What is Dialectical Behaviour Therapy (DBT)?

Dialectical behaviour therapy is a form of cognitive behavioural therapy that teaches people how to constructively cope with stress and emotional difficulties. It also introduces ways of building healthy relationships and is a popular treatment for those who struggle to regulate their emotions or engage in self-destructive behaviours (VeryWellMind). This plays an important part in treating substance abuse, alcoholism and behavioural addictions such as problem gambling.


How Does DBT Work?

DBT teaches you how to make changes to improve dysfunctional emotions. It helps one determine the impact that poorly regulated emotions have on relationships, personal health, and recovery in addiction. A major difference between CBT and DBT is that dialectical behaviour therapy encourages the validity of an experience or behaviour and then encourages change by improving emotional stability. CBT focuses on modifying behaviour by challenging faulty or negative thought patterns and belief systems. Today, dialectical behaviour therapy plays an important role in the treatment of emotional and substance addiction disorders.

DBT consists of five methods or techniques that are considered the phases of therapy before positive change can happen. These include:

Group Therapy

Group therapy can be conducted in a classroom setting where individuals are taught practical skills. It is also facilitated in roleplay sessions to help people improve upon their emotional communication.

Individual Therapy

One-on-one therapy encourages individual motivation by discussing the goals for treatment. The practitioner will help people learn new skills and explore the best ways to apply these skills to a perceived challenge or a negative event.

Call Therapy

Because DBT is more of an open therapy, patients can call their therapist between their sessions if they need guidance.

Skills Training

Skills training is a major part of successful DBT. Therapy focuses on core areas for change such as mindfulness, distress tolerance, interpersonal effectiveness, and emotion regulation. These modes form part of a structured programme and is primarily used to treat borderline personality disorder.

How Does DBT Help with Addiction?

While DBT was first meant to treat Borderline Personality Disorder, today, it is an effective approach for addiction and helping people in recovery. In addiction treatment, DBT will focus on acceptance and change. We can only change what we acknowledge and once we validate our emotions, we can learn how to achieve positive change.

The client and therapist will work collaboratively to help one abstain from substance use. To assist individuals through this process, smaller attainable goals are created to facilitate sobriety, even if for an hour or a day until a habit is formed. Achieving these smaller goals also strengthens one’s motivation to continue to maintain abstinence from substance use. Dialectical behaviour therapy in abstinence focuses on creating a clear mind through active support (NCBI Dialectical Behaviour Therapy for Substance Abusers).

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How Can I Take Part in DBT Sessions?

You can participate in individual or group therapy on a weekly basis. The frequency and direction for therapy are determined by the type of rehab programme you enter. You can also access off-site therapy by phone call or participation in therapist-led classes. Let’s take a closer look at options for participation in DBT.

Within a Rehab Facility

Dialectical behaviour therapy is successfully implemented within private rehab facilities. When you are looking for DBT as part of a residential rehab programme, determine whether the facility offers DBT as part of its programme. In rehab, individuals have the opportunity to actively participate in the results-oriented approach to recovery with regular support provided by the onsite therapist.

With a Private Therapist

While DBT consists of four modes, not every mode is incorporated in private therapy. A practitioner will complete an individual assessment to determine the structure for DBT. During skills training, individuals will receive a psychoeducational approach to therapy in which clients are taught new, practical skills they can incorporate in their daily lives. Intersession coaching is also made available in DBT where the client can call their therapist to receive immediate guidance on learned skills rather than engage in destructive behaviour (Counseling Today). Individual treatment with a private therapist is conducted every week with the purpose of increasing client motivation to refrain from substance use or destructive behaviour.

Through an NHS Outpatient Service (GP Referral)

To access an outpatient service through the NHS that specialises in DBT, you must be referred by a GP. Visit a GP who will perform an assessment of your medical history, psychological health, and the nature of your addiction.

The Pros & Cons of DBT

To understand the significance of DBT in managing addiction, we look at the pros and cons.

DBT Pros

Studies involving the effectiveness of DBT on mental health conditions such as depression showed slight improvements in groups where people were treated with DBT and antidepressants compared to a group where medication alone was used (Bluepages).

DBT helps individuals understand their behaviour through behavioural analysis. Through skill training, individuals can learn how to change their behaviour by improving emotional regulation (NCBI).

Dialectical behaviour therapy helps identify the cause of addiction through collaboration with the therapist. Sessions will include an exploration of past events in which the root of addiction is determined.

DBT can help individuals build confidence by focusing on skills training to improve communication and build healthier relationships or connections with others.

In substance addiction, dysfunctional thoughts and emotions compromise the ability to cope with challenges which maintains addiction. In a study involving DBT for patients with borderline personality disorder and substance addiction published in the American Journal on Addiction, marked improvements were noted in emotion regulation when patients practiced DBT skills (Bartleby Research).

DBT Cons

DBT is a lengthy therapy in which clients visit a therapist for a few months up to a year. This can become expensive especially if it is not covered by a medical insurance.

DBT focuses on “dialectical abstinence” from substance use. The purpose is to motivate clients to stop using and to focus on achieving their goals even if they relapse. It can be difficult for individuals in an outpatient programme who are exposed to the same triggers and environment to manage abstinence and actively participate in weekly sessions (Goodtherapy).

The different modes involved in DBT may be too time consuming for private therapists to implement. Many therapists only provide certain aspects of DBT which excludes call therapy owing to time constraints.

Jason Sheirs
Author / Jason Shiers / Dip. Psych MBACP
Jason Shiers is a Certified Transformative Coach & Certified Psychotherapist who is a specialist in addiction, trauma and eating disorders. He has been working in the field of addiction for 25 years now.