Should I Consider Dialectical Behavior Therapy (DBT)?

Dialectical behavior therapy, sometimes called dialectical-behavioral therapy or DBT, is a kind of psychotherapy approach that is often used for treating substance use disorder (SUD) and other serious mental health conditions. Today, DBT is one of the most used therapeutic approaches for people with severe SUD as well as for those with co-occurring mental illnesses.

Originally developed as a therapy approach for suicidal patients, DBT’s ultimate goal is to help the patient envision and pursue a life worth living. It is a type of cognitive-behavioral therapy (CBT), though it does differ from basic CBT in a few areas.

While not universally available at drug rehab and treatment programs in Boston, DBT has become more available over the decades, thanks to its track record for addressing the needs of people with severe SUD.

What is the premise of DBT?

Dr. Marsha M. Linehan, one of the developers of DBT, theorized that people who wanted to be dead (as is often the case with severe SUD cases) lack the emotional and behavioral skills needed to build a life worth living.

However, the focus on building life skills and the resulting lack of acknowledgment given to the experiences of those in serious mental distress often resulted in pushback, and sometimes violence against therapists. Doing the opposite, encouraging acceptance, also resulted in similar negative results, as patients began to feel hopeless.

To overcome this challenge, DBT attempts to synthesize two apparent opposites, change, and acceptance. This is the dialectic part of DBT. DBT attempts to reconcile both approaches, validating the patient’s feelings while pushing them to improve their emotional regulation. This way, the patient can learn to tolerate emotional pain even as they work through their issues.

Comparisons have been drawn between the simultaneous acceptance of tolerance and change in DBT and the ideology of Twelve Step programs, particularly in the Serenity Prayer: “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.”

When is DBT used?

DBT is most often used for high-risk patients, who may be in danger of harming themselves or others. It’s also used in situations where the patient has been behaving erratically or has shown themselves unable to regulate their mood.

Many common SUD treatment scenarios have been successfully addressed with DBT. People with SUD have a high chance of also having a co-occurring mental health disorder, including borderline personality disorder. SUD patients with co-occurring mental conditions often have ideas of committing suicide and usually find it hard to regulate their emotions. These are both areas DBT can help with.

What does DBT involve?

While there may be different interventions for different cases, classic DBT has five essential functions:

• improving patient motivation to change
• enhancing patient capabilities
• generalizing new behaviors
• structuring the environment
• enhancing therapist capability and motivation.

Some common modes for delivering these include individual therapy, group skills training, telephone consultation, and therapy for the therapist. Therapists will specifically target behaviors that are considered to be the greatest threat to the patient and others and work their way down to less-imminent threats as the more serious issues are minimized or resolved.

Mindfulness and DBT

In contrast to basic CBT, which tends to use the Socratic method as a problem-solving approach, DBT uses mindfulness and meditation practices to help patients reconcile change and acceptance. The mindfulness skills learned in DBT often serve the patient even as they move on to other therapies.

Mindfulness is also used in other therapeutic approaches. However, DBT does tend to lean much more into it than other commonly used approaches for SUD treatment. In a way, mindfulness forms the core of DBT practices, and the approach relies heavily on mindfulness principles to help patients better tolerate the difficulties that come with recovery.

Should I try DBT?

Recovering individuals, whether they’re currently in rehab or are receiving post-rehab aftercare, should consult with a qualified mental health specialist to find if DBT is a good fit. While popular for severe SUD cases with co-occurring mental health issues, DBT and other types of cognitive-behavioral therapy will not necessarily work in all cases. Thankfully, therapists today have access to several interventions and therapeutic approaches for SUD.

The principles of dialectical-behavior therapy are widely available online. However, individuals should not practice psychotherapy without the advice of a qualified psychiatrist. It’s now known that even talk therapy can be harmful to some people when misapplied.

The best strategy for treating SUD and other mental health conditions in most cases is to try a variety of approaches and sticking with what works. If you’re in the Greater Boston Area, you can get in touch with Boston Drug Treatment Centers to find which facilities and programs offer DBT and other less-used therapeutic approaches.