If you’re somewhat familiar with talk therapy styles, you’ve probably heard of CBT or cognitive behavioral therapy. It’s a gold standard of short-term, evidence-based treatment that works for a wide variety of mental health issues, including substance use disorder. CBT is based on the principle that how we think directly impacts how we feel, and that we can change the way we feel by learning how to monitor thoughts. A CBT therapist helps clients become aware of their negative thinking patterns and employ strategies to counteract them. 

As suggested by its name, CBT is very head-based, focused on analyzing thought patterns. But for some clients, emotions get in the way of any attempt to think their way out of a negative pattern. When a client experiences intense emotions, other strategies are needed. Enter dialectical behavior therapy (DBT). 

What is DBT?

Developed in the 1970s by Marsha Linehan, DBT operates on the dialectic principle: the synthesis of opposites. In the case of therapy, the opposites are change and acceptance. Clients learn how to change their painful patterns but also learn how to accept pain as part of life. In this way, the principles of DBT are much like the first part of the Serenity Prayer frequently quoted in 12-step support groups: “God, grant me the serenity to accept the things I cannot change, the courage to change the things I can, and the wisdom to know the difference.”

How does DBT work?

While each therapist will approach dialectical behavior therapy somewhat differently, most therapists work with four types of sessions:

 Pre-assessment (therapist meets with potential client to explain how DBT works and to determine whether it’s a good fit for the client)

  • Individual therapy (generally, weekly sessions of 40-60 minutes each, with a four-fold purpose: to keep the client safe from self-harm/suicide; to limit behaviors that interfere with therapy; to help client improve quality of life and meet goals; to teach client new skills to replace unhelpful behaviors)
  • Skills training in groups (therapist teaches DBT skills in a classroom setting)
  • Telephone crisis coaching (therapist arranges times when clients may call to resolve a crisis or get in-the-moment advice)

What Skills does DBT Teach?

The skills training aspect of DBT addresses four core skills that are useful in everyday life and that clients can practice at home, at work, and in their community. 

  1. Mindfulness – Clients are taught to bring their attention to the present moment and to observe and describe their feelings, thoughts, and situations in a non-judgmental way. They are taught to focus on doing one thing at a time and to choose coping mechanisms that are personally effective for them.  
  2. Distress tolerance – Clients learn grounding techniques to use in moments of intense emotional pain so they can “act, not react.” For example, a person may take a cold shower or go for a long walk to help ease the tension so that they can approach the pain in a more balanced way.  
  3. Interpersonal effectiveness – Clients learn and practice skills that will benefit their relationships. For many people, this means learning how to say no and speak up for what they need. As clients learn to set and enforce their boundaries, they develop greater self-respect. 
  4. Emotion regulation – Clients learn how to gain control over their emotions by accepting them without judgment while at the same time checking how well their emotions reflect the reality of the situation. For example, if you’re feeling enraged that someone cut you off in traffic, you can accept the anger as it is while also being aware that it’s out of proportion to the situation. Then, you can choose to do the opposite of what the anger wants you to do. If it wants you to retaliate by tailgating the car, you can instead choose to put extra space between you. 

The purpose of DBT techniques is to help you feel empowered, knowing that you can have strong emotions without letting them determine your actions. Over time, as you learn to manage your feelings and respect your needs, you’ll feel a greater sense of peace in life. 

DBT & Substance Use Disorder

By now, it’s probably easy to see how DBT can help with substance use disorder. People suffering from addiction are controlled by their emotions, unable to tolerate distress, and untrustworthy in relationships. When they go through treatment and enter recovery, they need to learn to deal with their feelings in ways that don’t involve substances. DBT can help clients manage the strong cravings that may arise and, over time, develop the emotional sobriety that underpins self-respect and well-being. 

If you or a loved one struggles with addiction, Safe Harbor Recovery Center can help. Our compassionate team in Portsmouth, VA, offers evidence-based therapies and interventions catered to your specific needs. Contact us today to learn more.