DBT (dialectical behavior therapy) is a type of talk psychotherapy commonly used in individual therapy or group counseling sessions for addiction patients. It helps people manage emotions to change harmful behaviors: in this case, that’s substance use.
Learn more about DBT for addiction treatment, whether it’s right for your needs, how a DBT session goes, and what research says about its efficacy. You’ll also read about some practical details if you decide to receive DBT for addiction treatment in New Jersey.
What Is Dialectical Behavior Therapy for Addiction Treatment?
Dialectical behavior therapy is a more specialized type of cognitive-behavioral therapy. Developed in the 1980s by Dr. Marsha Linehan, DBT’s primary purpose was to treat suicidal individuals diagnosed with borderline personality disorder (BPD).
Since then, its applications have extended to helping people with substance use disorders (SUDs), eating disorders, PTSD, and depression (major depressive disorder).
In addiction treatment, DBT encourages patients to:
- Learn healthy coping strategies to manage stress and difficult emotions without returning to drug or alcohol abuse.
- Change the way they perceive their own image.
- Change their perspective on addictive substances and their interaction with them.
Is DBT Right for You?
A good candidate to receive DBT treatment is someone who:
- Tends to drink or self-medicate to deal with stressful experiences or complex emotions.
- Has a co-occurring mental health condition with the substance use disorder (especially if it’s borderline personality disorder, but also anxiety, depression, bipolar disorder, and PTSD).
- Uses drugs not to get high, but for their numbing effect or to shut down intensely felt emotions.
- Needs a supplementary therapy approach alongside typical cognitive-behavioral therapy (CBT) due to issues with compliance or recurrent relapses.
- Struggles with high impulsivity.
- Is ready to focus on their present and future instead of their past.
- Is open to occasionally attending group therapy sessions.
- Needs to work on how to improve their relationships after being affected by substance use.
- Exhibits self-harm tendencies or suffers from suicidal thoughts (suicidal ideation).
Who DBT May Not Be Suitable for
As is the case with any therapeutic modality, DBT may not work for every person with addiction. Dialectical behavior therapy is not recommended for people who:
- Aren’t prepared to participate actively outside sessions and prefer reflective, deep-seated therapy.
- Want a more open approach, not structured therapy.
- Expect quick results.
- Have cognitive disabilities.
- Are displaying severe psychotic symptoms (although DBT services might be applied later, once the condition has stabilized).
In any case, DBT-guided sessions don’t pose a physical risk to recovering addiction patients, so this therapy is completely safe. However, as individuals confront tough feelings or concepts they’d rather avoid, they might feel temporary discomfort, stress, or emotional distress.
Fortunately, most of these effects gradually decrease over time, as the sessions progress.
What Is a DBT Session Like?
DBT in practice has four core elements: distress tolerance, mindfulness, interpersonal effectiveness, and emotional regulation. Here’s a brief overview of each technique used across therapy sessions:
1. Mindfulness
Mindfulness refers to a set of meditative practices and exercises that help ground patients in the present instead of focusing on their past experiences.
Mindfulness encourages embracing your thoughts and emotions, teaching two main skills: scrutinizing your current situation and maintaining your focus even when your present environment isn’t particularly positive.
Some examples of mindfulness exercises that DBT therapists use in their sessions are:
- Mantra repetition (Japa)
- Progressive muscle relaxation
- Walking meditation
- Guided imagery
- Diaphragmatic breathing
2. Distress Tolerance
The second set of skills you can expect to learn in a DBT session is related to distress tolerance. It takes the torch from mindfulness: with patients living in the present, they then learn how to cope with tough situations healthily and without resorting to drugs or alcohol.
Exercises involve:
- Self-soothing using positive activities, such as reading, crocheting, working out, running, swimming, listening to audiobooks or music, etc.
- Learning how to accept reality.
- Changing your view of the stressful situation to find the positives in it.
3. Emotional Regulation
This is a crucial skill to learn for people with substance abuse problems whose deep emotions cause them to seek out drugs. In emotional regulation, patients learn to pause and keep their feelings in check instead of taking immediate action by learning:
- What each emotion signifies.
- How to react to each emotion in a healthy, non-destructive manner.
- Fostering positive emotions and limiting the severity of negative emotions.
4. Interpersonal Effectiveness
The fourth set of skills that addiction patients learn in DBT sessions helps improve interpersonal relationships, which may have been damaged by their drug dependence. These skills involve:
- Communicating your needs to others.
- Setting healthy boundaries (saying no in a positive way).
- Dealing with difficult people (or disagreements in general) without it taking a mental or psychological toll on you.
- Articulating what you want in a relationship or situation.
The Working Mechanism of DBT (How It Works)
What makes DBT so effective for addiction treatment? It’s all in the way it works:
- Cognitive-based: This means that DBT helps you identify the tight-knit link between your thoughts, emotions, and beliefs and how they’re contributing to your addiction. By knowing such patterns, you can recognize triggers and learn how to cope with them.
- Grounded in support: The way that DBT is structured keeps you supported throughout the entire recovery process. You become more acquainted with your strengths, then use them as fuel to prevent a relapse.
- A joint effort: You and your therapist work together on a therapeutic approach tailored to your needs; there isn’t a one-size-fits-all mindset across therapy sessions.
Does DBT Work? What Research Says
DBT is evidence-based; it’s been thoroughly studied since its development and proven to work well for people struggling with substance use disorders. Here are some eye-opening studies related to the efficacy of DBT for addiction treatment:
- Stand-alone DBT skills training has been found to have significant therapeutic effects on impulsivity among individuals with alcohol and other substance use disorders.
- Pilot trials on marijuana use disorder and alcohol use disorder show that DBT-based treatments result in higher cessation rates and lower use frequency than psychoeducation or control groups.
- A meta-analysis of DBT for treating SUD reports that this form of therapy is effective in reducing SUD symptoms at post-treatment assessment and follow-up assessment.
DBT for Families Affected By Addiction
While DBT sessions are normally done individually or in a group setting, some treatment centers modify them to allow the families of an addiction patient to become part of their healing journey.
Family therapy sessions where DBT is used teach healthy, effective communication between family members.
It also arms them with knowledge about how to deal with the stress associated with having someone in recovery, how to create a supportive home environment, and other valuable skills.
DBT for families can take several forms. It’s available across multi-family skill groups (weekly training classes alongside a loved one), separate support groups for a spouse, parent, or sibling, or conjoint family therapy sessions.
DBT Logistics
Some questions you may have about DBT treatment’s practical details include:
- Does insurance cover DBT sessions? Health insurance typically covers behavioral therapy for addiction patients, including DBT sessions. Yet, the coverage specifics still depend on your insurance plan, diagnosis, and your treatment plan.
- Can DBT be done virtually? Telehealth can be used for DBT sessions via a secure, encrypted video connection. However, it’s not suitable for high-risk individuals who need to stay in a controlled, regularly monitored environment.
- Will my boss know I’m doing DBT sessions for addiction treatment? No, you’re not required to disclose your diagnosis, the name of the treatment facility, or the meds or type of therapy you’re receiving to your employer.
FAQs
Why is it called “dialectical” behavioral therapy?
It’s called “dialectical” because the main concept of this therapy is balancing two opposing ideas at the same time: acceptance and change.
It fosters validation of your current situation, yet it teaches you how to find the motivation to replace harmful behaviors with constructive ones.
What other evidence-based therapies might be used alongside DBT for addiction treatment?
Some common evidence-based treatment modules that are often paired with DBT include cognitive-behavioral therapy (CBT), motivational interviewing or enhancement (MI), and contingency management (CM).
How long does it take to start seeing results from DBT?
The duration it takes to start seeing results from DBT varies from one person to another. It’s based on how severe the substance use disorder is, how long the substance has been used, whether there’s a co-occurring mental health disorder, and other factors.
Generally, patients have reported seeing results within a few weeks of starting DBT sessions. However, significant improvements are frequently noted within a few months.
How long does DBT treatment last?
Most structured DBT programs run for six months to a full year. Usually, the planned protocol lasts 24 weeks, which is then repeated to make up a year of dialectical behavior therapy sessions.
Within your specific treatment program, you’ll alternate between individual counseling, group training sessions, and brief phone coaching calls (lasting 5–15 minutes) as needed between sessions.
