What is Dialectical Behavior Therapy? 

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Dialectical behavior therapy (DBT) is a form of cognitive behavioral therapy (CBT). It combines the behavior change techniques of CBT with therapies designed to help patients focus on two main components: change and acceptance (dialectics).

Definition of dialectical behavior therapy:

DBT is a type of cognitive behavioral therapy that focuses on the acceptance of a patient’s experience. It attempts to identify and change negative thinking patterns and behaviors and encourages positive outcomes. Therapists use four methods to administer DBT:

  • One-on-one therapy sessions
  • Group counseling
  • A therapist consultation team
  • Phone coaching

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Who Benefits From DBT?

DBT is mainly used to treat people with:

  • Suicidal thoughts — are often the result of stress, depression, or anxiety. People with substance use disorders are at a higher risk of suicidal thoughts.
  • Borderline personality disorder (BPD) — is a mental health disorder marked by a constant pattern of mood swings and severe changes in self-image, and behavior.
  • Substance use disorders (SUD)involve physical or psychological dependence on drugs or alcohol.
  • Binge-eating disorder (BED) — is a common eating disorder where a person habitually overeats to the point where it is detrimental to their health.
  • Depression in elderly patients — is a common and serious mood disorder that is often ignored or misdiagnosed in elderly patients. 

DBT and Co-Occurring Disorders

DBT is especially effective at treating patients diagnosed with co-occurring disorders. It was initially developed in the 1970s for patients diagnosed with suicidal thoughts or borderline personality disorder, and it is still used to treat a variety of mood and personality disorders today. This makes it an excellent tool for any addiction treatment program that treats patients with a dual diagnosis.

Dialectical Behavior Therapy (DBT) vs. Cognitive Behavioral Therapy (CBT)

CBT and DBT are both considered psychotherapy, or talk therapy. 

CBT is structured, short-term, goal-oriented, and focused on the present. It begins with education about the disorder and how it affects the patient. Then you learn and practice skills to help make changes in your thoughts, feelings, and behaviors. The skills you learn to deal with present problems will help you deal with problems in the future.

DBT is based on CBT, but with a greater emphasis placed on emotions, mindfulness, and social aspects. Validation (accepting yourself) and relationships are cornerstones of DBT. It shows the patient that what they went through and are currently going through is real and teaches them how to accept their situation.

The patient will also work with their counselor and peer group extensively. In addition to CBT skills, they’ll learn skills for managing your emotions, building relationships, coping with distress, acceptance, and mindfulness.

Dialectical Behavior Therapy vs. Cognitive Behavioral Therapy 

Dialectical behavior therapy is a very useful method used in some substance abuse or addiction treatment programs. It targets behavior related to substance dependency and focuses on building the skills necessary to manage cravings, prevent relapse, and build relationships that will help you on your path to recovery.

There are 4 main stages of DBT treatment for substance use disorders:
1: Out of control to in control.

The first stage focuses on decreasing reckless and dangerous behaviors. Patients also build skills to increase their attention, improve relationships, understand their emotions, and manage their distress.

2: Emotionally unavailable to emotionally engaged

People often shut off emotions when they become too difficult to manage. In this stage, patients practice experiencing emotions fully without using substances to escape them.

3: Building a normal life and solving normal problems.

In this stage, the treatment shifts from focusing on extreme symptoms to more common problems such as relationships, work problems, life goals, and other emotional issues.

4: Feeling incomplete to feeling complete/connected. 

While the first three stages aim at reducing harmful or unwanted symptoms, step 4 focuses on building happiness. DBT accomplishes this by connecting with the world around you.

What Should You Expect During Dialectical Behavior Therapy?

Dialectical behavior therapy usually involves individual therapy sessions and DBT skills groups.

Individual therapy meetings consist of one-on-one contact with a professionally trained therapist to address your therapeutic needs.

Your therapist will help you:

  • Remain motivated
  • Apply DBT skills into everyday life
  • Address obstacles or problems that may occur during treatment

During DBT skills groups, members learn and practice skills with others. Participants are encouraged to share their experiences and provide support. Groups are led by one expert therapist conducting exercises and teaching skills.

Participants are assigned homework, like practicing mindfulness exercises. Each group session lasts for around two hours, and groups usually meet weekly for approximately six months. Groups can be shorter or longer, depending on the requirements of participants.

However, DBT can also be provided by therapists in various ways. For example, some people attend one-on-one therapy sessions without participating in weekly skills groups. Others may decide to meet with the group without consistent one-on-one sessions.

What Should You Look for in Dialectical Behavior Therapy Treatment?

When choosing a dialectical behavior therapist, make sure you select someone who practices DBT skills themselves. The therapist must know basic behavior therapy techniques and DBT treatment approaches.

Look for a mental health professional with expert training and experience in DBT. The Linehan Board of Certification is a non-profit organization that has created certification standards for clinicians.

Most importantly, it is essential to find a therapist with whom you feel comfortable with.

How Does DBT Help With Addiction?

Dialectical behavior therapy for substance use disorders helps by focusing on the following behavioral targets:

  • Decreasing substance abuse
  • Helping reduce physical discomfort from withdrawal
  • Managing and reducing urges, cravings, and temptations to use
  • Avoiding triggers and separating yourself from past people, places, and items that give you opportunities to use
  • Reducing behaviors conducive to substance use
  • Building community reinforcement of healthy behaviors and relationships

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Resources +

Dimeff, Linda A, and Marsha M Linehan. “Dialectical Behavior Therapy For Substance Abusers.” Addiction Science & Clinical Practice vol. 4,2 (2008): 39-47. doi:10.1151/ascp084239, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2797106/

Chapman, Alexander L. “Dialectical Behavior Therapy: Current Indications And Unique Elements.” Psychiatry (Edgmont (Pa. : Township)) vol. 3,9 (2006): 62-8., https://pubmed.ncbi.nlm.nih.gov/20975829/

Goodman, Marianne et al. “Dialectical Behavior Therapy Alters Emotion Regulation And Amygdala Activity In Patients With Borderline Personality Disorder.” Journal of Psychiatric Research vol. 57 (2014): 108-16. doi:10.1016/j.jpsychires.2014.06.020, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4263347/

May, Jennifer M et al. “Dialectical behavior therapy as treatment for borderline personality disorder.” The mental health clinician vol. 6,2 62-67. 8 Mar. 2016, doi:10.9740/mhc.2016.03.62, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6007584/

Reddy, M S, and M Starlin Vijay. “Empirical Reality of Dialectical Behavioral Therapy in Borderline Personality.” Indian journal of psychological medicine vol. 39,2 (2017): 105-108. doi:10.4103/IJPSYM.IJPSYM_132_17, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5385735/

Dialectical Behavior Therapy, Behavioral Research & Therapy Clinics, University of Washington, https://depts.washington.edu/uwbrtc/about-us/dialectical-behavior-therapy/

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