Dialectical Behaviour Therapy (DBT)
Dialectical behaviour therapy (DBT) is more commonly known for its effectiveness at treating individuals with mental health issues such as bipolar disorder and borderline personality disorder, but it has also been adapted to be effective at treating a range of addictions.
DBT is centred around the belief that individuals struggling with addiction and mental health issues must learn to accept themselves and their circumstances while simultaneously changing their self-destructive behaviour and thought patterns.
What is DBT?
The word ‘dialectical’ can be defined as ‘acting through opposing forces’. In the case of DBT, these opposing forces are change and acceptance.
When a treatment plan focuses solely on behavioural change, many patients may feel attacked and react badly to this idea. However, if the treatment is centred around acceptance, they may feel hopeless and believe that their problems are not being taken seriously. Therefore it is necessary to combine both acceptance and change when undergoing a treatment plan for addiction, which is where dialectical behaviour therapy comes in.
While sharing many similarities with cognitive behavioural therapy, DBT differs from CBT in a number of ways as detailed below:
- While CBT is usually provided through one-on-one counselling sessions, DBT focuses more on group therapy.
- This form of therapy is centred around acceptance as well as behavioural change, while CBT has a strong focus on behavioural change.
- DBT was originally developed for people with multiple and severe psychosocial disorders. As many people with these issues also deal with substance addiction, DBT has been adapted to assist with abstinence and recovery from addiction.
Studies have shown that individuals struggling with addiction have responded well to DBT, particularly those that have been diagnosed with borderline personality disorder (BPD) or other mental health disorders. [1]
How does DBT treat addiction?
Dialectical behaviour therapy utilises a combination of one-on-one counselling, group therapy sessions and phone coaching to provide support and assistance to individuals dealing with addiction.
This form of treatment focuses on building and sustaining a high-quality and fulfilling life while reducing self-destructive and harmful behaviours. This is achieved by teaching key communication and emotional regulation skills along with complete abstinence from addictive substances.
DBT views therapy as a relationship between the counsellor and the patient – both have goals that they want to reach during treatment and they must work together in order to achieve them.
You and your counsellor will focus on the following five key areas throughout DBT treatment:
1. Mindfulness
Being mindful allows us to live in the moment without worrying about the past or the future. As the past has already happened and the future is yet to happen, neither of these things can be changed. All we have is the present moment.
DBT teaches mindfulness techniques to help individuals struggling with addiction be more present in their everyday lives. These include listening to the sounds around them, focusing on the colours that they can see and savouring the flavours of a meal. Mindfulness can help lower stress and reduce cravings for addictive substances and is an important skill to ensure long-term recovery.
2. Emotional regulation
It can be difficult for people struggling with addiction or mental health issues to control and harness their emotions, and many people receiving DBT treatment have trouble with this. Feeling extreme despair, hopelessness or anger can lead to relapse, and the techniques taught during dialectical behaviour therapy can lead to better emotional control and regulation thus reducing the chances of future relapse. [2]
3. Interpersonal skills
Our relationships with other people are some of the most important elements in our lives. Sadly, addiction can damage these relationships and it can be difficult to recover without a strong support network. DBT treatment provides effective techniques and strategies to improve your relationships and forge new ones, strengthening your emotional bonds and helping to surround you with a supportive group of people.
4. Distress tolerance
It can feel easy and even comforting to reach for addictive substances when we’re feeling overwhelmed and distressed. DBT teaches new ways to cope with unpleasant feelings and situations, primarily through radical acceptance.
By completely accepting the present moment and the feelings that come with it, no matter how unpleasant it may be, we can find a form of inner peace that will help us to get through it without relying on addictive substances.
5. Abstinence
Complete abstinence from addictive substances is a key goal throughout DBT treatment. As this can be an overwhelming task for many people, it is broken up into smaller goals – staying sober for one hour, one day or one week. As the patient begins to achieve these tasks their confidence will increase and they find it much less intimidating to imagine their future without these substances.
While the focus is on the behaviour change, it’s also important that they accept the possibility of relapse and understand that it doesn’t have to derail their treatment plan.
What are the main functions of DBT?
A successful DBT treatment plan is usually based on five key functions. These provide the framework for therapy and help the individual to identify, accept and change destructive behaviours, thoughts and patterns that are preventing them from achieving their goal of sobriety.
1. Enhancing capabilities
Through regular therapy sessions and real-life practice tasks, individuals are given the tools and life skills needed to function well in daily life. Building a sober lifestyle means first laying the foundation of stability, and the techniques taught in DBT help this to become possible.
2. Generalising capabilities
These new skills and techniques must be practised, and this can happen both inside and outside the therapy room. Counsellors will guide their patient in practicing their new skills during therapy sessions, and homework will be assigned which must be completed between sessions. Each person will have their own unique triggers and challenges, and these can be addressed and practiced under the guidance of a trained therapist.
3. Reducing destructive behaviours
The act of using addictive substances is not the only destructive behaviour that is present with addiction. Negative and unhelpful thought patterns, beliefs and other behaviours can also drive an individual into the arms of addiction or relapse. Therefore it is essential that a successful treatment addresses these behaviours and provides support and guidance to help remove them from the patient’s life.
4. Improving the environment
While it is important that a safe, supportive environment is created during therapy sessions, it is equally as important that the patient builds and maintains their own positive environment outside of the therapy room. This can involve removing people who have a negative impact on the patient’s recovery, getting out of a toxic work environment and replacing unhealthy influences with more positive role models.
5. Maintaining therapist capabilities
The therapist must also continue to learn and be supported as they move through the recovery journey with their patient. It’s important that they are provided with a safe environment and opportunities for professional development so they can continue to deliver a high-quality form of therapy and assist others on the path to recovery.
What are the benefits of DBT?
While not as thoroughly researched as some other forms of therapy, DBT has been proven to be effective at treating substance abuse and addiction.
With the wide range of treatment options available for people struggling with addiction, it can feel overwhelming and difficult to select just one. Becoming aware of the benefits of each treatment can be helpful when deciding which form of therapy is right for you.
Below are just a few of the benefits that dialectical behaviour therapy for addiction can provide:
1. Provides a safe, supportive environment
During dedicated one-on-one counselling sessions and group therapy, you will have the chance to express yourself and your emotions in a safe environment surrounded by non-judgemental people, many of whom will be dealing with similar issues.
2. Builds a mental toolkit for everyday life
DBT can help you build a mental toolkit filled with healthier ways to deal with stress and process unpleasant emotions without relying on addictive substances. It lays the foundation for a healthier, happier and more fulfilled lifestyle by challenging negative behaviours and making positive changes.
3. Less reliance on addictive substances
This form of therapy gives you the skills to examine your life and make the necessary changes required to break the chains of addiction. It’s an empowering way to let go of any substances that you feel dependent on, as you know exactly why and how you are choosing to do it.
4. A structured treatment with clear goals and progression
DBT is clearly structured, making it easy to look back during the treatment and see how far you have come on your journey. This boosts confidence and motivation and increases the chance of a successful recovery from substance addiction.
Dialectical behaviour therapy is one of the most promising options for anyone looking to start their journey to recovery from addiction, particularly if they also suffer from co-occurring conditions such as bipolar disorder or borderline personality disorder. [3]
Get in touch with our team today – we’re here to listen to your concerns, answer any questions you may have and help you choose the treatment option that works best for you.
References
[1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2797106/
[2] https://pubmed.ncbi.nlm.nih.gov/10740986/
