Dialectical Behavior Therapy
Learn more about dialectical behavior therapy, its modules, and how it can help you recover from substance abuse.
What is Dialectical Behavior Therapy (DBT)?
Dialectical behavior therapy (DBT) aims to teach people to accept change and where they are in the present moment. Dr. Marsha M. Linehan created dialectical behavior therapy in the late 1980s to treat borderline personality disorder (BPD). Whereas CBT focuses on your thoughts, behaviors, and feelings, DBT digs a little deeper. It teaches you how to improve your relationships, healthily cope with stress, and control your emotions.
This mode of CBT is focused on the theory of dialectics, or “balancing opposites.” The philosophy behind dialectics is that everything has opposites. Change happens when there’s a dialogue between these opposites.
Dialectical behavior therapy makes three assumptions:
- Change is inevitable and constant
- All things connect with each other
- Opposites can be integrated to form a closer likeness of the truth
Although DBT mainly treated BPD when it was first developed, it’s been adapted to treat many other mental health disorders. This includes addiction.
How Does Dialectical Behavior Therapy Work?
When enrolling in dialectical behavior therapy, you can expect three kinds of settings:
- Group settings: These will make up the majority of your DBT sessions and last about two and a half hours. Here, you and your fellow members will learn behavioral skills through role-playing and homework assignments.
- Individual settings: You and your therapist will also have one-on-one sessions together. Here, you’ll apply these new skills to your life challenges.
- Phone coaching: If you need guidance in between sessions, you can call your therapist to help you cope with a difficult situation.
Characteristics of DBT
- Cognitive: You will learn to change your beliefs/thoughts and actions/behaviors that aren’t productive or helpful.
- Behavioral: You’ll replace destructive patterns of behavior with effective and healthy ones.
- Skill sets: The skills you learn in DBT will enhance your potential.
- Support: Your therapist and fellow group members will encourage you to recognize your attributes and strengths and put them to work.
- Collaboration: You, your therapist, psychiatrist, and group therapist will work as a team and learn to communicate effectively with each other.
- Change and acceptance: Most importantly, you’ll eventually learn to tolerate and accept your emotions, your life, and yourself. You will also make healthy changes in your behaviors and interactions.
Stages of Dialectical Behavior Therapy
The first stage of dialectical behavior therapy is to treat the most self-destructive behavior first. This can be a suicide attempt or any kind of self-harm. Here, your therapist aims to stabilize you and control some of your behaviors.
After that, you’ll begin the second stage: addressing your quality-of-life skills. These are made up of the four modules we discussed earlier. At this point, you’re most likely going to bring up painful feelings, and you’ll safely explore any traumatic events in your life.
The third stage involves improving your self-esteem and focusing on your relationships. You’ll set goals during this stage to work on your happiness and stability. Your therapist will also maintain your progress at this point.
Finally, you’ll begin advancing your life to the next level. The goal of the final stage of DBT is to help you achieve an ongoing capacity for success.
Modules of Dialectical Behavior Therapy
Dialectical behavior therapy works through four main modules.
Interpersonal Effectiveness
People with borderline personality disorder usually have trouble maintaining relationships. Learning interpersonal effectiveness will help you become more assertive with your friends, family, and coworkers. At the same time, your relationships will remain healthy and positive.
You’ll also learn how to deal with difficult people in volatile situations and respect yourself.
One example of an exercise involving interpersonal effectiveness uses the acronym GIVE. This allows you to practice positive communication:
- Gentle: Don’t threaten, judge, or attack the person.
- Interest: Listen carefully and show interest, and don’t interrupt the person when they speak.
- Validate: Acknowledge the person’s feelings and thoughts.
- Easy: Stay lighthearted, smile, and have an easy-going attitude.
Mindfulness
Mindfulness is a key component of dialectical behavior therapy. This is considered the foundation for the other three DBT modules. When you practice mindfulness, you learn to live in the moment and observe what’s going on inside and outside of yourself, without judgment.
Learning mindfulness will help you stop engaging in impulsive behaviors and negative thought patterns in tough situations. Instead, you’ll learn how to slow down and develop healthy ways of coping.
When you practice mindfulness in DBT, you’ll learn six core skills among these two categories: “what” skills and “how” skills. The “what” skills include “observe,” “describe,” and “participate,” and they are the answers to what you do to practice core mindfulness skills. The “how” skills are “one-mindfully,” “effectively,” and “non-judgmentally.” These are the answers to how you must practice core mindfulness.
One way you can practice mindfulness in your sessions is to focus on your breathing. Notice how your belly rises and falls with each breath, as well as your inhaling and exhaling.
Emotion Regulation
When you have borderline personality disorder, you tend to have difficulty controlling your emotions. DBT will teach you how to handle any intense feelings you’ll have about a situation by identifying, naming, and changing them. When you do this, you’ll lessen your emotional vulnerability and have more positive experiences.
Opposite action is a common exercise for practicing emotion regulation. This involves doing the opposite of what you’re feeling. For example, if you’re feeling withdrawn and sad, make plans to see your friends and family instead of staying inside.
Distress Tolerance
Like mindfulness, distress tolerance teaches you to accept yourself and your situation as it is right now. You learn how to tough out crises in four ways:
- Self-soothing
- Distraction
- Coming up with pros and cons for not tolerating distress
- Making the moment better
When you learn these techniques, you’ll be prepared to handle any intense emotions you have and be able to cope with them in a healthy manner. While most therapies tell you to change your distressing emotions, DBT teaches you to tolerate and accept these feelings.
To practice distress tolerance, you can “put your body in charge.” By allowing your emotions to follow your body, you’ll distract yourself. Get up and walk around if you’re sitting, or go outside if you’re inside.
What Does Dialectical Behavior Therapy Treat?
Dialectical behavior therapy is mainly used to treat borderline personality disorder, but it can also treat a range of other mental health disorders. It’s mostly effective for the following:
- Eating disorders like bulimia and binge eating
- Anxiety disorders
- Bipolar disorder
- Attention-deficit disorder/attention-deficit hyperactivity disorder (ADD/ADHD)
- Depression
- Substance use disorder
- Post-traumatic stress disorder (PTSD)
What Are the Benefits of Dialectical Behavior Therapy?
Dialectical behavior therapy offers a multitude of benefits. Since it’s mostly used to treat people with borderline personality disorder, it can greatly improve how they interact in their relationships.
This mode of talk therapy also provides you with the strength to be more assertive and value yourself. Having self-respect is one of the keys to overcoming addiction. DBT also teaches you how to set goals for yourself to create a fulfilling and happy life. At the same time, you’ll learn to get rid of behaviors that aren’t productive and detract from your life.
How to Get the Most Out of a DBT Session
- Show up to all of your meetings. The most important thing you can do to improve your DBT progress is to just show up. Although some group sessions might have specific attendance requirements, you want to show up every time to get the most out of your therapy. By showing up even when you don’t want to, you’ll be practicing the opposite action, which contributes to your emotion regulation skills.
- Make sure you pay attention in your sessions. After a long day of work, it’s easy to pay attention to what happened that day right before your DBT session. However, you must be present mentally and physically to see any success. Since many patients suffering from addiction or BPD don’t have immediate access to DBT, appreciate where you are. Listen to what the other members are saying, and offer input where it’s appropriate.
- Participate in mindfulness exercises. As mindfulness is one of the four modules of DBT, you should participate in the mindfulness exercise during the first five minutes of your session.
- Take notes during your sessions. Note-taking can help you retain what you’ve learned during dialectical behavior therapy. You can put concepts into words that you can easily understand.
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