Dialectical behavioral therapy is a psychotherapy option used to treat several different mental health disorders. It was initially designed to treat a specific disorder that was proving challenging to treat with standard cognitive behavioral therapy. However, DBT was designed around addressing emotional instability, which is a common consequence of many mental and behavioral health disorders, including anxiety, depression, and substance use disorders. But how does dialectical behavior therapy work? Does it help with substance use disorders? Learn more about this behavioral therapy and if it’s right for your needs.

What Is Dialectical Behavior Therapy?

Dialectical behavior therapy (DBT) is a form of psychotherapy that treats mental health disorders. It’s a behavioral therapy, which is a broad category of psychotherapies that address behavioral health problems and how thinking influences behavior. DBT is a modified form of cognitive behavioral therapy. This therapy option examines how unhelpful thinking and behaviors can lead to poor coping mechanisms that lead to negative symptoms. 

While CBT focuses on overcoming challenges by finding more effective coping responses, DBT encourages acceptance and contentment. DBT helps people live in the moment through contentment. It can also help you learn to cope with negative emotions and stress more effectively. Ideally, this can lead to improved relationships with other people and an easier time managing the symptoms of several different mental health disorders. 

DBT is often used to treat mental health disorders that involve poor emotional regulation, anxiety about future events, poor concentration, and behavioral problems. Dialectical behavior therapy was initially developed to treat borderline personality disorder, a unique mental health disorder characterized by emotional instability, the inability to maintain relationships, and angry outbursts. 

Since its success in treating borderline personality, it has been adapted to treat various mental health issues, including common problems like depression and anxiety disorders. Its principles may also be used in general talk therapy to help people who have trouble dealing with emotions. It may also be used to treat self-destructive behaviors, especially with issues like eating disorders and substance use disorders. 

Psychologist Dr. Marsha Linehan first created dialectical behavior therapy in the 1980s. While cognitive behavioral therapy is one of the most commonly used and effective therapies, Linehan developed DBT when she found limited success in using CBT to treat clients with borderline personality disorder.

Borderline personality often causes overactive self-defensiveness. CBT often requires the acknowledgment that your thinking and behaviors are ineffective, which borderline clients may not respond well to. Instead, DBT focuses on acceptance and impartially reflecting on yourself and your surroundings. With DBT’s effectiveness in treating borderline personality disorder, it was adapted to treat other mental health issues that also involve emotional instability.

How Does DBT Work?

The name comes from the concept of dialectics, a discourse that investigates the truth of opposing viewpoints. In other words, it’s a debate. DBT is centered on the dialectic between acceptance and change. Acceptance is often the first step in DBT. The therapy features the idea of radical acceptance, which is accepting negative and positive situations without judgment. In order to achieve radical acceptance, emotion-regulating techniques are learned. And after acceptance comes change. 

DBT uses the stages of change model, which involves the following:

  • Pre-contemplation. Not thinking about change or not believing it is necessary at all. 
  • Contemplation. Considering the possibility of change and whether it’s needed. 
  • Preparation. Beginning preparations that are necessary to make a change. 
  • Action. Making intentional actions toward change.
  • Maintenance. Maintaining change so that it becomes long-lasting or permanent. 

The stages of change are useful for people who may not be ready to make changes in their life. For instance, if someone enters addiction treatment just to appease their family, they may not buy into their treatment plan or believe they actually have a substance use problem. The stages of change model help people increase their readiness to make a change. 

DBT is made up of four modules that form the basis for the therapy. These four factors include the following:

Core Mindfulness 

Mindfulness is a technique that has its roots in the ancient world in India. The meditation skill has been used for thousands of years. Today, it’s used in DBT and in other therapies. Mindfulness is a contemplative practice where you intentionally live in the moment. Mindfulness practices help you pay attention to yourself and your immediate surroundings, including your thoughts, feelings, and senses. You will react to these observations without judgment, refraining from negative or positive reactions. 

Practicing these skills can help you slow down and use more effective coping skills when you face negative emotional triggers. This is helpful if you have a tendency to default to negative thoughts that lead to impulsive behaviors. Because it encourages you to slow down your emotional reactions, it’s helpful in treating emotional instability. 

Distress Tolerance

Distress tolerance is about building up skills that allow you to accept your current situation and yourself. Many negative experiences can feel like an emotional crisis. Learning to handle those moments better can help address several mental health disorders. 

Techniques DBT uses to improve distress tolerance include:

  • Distraction
  • Improving the moment
  • Self-soothing 
  • Acceptance 

In many cases, distressing circumstances can trigger the symptoms of several mental health disorders. Increasing your ability to withstand stress can help you overcome challenges in your daily life. 

Interpersonal Effectiveness

Interpersonal effectiveness is important in forming and managing relationships with other people. In DBT sessions that address interpersonal effectiveness, you may learn to become more assertive in a positive way. This may help you set boundaries and say no without jeopardizing your relationships or creating negative interactions. You will also learn communication skills that can help you let other people know your thoughts and feelings effectively. This can also help you deal with challenging people and resolve interpersonal conflicts.

Emotion Regulation 

Emotion regulation is a key component of DBT that is vital in treating certain mental health disorders. This can help you manage intense emotions in a way that doesn’t allow them to interfere with your life or relationships. You’ll learn to identify and label emotions and identify any obstacles to changing your emotions. 

You will also learn to increase instances of positive emotions. Not only will learning emotion regulation help you to better manage negative emotions like anger, but it will also increase your enjoyment of positive emotions. For instance, not letting a situation lead you to an angry outburst may prevent the event from ruining your day, allowing you to enjoy more of your life.

What Does Dialectical Behavior Therapy Look Like?

dialectical behavioral therapy

DBT has evolved over time and is now recognized as an evidence-based psychotherapy approach that can be used to treat many different conditions. DBT is often used in:

  • Phone coaching. Clients can contact their therapist in between meetings and talk through a difficult situation they’re facing. The counselor provides guidance in real-time.
  • One-on-one therapy. Where a client learns new behavioral skills that help them effectively cope with challenges in their life.
  • Group therapy. This is when clients learn new behavioral and coping skills as a group.

Is Dialectical Behavior Therapy Right for You?

If you have a mental health disorder and are investigating potential treatment options, DBT may help you in your treatment plan. Dialectical behavior therapy is designed around learning acceptance and emotional resilience. If you find yourself worrying about things that are out of your control, or if you struggle to manage painful or intense emotions, you may want to talk to your doctor or therapist about dialectical behavioral therapy. 

However, each person is different, so your treatment plan should be tailored to your needs with help from your therapy provider. No single medication or therapy works for every person. 

Is Dialectical Behavior Therapy Used to Treat Substance Use Disorders?

On its own, DBT does not treat substance use disorders. However, it has been proven to be a valuable tool in comprehensive treatment plans for those with co-occurring disorders, such as depression or borderline personality disorder.

If you have an addiction, it’s crucial to ask for help. Addiction-focused DBT can help: 

  • Decrease harmful behaviors that lead to substance use
  • Decrease impulsivity and drug or alcohol cravings
  • Decrease the physical discomfort of withdrawal 
  • Avoid triggers that could lead to a relapse 
  • Create and follow the boundaries needed for long-term recovery 
  • Promote healthy relationships with loved ones 

To find out if DBT is right for you, speak to a specialist. They will analyze your symptoms and recovery goals to determine if DBT could be beneficial for you.

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