addition of acceptance skills is a crucial part of DBT for substance abuse as many of the deep-seated and chronic issues that people deal with every day have to do with people not being able to accept certain facts related to the problem. This element of acceptance is critical to the success of the therapy because once there is acceptance on the part of the patient, it is only then that the positive changes could be affected.
Dialectical Behavior Therapy (DBT) is a type of Cognitive-behavior therapy (CBT). It was created in the 1980s to treat borderline personality disorder, but it is now a viable therapy for a variety of conditions such as substance use disorders. In this post, we’ll look at what DBT is and how it can be used, as well as its key benefits.
Although DBT was designed to treat risky behaviors, it can also be used to treat a variety of other mental health issues. DBT has now been shown in research to have the potential to help if you have been diagnosed with any of the following disorders:
- Substance use disorders (SUDs)
- Attention Deficit Hyperactivity Disorder (ADHD)
- Bipolar Disorder
- Eating Disorders
- Anxiety disorders
- Obsessive-compulsive disorder (OCD)
DBT is a particularly effective approach because the person learns to envision, articulate, pursue, and sustain set goals, such as being sober or accepting and love of self to prevent self-harm.
Borderline Personality Disorder (BPD)
DBT was first used to treat borderline personality disorder (BPD). BPD is a mental illness that affects how a person perceives themselves. Borderline Personality Disorder is characterized by intense emotions, as well as unstable relationships with others. DBT has been shown in studies to be effective in managing these BPD symptoms, particularly in people with BPD who also self-harm.
Depression and Suicidal Ideation
Dr. Marsha Linehan, the creator of DBT, was the first to discover the link between suicidal ideation and BPD. She observed that DBT significantly reduced the risk of suicide attempts in people with BPD, which is a key feature of the disorder.
This is reasonable. Suicidal people frequently struggle to tolerate their distress, manage intense emotions, and communicate with others. DBT addresses each of these, as well as assists the individual in developing alternative, healthy coping skills, and strategies.
Deliberate self-harm can exist on its own or in conjunction with another mental health condition. People who self-harm usually do so to avoid unpleasant feelings or experiences. DBT can assist these individuals in learning new ways to cope with their emotions, memories, and urges. DBT first assists the individual in accepting their feelings as a valid part of their experience, and then it builds tolerance to distress and improves emotion regulation.
It is important to note that positive change within the patient could only happen if the patient validates that the change is acceptable and that it is positive to them specifically. Validation in this context only comes with acceptance, and it is not just in one facet. The validations need to be in the form of the emotions the patient feels, their ideas about their issue, and the fact that no positive change will happen if they do not accept the fact that the current state they are in with their issue(s) is harming them and those around them.
DBT helps in this manner because it brings back conscious thought and focuses on some aspects that will help a person not only manage their urges and cravings to take substances again, but also change their perception about certain aspects of their life that could harm them. These aspects include:
DBT has four main components, which are often referred to as modules or skills. Two of these are about acceptance, and the other two are about behavioral change. They are as follows.
- Being mindful
- Tolerance for Distress
- Emotional Control
- Interpersonal Competence
A therapist specializing in treating substance abuse with dialectical behavior therapy will usually start with mindfulness to help promote acceptance. This entails observing your thoughts, emotions, and actions objectively.
Mindfulness teaches people how to focus on the current situation, and not simply relate this to a painful experience. Focusing on the present also means not sifting through all the fearful and terrible things that might happen in the future due to the action.
By dwelling on past painful experiences that might be related to the current situation, people only feed their anxieties and stress themselves to the point of indecision, confusion, and even panic. This goes the same for trying to overthink what a potential decision might result in moving forward. Considering if an action is harmful is one thing, trying to figure out what repercussions it could have on a grand scale in the future is something else completely.
This concept is central to everything else in DBT, as it is at the core of treatment. Patients are taught the importance of bringing awareness into the moment. This aspect teaches how to focus, understand, and accept what is happening right now, at this exact moment, and how it affects the patient.
By being able to consciously observe, understand, and relate what is happening at the moment to the patient, and how it affects what is inside of them, their feelings, thoughts, sensations, and impulses, the patient could then discern what the best course of action would be, and by “best course of action”, it would necessarily mean that the action will not harm them or others around them.
By being focused and grounded on what is currently happening, a patient is better able to recognize the impulsive behaviors and forceful emotions that often dictate their actions. Recognizing this allows them to consider better thoughts, decisions, and actions relevant to the situation.
Mental and behavioral issues often result in challenges in relationships, mostly due to the inability to communicate properly and appropriately. Nothing demonstrates this more than the behavior of people who have a substance abuse disorder. Certain substances could seriously affect a person’s ability to communicate properly, such as the slurred speech pattern resulting from too much alcohol, or the incoherent ramblings of someone high from drugs.
Interpersonal effectiveness also extends into how a person behaves around other people. Certain substances can induce irritability, belligerence, indifference, or a great desire for isolation in the people who take them. These behaviors are, of course, not things that would work well if a person desires to be socially acceptable. Interpersonal effectiveness dictates that a person should observe and recognize if their behavior is something that would push people away from them, and if so, what could they do to improve the situation.
People necessarily have different opinions and ways of accepting things. While the difference is typically acceptable and normal, there are also certain responses that others find to be offensive and unacceptable. This is particularly true with certain emotional responses that come off as negative or intense.
Managing one’s emotions, even for people who don’t have a substance abuse disorder, could be quite challenging. Anyone who has ever been in anger management will attest to this, which is why this is an important aspect of DBT. It has been said time and again, but it remains true: a person must learn to control their emotions, and not let their emotions control them. On top of this, substance abuse could exacerbate a person’s negative emotional response. DBT seeks to correct this right from the root, by preventing negative or unwanted emotions from escalating in the first place. This discipline takes time because emotions are extremely powerful drivers of human thought and action, but it is an essential component of treatment.
This aspect of DBT is tied in with emotional regulation. Life is naturally stressful, and there are many stressful instances where the option a person has is to experience it and hope to come out alive and well. A person in distress is quite likely to react blindly, in the attempt to remove themself from the stressful situation. Others are likely to take a negative action after a stressful situation, such as going on an alcohol binge.
Distress tolerance involves learning techniques that implement distraction and self-soothing skills to prevent the mind from focusing on the stress and induce a mindset not conducive to constructive thought. This aspect teaches people coping skills that will be crucial while in a crisis or in instances that are likely to cause a person to react blindly.
What Are the Goals of DBT for Substance Abuse?
DBT operates on the principle that given an opportunity, a person could either take control of a situation that would cause them great distress and ensure that it does not or at the very least, maintain enough internal determination and control so that the situation does not become one where a person is left with no choice in their response or action. The four main goals of Dialectical behavior therapy include:
- TRANSITIONING FROM OUT-OF-CONTROL, TO IN CONTROL
- MOVING FROM EMOTIONAL UNAVAILABILITY TO EMOTIONAL REGULATION AND ENGAGEMENT
- BUILDING A HEALTHY LIFE AND SOLVING EVERYDAY PROBLEMS
- IMPROVING THE OVERALL QUALITY OF LIFE THROUGH MINDSET AND ACTION
DBT improves interpersonal effectiveness, communication skills, and the ability to deal with stress and conflict. You create a comprehensive toolkit of strategies to use in difficult situations and in everyday life.
DBT, along with other approaches, is recommended by the Luna Recovery team as part of integrative mental health treatment plans. DBT works well in conjunction with other traditional and complementary therapies, such as neurofeedback treatment, to rewire mentally unhealthy thought patterns and improve mood regulation. Here are more benefits of this type of therapy:
Improve your understanding of your emotions and thoughts
DBT is a type of cognitive behavioral therapy that focuses on “dialectics,” which is the use of dialogue to work through past traumas and current symptoms. DBT treatment makes you aware of the complex emotions and thought structures that influence your behavior and choices.
When you fully comprehend your emotions and mental assumptions, you gain the ability to make sound decisions. DBT improves your mindfulness, allowing you to stay in the present moment and give your full and calm attention to your current situation and the people around you.
It strengthens your relationships
When dealing with mental health issues, a strong support network is essential. Many types of therapy fail to consider this, expecting you to go it alone.
However, DBT advocates recognizing the significance of our social relationships in overcoming obstacles. Developing healthy relationships with respectful boundaries and trust can benefit health and well-being in a variety of ways.
The Capabilities Extend Beyond Mental Illness
Although the goal of Dialectical behavior therapy is to alleviate the symptoms of people suffering from mental illnesses, it does not stop there. DBT therapists teach skills that can be applied to many other aspects of life.
For example, studies have linked mindfulness to a variety of other aspects of health and well-being. Once you’ve mastered this skill, it can help you in many areas of your life, including work, home, and play.
It enhances one’s quality of life.
One of the primary goals of DBT is to improve one’s quality of life. The truth is that we cannot always control what happens to us. For some, mental health issues will be with them for the rest of their lives, and accepting this fact is essential to moving forward.
DBT aims to improve people’s quality of life by gently assisting them in making changes that will move them in the right direction, while also letting them know it’s okay to find things difficult.
Quality of life can be severely impacted for those experiencing intense and disruptive emotions. The distress tolerance and emotion regulation modules really shine here.
This situation is a pitfall that practically everyone is sure to go through at some point in their life. It is important to note that while it might be possible to be in a situation where a person has no control, a person will always have control over how they react to the situation.
In the context of substance abuse, there are situations in life that could be emotionally devastating, but this does not necessarily mean that a person should go on excessive alcohol intake or drug use. DBT for substance abuse helps a person focus on what is happening at the moment, understand how they feel about that moment, and decide on a non-harmful way to respond to it.
Anger, sorrow, and hate could push a person to take action that they will most certainly regret later on. These are intense emotions that are difficult to handle, but they are not impossible to handle. It is this mindset that DBT seeks to develop in a person.
Emotional regulation is not the denial of how a person feels, since being a human being also means having emotions. Emotional regulation means knowing how intense the emotion is, and understanding how much of it is manageable. This also means that if the emotion is beyond a person’s threshold, asking for support from others is also an option, rather than reacting to the intense emotion blindly and unconsciously.
While this type of therapy teaches a person to focus on the here and now, it also teaches a person to veer away from overthinking the future, and from dwelling on past mistakes. The last two scenarios are known to create problems for people because it induces unnecessary stress, worry, and even outright fear.
DBT for substance abuse instead focuses more on the things that a person could fix and affect a positive change on, such as a person’s reaction to stressful situations, better communication skills, and choosing courses of action that do not involve self-harm or harming others.
DBT helps in knowing the massive negative impacts of substance abuse and in ways to avoid them. This is not, however, the end-all and be-all target of DBT. This therapeutic approach seeks to improve the overall quality of life by understanding the current situation one is in and making informed decisions.
If you are wondering if dialectical behavior therapy is right for you, ask yourself the following questions below to help guide you.
- Do you struggle to find meaning in your life and feel worthless or hopeless at times?
- Do you have trouble controlling your emotions or thoughts?
- Do your mood swings seem to take control of your life, causing you to make rash decisions that you later come to regret?
- Do you have trouble paying attention or focusing on school or work tasks?
- Do your relationships elicit strong emotions? Or do your emotions have an adverse effect on your relationships?
Dialectical behavior therapy works best for motivated people. DBT will not work for someone who is adamantly opposed to changing. Clients who want to learn new coping skills and are willing to recognize and work to improve unhealthy behaviors benefit the most from this treatment.
When May DBT Not Work?
Dialectical behavior therapy is not advised for people who have intellectual disabilities. DBT is also not intended to treat panic disorder/panic disorder with agoraphobia, PTSD, or psychotic disorders. Individuals may benefit from other therapy modalities, depending on their symptoms.
DBT for Substance Abuse Can Help You Recover
We understand that making life changes can be frightening. Your desire to make changes or participate in therapy may fluctuate at times. DBT is uniquely positioned to meet these challenges. DBT includes learning skills to address willfulness as well as accepting the changes required to achieve your short and long-term goals. If you are still unsure whether DBT is right for you, schedule a consultation with a DBT provider.
The beginning of the journey to recovery is all about understanding and patience. We know that quite well, and that is what we practice in our treatment programs here. Find the most effective therapy approach for you and your needs at Luna Recovery Services in Houston, TX. Contact us today.