People who enter a substance abuse rehabilitation program need to make changes in their lives. That much is obvious. Living with an addiction can take a serious toll on the person’s health, finances and relationships. But while the person might know that change is necessary, and the person might even want to change, making adjustments that will stick, day in and day out, can be difficult. Sometimes, the way a person thinks, and the way a person reacts to the world outside, can create a major stumbling block on the road to recovery. Dialectical Behavior Therapy (DBT) is designed to help people understand and adjust their thoughts and emotional responses.

While DBT was originally created for borderline personality disorders, it’s been modified for use in the treatment of a wide variety of other mental health issues, according to the magazine Social Work Today. DBT is now used to treat:

  • Substance abuse issues
  • Eating disorders
  • Post-traumatic stress disorder
  • Anxiety
  • Obsessive-compulsive disorder

Early Stages of DBT

According to an article written by Marsha Linehan in the Journal of the California Alliance for the Mentally Ill, DBT relies on the ability of the therapist to accurately listen and support the person in therapy, without indicating that the person does not need to change. She writes, “…treatment requires confrontation, commitment and patient responsibility, on the one hand, and on the other, focuses considerable therapeutic energy on accepting and validating the patient’s current condition.” This can be a bit of a balancing act, as the therapist tries to support the person in therapy and help that person feel accepted, while at the same time pointing out why change is necessary. Since this relationship between the therapist and the person in therapy is so important, early stages of DBT often involve very long, intense conversations between the therapist and the patient. These sessions, which might last for two hours or more, allow the two to build up a relationship and understand one another.

As the therapy progresses, the therapist begins to provide instruction on mindfulness techniques. This is a concept pulled from

Eastern religions and it can be quite powerful. The therapist encourages the patient to identify when thoughts are coming from the emotional part of the brain. When those emotional thoughts are identified, the person is then asked to take a step back and observe the situation with logic and objectivity before choosing to react. For some people, this means learning how to simply accept a situation without approving of it. In other words, some people learn how to move beyond things they cannot control. No judgments are needed, and no intercessions are required. The person can just move past the moment.

Some therapists ask people to separate thoughts from facts. If a person feels unintelligent or unloved, it might not mean that the person actually is unintelligent or unloved. The basic thought is faulty, while the emotions that generate that thought may be very real. Teasing out the separation between thoughts and emotions can allow people to stop behaving in a negative manner due to overwhelming emotions.

Middle and Late States of DBT

Therapy sessions may be incredibly helpful, but they may not allow the person to truly practice the lessons and apply them in real time. Group sessions can help to fill this gap. Group sessions in DBT tend to begin weeks after the person has started to work with a therapist, and that therapist remains in charge of the group sessions. These meetings are not similar to addiction support group meetings such as Alcoholics Anonymous. Instead, DBT meetings are tightly structured and controlled by the therapist, and they’re designed to allow people to interact in a safe environment, practicing their skills. The therapist might ask people to role-play or talk about their experiences and get advice from others. Typically, the group works on one of four areas in each group session:

  • Mindfulness
  • Interpersonal relationships
  • Tolerating and accepting reality and dealing with distress
  • Regulating emotions

In addition to these group sessions, people in DBT are often provided with lengthy homework assignments. They may be asked to read articles and write about them, or they might be asked to use a specific technique in a stressful situation coming up that week, and then describe how that technique either worked or did not work.

Some therapists using DBT also help people find new places to live, connecting them with community resources for low-income housing or helping them to build up the skills they’ll need to get better jobs, so they can afford new and better places to live. Again, these sorts of changes can help to support long-term improvement, as the person won’t be returning to the life of dysfunction that supported the original addiction.

Effectiveness of Dialectical Behavior Therapy

Many studies have focused on the ability of DBT to help people resist the urge to harm themselves or commit suicide. The therapy has been proven remarkably effective in this respect. For example, according to a study published in the journal Archives of General Psychiatry, people who received DBT were half as likely to attempt suicide as compared to people who received other types of therapy. The skills the people learned in therapy seemed to allow them to keep these destructive ideas at bay.

Similarly, the therapy has been proven effective in helping people who have a Dual Diagnosis, or a substance abuse problem in addition to a mental health problem. A study in the American Journal on Addictions found that women with addictions and borderline personality disorder who were given DBT had large reductions in their drug abuse, and those reductions were greater than the reductions seen in people who were assigned to other forms of treatment. The results for people who have only a substance abuse issue without an underlying mental health issue seem a bit less clear. According to the Substance Abuse and Mental Health Services Administration, some studies have found that DBT is effective in reducing drug use, as compared to other treatments, but other studies have found that people given DBT returned to drug use within the following year. It’s unclear why this would be the case, but it’s almost certain that researchers will be examining this issue closely.

At Michael’s House, we’ve used DBT techniques with our residents, and we’ve found the therapy to be remarkably effective. If you’d like to learn more about how we integrate this therapy into our programs, please contact us.

Speak with an Admissions Coordinator 877.345.8494