Living with addiction takes a serious toll on a person’s health, finances and relationships. While he or she knows change is necessary, making adjustments that will stick, day in and day out, can be difficult. Sometimes, the way someone thinks and reacts to the world outside of treatment can create major stumbling blocks to recovery. Dialectical Behavior Therapy (DBT) is a treatment approach designed to help those struggling with drug or alcohol addiction understand and adjust their thoughts and emotional responses.
The History of DBT
Traditional forms of therapy encourage people to look closely at their lives, see the areas where change is needed, and determine how best to make those changes. While some forms of therapy can be supportive, other types are confrontational and force people to look at reality and why change is so important. In the late 1980s and early 1990s, Marsha Linehan, a therapist and researcher in Washington State, determined that confrontational tactics were not working with her patients. Many of these patients had borderline personality disorders, and when confronted, they responded with anger or distress. Patients dropped out of the program or shut down in therapy sessions without making progress. In order to reach these patients and come up with a program that could help them to truly change their lives, Dr. Linehan developed DBT. She and her colleagues then created a manual that other therapists could use to apply the DBT principles with their own patients.1
While originally created for borderline personality disorders, DBT been modified for use in the treatment of a wide variety of other mental health issues, including:
- Substance abuse issues
- Eating disorders
- Post-traumatic stress disorder
- Obsessive-compulsive disorder2
Understanding the Power of Thought
For many people, huge emotional responses only come about after a long period of stress. When that stress is removed, the person returns to a calm state relatively quickly. By contrast, there are those who only need a tiny bit of heat to explode, and they may stay in this heightened state for an incredibly long period of time. Living like this can take an extreme toll on a person’s relationships. Some people become extremely upset at even the slightest bit of inattention or disapproval from others, and they may yell and scream at the slightest provocation. They may swing from one emotion to another, and always feel isolated and misunderstood. People who feel consistently alone because of their behavior may feel as though drugs and alcohol provide the only reasonable means of comfort. DBT strives to help people change their thoughts, so they don’t have to numb those thoughts with substance abuse.
Early Stages of DBT
DBT use a skill-based approach to help patients learn to control and manage their emotions, tolerate stress and improve interpersonal relationships.3 In the early stages of treatment, therapists focus on the need for change while accepting and validating the patient’s current condition. The therapist must find a balance between supporting the person and helping him or her feel accepted while 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 early sessions allow patient and therapist the opportunity to build a relationship and understand one another.
As the therapy progresses, the therapist begins to provide instruction on mindfulness techniques. 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.4
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. DBT group sessions are tightly structured and controlled by the therapist and are designed to allow people to interact in a safe environment and practice their skills. In addition to 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.
Supporting Lasting Changes
While therapy might allow a person to make significant changes in the way she thinks and responds to the world, those changes may not truly stick when therapy ends unless the environment around the person changes as well. For this reason, DBT also includes a significant amount of family therapy, allowing the group to come together and work through their past trauma. Family therapy sessions in DBT always include the patient. While other forms of addiction family therapy may allow members of the family to meet in their own private sessions with the therapist, this might be seen as a violation of trust for some patients. By allowing the patient to be in all family therapy sessions, the trust between the therapist and the patient stays intact.
Finding Help for Mental Illness and Addiction
At Michael’s House, we use DBT techniques with our residents and have found the therapy remarkably effective. If you or a loved one struggles with addiction or mental illness, call us now. Our admissions coordinators are available 24 hours a day to answer your questions about how we integrate this therapy into our programs.
1 “Our Team.” Behavioral Research Therapy Clinics. Accessed 28 Mar. 2018.
2 Olenchek, Christina. “Dialectical Behavioral Therapy – Treating Borderline Personality Disorder.” Dialectical Behavior Therapy – Treating Borderline Personality Disorder. Accessed Mar. 28, 2018.
3 “Borderline Personality Disorder.” Mayo Clinic, Mayo Foundation for Medical Education and Research, 30 July 2015.
4 Grohol , John M. “An Overview of Dialectical Behavior Therapy.” Psych Central, 23 Mar. 2018.
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