Dialectical Behaviour Therapy (DBT) was developed out of a branch of therapy called cognitive behavioural therapy (CBT) but was specially adapted for people who were struggling with very intense emotions, such as Borderline Personality Disorder. DBT has shown to be effective in treating these serious cases, and more recently therapists have turned to DBT in working with people with substance use disorders, eating disorders, or suicidal behaviour.
Substance misuse is related to the emotional life of a person – often people turn to substance misuse as a form of self-medication. Some of the core principles of DBT -such as improving self-image, communication, and coping skills – are vital points of development that can help someone move away from drug use.
What is DBT?
In simple terms, the aim of DBT is to:
- Accept difficult emotions and thought processes
- Learn how to manage these emotions and thoughts
- Learn how to make positive changes and move forward
‘Dialectical’ is about trying to understand how two things that appear to be opposites might both be true and can coexist with one another. With DBT, these two things are understood as ‘acceptance’ and ‘change’, might seem contradictory to both accept yourself as you are and also strive to make changes to your life. However, DBT can teach you how it is possible to achieve these goals together.
For some people this is more helpful for them than the approach of CBT, which is wholly focused on how to make positive interventions to change your life habits.
For some people, the dialectical approach of DBT is more helpful than the approach of CBT. Therapy is personal experience and different methods suit different people.
The two types of therapy are related, but some useful distinctions to understand are:
- CBT helps you to make positive changes to difficult/harmful life habits or ways of thinking
- DBT also does this, but at the same time it focuses the individual on how they can also accept their emotions and ways of thinking
- DBT usually involves more group work
- DBT therapists will use a balance of acceptance and change techniques to build these skill sets in the individual
Acceptance techniques will focus on:
- How to understand yourself as an individual
- Coming to understand why you might be doing things that bring you or others harm
For example, a therapist might help you to identify your reasons for misusing substances, which could be related to needing to cope with intense emotions that are difficult to face otherwise. This helps to show you how your behaviour can be made sense of from a certain angle, and therefore explains why you might persist with something that is damaging in the long-term.
Change techniques will focus on how to make interventions into these harmful behaviours. Its aim is to replace these behaviours with forms of behaviour that ultimately are of help to you. The therapist will assist you in:
- Challenging unhelpful thoughts
- Finding different methods for dealing with distress
In practical terms, change techniques could also include encouraging the individual to remove themselves from people or environments that act as triggers for their drug use.
DBT’s therapeutic approach is built on four core principles. These are:
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- Mindfulness
Mindfulness is about being aware of the present moment. In mindfulness practice, the person learns how to observe their thoughts and feelings as they happen and to ground themselves by paying attention to their immediate senses (hearing, sight, smell). These mindfulness strategies are intended to help someone slow down their thoughts, re-focus, and stay calm whilst experiencing emotional pain. It is intended to prevent automatic and non-thinking engagement in negative thought patterns or impulsive behaviour. - Emotion Regulation
Emotion regulation is about learning how to recognise, label, and control one’s emotions effectively. It shows the person how to be less reactive when responding to people and situations, so as to not let emotions take control and interfere with what could be a rational thought process. - Interpersonal Effectiveness
Interpersonal effectiveness is learning how to build and maintain positive relationships. It understands that relationships should meet personal needs whilst preserving boundaries and self-respect. - Distress Tolerance
Distress tolerance is one of the acceptance techniques, and it focuses on how to tolerate intense emotions in healthy ways (for example without engaging in harmful behaviours) and without trying to change these emotions.
- Mindfulness
We offer DBT as a form of treatment during our residential treatment programme, to be put in combination with the holistic medical and psychological support that is designed to assist individuals in passing beyond their addictions. As with all our therapeutic strategies, the treatment methods we use are tailored to the individual and respond to their personal needs. One of our therapists can help you to decide if DBT is suited to your personality or has the potential to assist you in your recovery.
Our treatment centre delivers DBT treatment through individual therapy sessions and group work. The therapy sessions attend directly to the individual’s needs and your personal therapist will be developing the sessions according to your progress. Group work allows individuals to practise the skills they have been learning in a safe and secure environment, for example through role-play scenarios, and is intended to allow open communication to develop between peers. As part of making DBT effective, our therapists also assign you homework tasks, for example journalling the emotions, urges, and behaviours as you experience them throughout the day.
The residential treatment format allows DBT to be integrated into your whole recovery experience. The staff at our private rehab centre are all professionally trained in DBT skills, meaning that at any period of crisis a member of staff would be able to help you put your DBT skills (for example self-soothing) into effect.
