Dialectical Behavior Therapy (DBT)

What Is Dialectical Behavior Therapy (DBT)?

Dialectical behavior therapy (DBT) is a form of psychotherapy that combines cognitive and behavioral approaches to address complex treatment needs, like personality disorders, substance use disorders (SUD), and eating disorders. DBT first evolved from Marsha Linehan’s efforts to create a treatment plan for individuals experiencing chronic, suicidal thoughts who also met the criteria for borderline personality disorder (BPD). The behavioral and cognitive techniques developed during Linehan’s and others research led to a comprehensive, multifaceted treatment approach increasingly used in alcohol use disorder (AUD) and substance abuse treatment programs. 

Several essential functions of DBT include teaching individuals mindfulness, how to cope with stressful situations healthily, how to regulate emotions, and how to build relationships with others. Due to DBT’s modularity, or its ability to have multiple aspects of treatment switched and combined, DBT can target many elements that an individual with an AUD may be struggling with. For example, DBT can target aspects like a low sense of self, harmful emotional responses to negative stimuli, and harmful coping skills that can result in alcohol misuse or abuse.

The dialectical philosophy in DBT is best understood as the knowledge that reality consists of 2 opposing forces. In the case of DBT, these 2 opposing forces for individuals in treatment are “change” and “acceptance.” 

How Is DBT Applied To Alcoholism Treatment?

Dialectical behavior therapy is often used for individuals with co-occurring disorders, but for individuals with an AUD, it is not uncommon to experience multiple conditions at once. With complex, multi-diagnostic individuals comes the need for flexible treatment. For those with an AUD, DBT aims to implement strategies that will decrease alcohol use, reduce cravings, urges, and temptations to use, and alleviate physical discomforts associated with withdrawal and abstinence. Additional behavioral targets of DBT include:

• Avoiding opportunities and triggers of substance abuse. 
• Reducing behaviors conducive to substance abuse. 
• Increasing community reinforcement of healthy behaviors. 

DBT uses several approaches to achieve these goals, including individual psychotherapy, telephone coaching, and a therapist consultation team. Psychotherapy, or talk therapy, can help individuals with an AUD identify and change troubling thoughts, emotions, and behaviors. Telephone coaching means that therapists are available by phone in between therapy sessions. These calls can help an individual get through a crisis (either suicidal or otherwise), or they can help an individual use the skills learned during their therapy session and apply them to everyday situations. Finally, a therapist consultation team is often referred to as “therapy for the therapist.” The therapist consultation team ensures that the therapist remains balanced and motivated in treating patients who are often experiencing high-risk situations.

DBT Skills And How They Help

There are 4 skill modules that individuals are taught during DBT, including mindfulness, interpersonal effectiveness, emotional regulation, and distress tolerance. These skills are separated into two groups: “acceptance” skills (mindfulness and distress tolerance) and “change” skills (interpersonal effectiveness and emotional regulation). These skills can help an individual manage difficult emotions or circumstances that may have previously triggered alcohol misuse. 

Mindfulness

In DBT, mindfulness skills help individuals remain present in the moment. This presentness is achieved through observing the moment at hand in a nonjudgmental manner, describing the facts of the current experience, and fully participating in the present moment. For those using DBT to treat an AUD, mindfulness skills help individuals engage with emotions or memories that may be potentially triggering in a healthy and nonjudgemental way.

Distress Tolerance

Distress tolerance skills teach individuals to accept and tolerate distressing emotions or experiences. Some individuals use alcohol to cope or distract themselves from intense, negative emotions, so improving distress tolerances allows individuals to healthily manage emotions like shame, anger, anxiety, and sadness without turning to alcohol.  

Interpersonal Effectiveness

Interpersonal effectiveness refers to the collection of skills that allows an individual to manage interpersonal conflict, build new relationships, and end destructive relationships. Oftentimes, an individual struggling with an AUD will have difficulty maintaining healthy relationships, so these skills can help an individual rebuild or create a support system. 

Emotion Regulation

Emotion regulation training teaches a range of behavioral and cognitive strategies for reducing unwanted emotional responses and increasing desired emotions. These strategies include identifying emotions, changing emotional responses, and managing difficult emotions.  

Five Functions Of Treatment

Dialectical behavior treatment is a program of various treatment methods versus a singular treatment method. That is because DBT consists of individual therapy, group therapy, and a therapist consultation team. DBT can address a wide range of disorders in various ways due to differing circumstances, but there are 5 key functions of treatment that are critical to DBT. These 5 functions include enhancing capabilities, generalizing capabilities, improving motivations and decreasing dysfunctional behaviors, maintaining therapist capabilities, and structuring one’s environment. 

Enhancing Capabilities

DBT aims to improve important life skills for individuals like regulating emotions, distress tolerance, interpersonal effectiveness, and mindfulness. These skills are usually cultivated in DBT through group skill sessions using active participation and homework assignments that help individuals practice their skills. 

Generalizing Capabilities

Generalizing capabilities is another way of adapting skills learned in therapy to one’s everyday life or environment. Therapists help individuals in DBT to use these new skills in their daily lives or have them practice these skills during individual therapy sessions. 

Improving Motivations And Decreasing Dysfunctional Behaviors

In DBT, this function improves an individual’s motivation for change, including reducing behaviors inconsistent with one’s life goals. For example, an individual with an AUD may have a plan to stop drinking but does not know how to achieve this. A therapist using this function of DBT will help the individual understand what led up to the behavior(s) in question and the consequences that may be reinforcing or maintaining their drinking habits.

Maintaining Therapist Capabilities And Motivations

Due to the complex nature of many DBT patients conditions, therapists require continued support, validation, training and skill-building, feedback, and encouragement to offer sustained levels of care. 

Structuring Environment

Structuring the environment in DBT refers to structuring treatment to reinforce effective progress and behavior. Individuals in DBT are encouraged to modify or adapt their personal lives to support positive change. For instance, individuals with an AUD may begin avoiding social circles that promote alcohol use if they are trying to restructure their environments. 

Finding Treatment Today

Comprehensive and effective treatment for an individual with an AUD will often involve multiple forms of treatment, and most drug and alcohol rehabs offer DBT in their recovery programs. By targeting the behavioral and emotional factors that play into alcohol abuse, DBT provides a framework for individuals to learn how to cope without alcohol. DBT is often paired with additional treatment programs within inpatient or outpatient facilities like cognitive behavioral therapies, contingency management (CM), and motivational enhancement therapy (MET). For more information on DBT, contact a treatment provider  today.