DBT’s Role in Addiction Treatment

At Encore, we see despair in many of our patients who struggle with addiction and co-occurring disorders. Part of our focus as providers is to help them find healthier ways to live and experience life. We use many different types of therapies to do that, but one modality that is very helpful with changing thought patterns and developing coping skills is dialectical behavior therapy (DBT). “Addictive” thinking patterns feed despair, but the lessons and skills afforded by DBT can help patients develop healthier thought patterns and behaviors. 

First developed by clinical psychologist Marsha Linehan to treat borderline personality disorder, DBT is an effective, evidence-based treatment for a range of mental health conditions, including depression, anxiety, substance use disorder, and process addictions. Based on the core concept that “life is worth living,” DBT in addiction treatment emphasizes that there is a way forward for patients who feel hopeless or worthless. 

How Does Dialectical Behavior Therapy Work?

The word “dialectical” means holding two opposing ideas at the same time – a concept that is at the heart of DBT. It gives patients the ability to both accept themselves as they are and to change what is not working in their lives. For example, it is common for many entering recovery to believe they need and want help while, at the same time, they continue to want to continue in their active addiction. DBT can help patients see this struggle within themselves and resolve it by accepting that the desire to engaged in addictive behaviors may always be with them, but these urges do not have to define them or continue to impact their lives. DBT helps patients realize another way is possible. 

DBT uses the “wise mind” concept — training patients to step back and put our rational mind to work. This training helps them to not give into impulses but rather ask, “What am I feeling? What is the best way to respond?” DBT teaches patients how to become more aware of the emotional, reactive part of themselves, while also integrating their rational brain and “wise mind.” DBT helps patients to accept their emotional state: “Getting fired from my job stinks” or “I cannot stand arguing with my parent/spouse/significant other all the time.” They can gain control over impulsively reacting to such circumstances and learn to pause to consider options. Essentially, DBT teaches the patient to accept difficult experiences and provides the skills to cope in more productive ways.

Skill Building

DBT teaches patients four core skills that they can use to manage their emotions:

• Mindfulness: Bringing awareness to the situation and staying present in the “now,” rather than the past or the future
• Distress tolerance: Tolerating rather than seeking to alleviate pain in difficult situations
• Interpersonal effectiveness: Being able to interact with others, maintain relationships, and get needs met, including self-respect
• Emotion regulation: Managing emotions, including changing them as needed, from anxiety, for example, to trust, or from despair to resilience

By learning and using these skills, patients can identify what they are feeling, move away from emotional absolutes, decrease destructive responses to emotions, and tolerate emotional vulnerability. The goal is to move the patient away from all-or-nothing thinking that can lead to catastrophizing, which in turn can lead to the patient experiencing anxiety, anger, or other emotions. Using DBT, we can help patients see substance use as a problem to solve, rather than a failure, and we give them a tool to help manage their disease.

Dialectical Behavior Therapy and Relapse

A recurrence of an individual’s substance use disorder can be very difficult to process – especially for the person suffering the relapse. It can bring with it a tremendous amount of shame and despair. DBT is very effective for individuals experiencing a relapse because the therapist can guide the patient into looking at what happened—before the relapse, during the relapse, and after, examining the patient’s behavior, not to blame, but to figure out how to change the behaviors to avoid future lapses. Focusing on the relapse as a problem to be solved keeps the patient from seeing themselves as the problem. This is another example of synthesizing opposites: acceptance of self and the need to change, behaviors, situations, etc. to move forward in recovery.

How We Use DBT in Addiction Treatment at Encore

All the therapists at Encore are well-versed in utilizing DBT in addiction treatment. The key concepts of DBT are integrated into our individual and group therapies across all of our programs and levels of care. 

The DBT approach provides practical tools to support our patients’ ability to develop self-trust and confidence, and deal with the challenges that daily living, and, more specifically, living in recovery will bring in healthy, life-affirming ways. Contact Encore Outpatient Services at 703-436-8158