DBT is a form of cognitive behavioral therapy. Dialectical means bringing two opposing concepts together. In the case of DBT, those two concepts are change and acceptance. The strategies that are used focus on acceptance and problem solving. A key component is the relationship between therapist and patient. They must work collaboratively for the client to be successful. They work together to build techniques that allow the patient to overcome negative emotions and behaviors that may have led to their substance abuse. Clients learn skills to handle everyday life situations that may have been triggers for substance abuse in the past. DBT targets behaviors and focuses on the behavior that is deemed to be the most prevalent issue the client is experiencing. Behavioral targets include decreasing life-threatening behaviors, such as suicidal thoughts, and reducing actions that are interfering with treatment, such as skipping or showing up late. They also work to decrease behaviors that lead to a lower quality of life and increase behavioral skills to handle situations without reverting back to negative thoughts and actions. DBT uses individual and group sessions to reinforce all the skills learned.

There are five components used within DBT.

1. Improving motivation- Motivation to change problematic behaviors is developed through treatment plans such as self-monitoring sheets. Tracking behaviors that negatively affect their quality of life can allow clients to become more aware of these actions and more motivated to change them.
2. Enhancing Capabilities- Skills are developed in four main categories:
   1. Emotion regulation- Teaches how to handle any intense emotions without self-destructive behaviors
   2. Mindfulness- Allows the person to accept things and remain present in the moment instead of focused on past mistakes and problems.
   3. Interpersonal effectiveness- Allows a person to strengthen relationships and improve their communication skills.
   4. Distress Tolerance- Helps the client learn how to handle negative emotions and situations instead of trying to escape them
3. Generalization of New Behaviors- Applying all new and improved capabilities across all settings and situations
4. Structuring their Environment- Encouraging use of new behaviors and ways to adapt are used across all environments the patient may encounter. If the patient is in different types of therapies, reinforcement of positive behaviors are used across all of them. Harmful influences that may threaten their sobriety are removed during this stage.
5. Enhancement of capability and motivation of the therapists- DBT treats people with severe mental health issues and can cause burnout in therapists. This component provides support for the therapists through team meetings that provide support, training, and guidance to make sure they are providing the best possible treatment for their patients.

When DBT was first developed, it was used to treat patients with suicidal thoughts and borderline personality disorder. Since its development, it has been adapted to treat people with substance abuse disorders and co-occurring mental disorders at DBT inpatient treatment centers and outpatient therapy. To learn more about the development of DBT and how it is used to treat co-occurring disorders, click here.

Specific behaviors are targeted for those receiving treatment for substance abuse. These include:

• Reducing abuse of substances
• Easing any withdrawal symptoms causing physical discomfort
• Reducing cravings and temptations
• Avoiding triggers that have led to abuse in the past
• Reinforcing healthy behaviors and building a community of support

DBT brings together the opposing forces of abstinence and acceptance of relapse. Abstinence from all drug and alcohol use is enforced by asking clients to take a pledge to stop using. Instead of asking for a pledge of never using again, the client is asked to make a goal that feels attainable for them. They can pledge to go a day without abusing, and then make longer commitments as their journey of sobriety continues. DBT also teaches that if a relapse should occur, the client can still reach their goals of acceptance and sobriety. The relapse is viewed as a problem to solve instead of failure, allowing the client to accept themselves and the mistakes they have made. This acceptance then allows them to find ways to avoid making the same negative choices in the future.

DBT focuses on setting attainable goals, one step at a time, for the client to achieve. DBT is used with a combination of other treatment methods to help the person achieve their goals of a successful life in sobriety. Skills are developed that allow the person to replace negative behaviors with positive ones and find better and healthier ways to cope with any issues they may face.

DBT aims to help a person attain a state referred to as “clear mind”. Clear mind means that a person stays focused on their goals of recovery but is also mindful of possible triggers that may lead to relapse, with a plan in place to handle them. The “enhancing capabilities” component of DBT that was discussed earlier allows the client to build sober skills.

Emotion regulation teaches skills to handle emotions without abusing drugs or alcohol. In the past, they may have used a substance to avoid intense feelings and emotions that they couldn’t handle and learning to regulate those emotions will reduce the chances of relapse. Mindfulness allows the client to remain present instead of focusing on the past or the future. Stress can be reduced by maintaining a balanced state of mind that is not overwhelmed with past mistakes or future worries. Developing improved interpersonal skills can allow the patient to repair past relationships that may have been damaged due to their addiction. They learn communication skills to help build healthier relationships. Distress tolerance teaches a person to handle stressful situations and negative emotions without resorting to self destructive behaviors. Acceptance of the current circumstances instead of avoidance is taught and reinforced to ensure they are not overcome with stress and resort to substance use.

Coping skills to handle everyday and extreme situations and emotions allow a person to find success in their recovery. Skills are developed to avoid triggers and to handle them if they cannot be avoided. DBT encourages healthy relationships and cutting ties with toxic ones to avoid temptations. All the behaviors learned through DBT can be applied to any environment or situation a person may encounter, allowing them to maintain their sobriety.

DreamLife Recovery is a rehab facility located in western PA. We use detox, MAT, residential, and. aftercare programs for people struggling with drug or alcohol addiction and co-occurring disorders. DreamLife employs therapies such as DBT for alcoholism and & drug addiction to treat the whole person and give them skills to find success in their recovery and sobriety. If you or a loved one are struggling, fill out a contact form now or call our admissions team.