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Dialectical Behavioral Therapy

dbt guideOver the years, different treatment therapies for substance abuse have emerged to help with every step of the recovery process. One such approach is Dialectical Behavior Therapy. This guide to DBT explains the unique ways it treats addiction and mental health concerns.

How Does Dialectical Behavior Therapy Work?

self medicationDialectical Behavior Therapy takes into consideration a patient’s social and environmental circles.[1] There are certain situations that cause people with impulsive behavior to react dangerously. They are more likely to respond in inappropriate and harmful ways.For example, individuals with mental health disorders are more likely to use drugs or alcohol to self-medicate.[2] Borderline personality disorder (BPD) is one such condition.

Patients with BPD cannot control their emotions and thoughts.This makes it difficult to maintain relationships and connections with other people. The National Institute of Mental Health states that people with BPD often have other medical and mental health issues, one being substance abuse. [3] Research shows that individuals with severe mental illnesses (like BPD) do not have “certain protective factors.” This can lead to serious struggles with using dangerous amounts of alcohol or drugs.[4]

Those who have borderline personality disorder often do not understand why they act the way they do.In some cases, patients lack any methods to control their emotions.

This is where Dialectical Behavior Therapy comes in to play. DBT can teach patients skills and techniques to manage their emotions and behavior.

DBT can help individuals discover the prompts that cause the patient to react impulsively. A therapist can help the patient develop coping strategies to implement in real life. Over time, the patient can learn how to manage their emotions, thoughts and behavior.

The Paradox Behind DBT

Dialectical Behavior Therapy was devised by Marsha Linehan. Linehan is a psychologist who combined Zen Buddhist teachings on reality with wanting to see a genuine change in life. A patient who refuses to accept their situation cannot be fully treated. The DBT school of thought holds that it is only from this place of acceptance that a patient can start to think about changing her life.[5]

A therapist using Dialectical Behavior Therapy will make it a point to accept and validate the patient’s feelings.The individual learns certain feelings and behaviors are harmful. DBT has been used in a number of other treatment settings, such as with suicidal clients and patients with eating disorders.[6]

DBT works by helping patients form a well-realized, tangible goal in their minds. The goal is more than simply sobriety.The goal is a vision for who they want to be, how they want to live, and what they want to do with a life free of addiction. In this way, Dialectical Behavior Therapy looks at treatment standards in the context of creating a live worth living.[7]

Dialectical Behavioral Therapy and Mindfulness

woman in dbtDBT is based on the concept of mindfulness. This is the principle of noticing, articulating and engaging in the moment. A therapist uses DBT as a way to let a patient acknowledge how his actions have a negative impact on people around him.Then the patient makes appropriate decisions based on that acknowledgement.

When the individual gives their attention to the present, counselors can help patients regulate their emotions.This allows stressful situations to be treated in a healthy and productive manner.

In one of the first steps of DBT the therapist asks the patient to record his thoughts, feelings and actions. The patient then later shares the content of the cards during therapy sessions. Whenever a patient writes down a thought or feeling, the patient and therapist identify what prompted the unwelcome emotional or physical response. As each weak link—or unhealthy thought process—is called out, the therapist offers suggestions how to act in a healthier way. The next time the prompt shows itself, the patient has a better idea of how to deal with it.[8]

The concept of recording thoughts, feelings, and actions is also a foundational concept of Cognitive Behavioral Therapy (CBT). This is an area where the two methodologies overlap. From that point DBT and CBT take on their own unique approach.[9]

Dr. Linehan believes patients who cannot regulate their emotions lack perspective based on their experience. This makes it easy to be stuck in static, rigid thought patterns that blind them to the bigger picture. These individuals often find themselves fixating on the small, negative details. DBT teaches patients to live in the present. This allows individuals to focus on something positive and that is the point of Dialectical Behavior Therapy.[10]

Examples of the Effectiveness of DBT

women and dbtResearch studies on the effectiveness of Dialectical Behavior Therapy have shown the following results:

  • 22 women with severe cases of borderline personality disorder received DBT treatment and were compared to 22 women with BPD who received standard treatment. Researchers found “a significant reduction in the frequency and medical risk” of suicidal behavior, summarizing that DBT kept patients in therapy.
  • Out of 28 women, 12 women with BPD who were dependent on drugs and the remaining 16 women went through regular treatment. 73 percent of the women in the regular treatment group discontinued their therapy compared 36 percent of the women in the DBT group.
  • A third study compared the use of DBT and a combination of comprehensive validation therapy and 12-Step groups for a patient population of women who were addicted to heroin. Four months after treatment, subjects who received DBT kept their low levels of heroin abuse, while those using other therapy approaches “significantly increased opiate use” during the same time-frame.[11]

Living Clean

Living a life of abstinence from substance abuse is not easy, by any means.The temptation to relapse when life is good—or bad—is a cross that addicts have to carry every day. The skills and methods DBT will prepare the patient for everyday life. Then aftercare such as12-Step programs and support groups helps patients continue to heal and grow. Each day is the opportunity to move forward and to continue on the path of recovery from addiction.


1 “An Overview of Dialectical Behavioral Therapy.” (January 2013). PsychCentral. Accessed June 5, 2015.

2 “People With Mental Disorders More Likely to Use Alcohol, Drugs.” (January 2014). Nature World News. Accessed June 5, 2015.

3 “What is Borderline Personality Disorder?” (n.d.) National Institute on Mental Health. Accessed June 5, 2015.

4 “Severe Mental Illness Tied to Higher Rates of Substance Use.” (January 2014). National Institutes of Health. Accessed June 5, 2015.

5 “The Paradox of Acceptance and Change.” (March 2014). Psychology Today. Accessed June 5, 2015.

6 “Dialectical Behavioral Therapy in a Nutshell.” (2003). The Center for Dialectical and Cognitive Behavioral Therapies, LLC. Accessed June 5, 2015.

7 “Dialectical Behavior Therapy for Substance Abusers.” (June 2008).Addiction Science & Clinical Practice. Accessed June 5, 2015.

8 “Dialectical Behavioral Therapy: A Primer [Free Article].” (n.d.) The Carlat Report. Accessed June 6, 2015.

9 “Cognitive Behavioral Therapy.” (2008). Simply Psychology. Accessed June 6, 2015.

10 “Further Delineating the Applicability of Acceptance and Change to Private Responses: The Example of Dialectical Behavioral Therapy.” (2006). The Behavior Analyst Today. Accessed June 6, 2015.

11 “Dialectical Behavior Therapy Versus Comprehensive Validation Therapy Plus 12-Step for the Treatment of Opioid Dependent Women Meeting Criteria for Borderline Personality Disorder.” (June 2002). Drug and Alcohol Dependence. Accessed June 6, 2015.

12 “Research Studies on Dialectical Behavioral Therapy (DBT).” (n.d.) Columbia School of Social Work. Accessed June 6, 2015.