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Dialectical Behavior Therapy Techniques for Addiction Treatment

What Is Dialectical Behavior Therapy?

Dialectical behavior therapy (DBT) is a form of cognitive behavioral treatment that was initially established to help suicidal clients who were suffering from borderline personality disorder (BPD).

  • Adapted from cognitive behavioral therapy (CBT).
  • Teaches you skills to manage emotions and deal with cravings.
  • Shown to be effective at treating a variety of mental health disorders and addictions.
  • Used in many different settings, including mental health programs, hospitals and schools.

Origins of DBT Therapy Techniques

Dr. Marsha Linehan is often credited with promoting dialectical behavior therapy. During the 1970s she offered the standard version of cognitive behavioral therapy (CBT) to most of her clients, who were women experiencing suicidal ideation. She later discovered that many of her clients met the criteria for borderline personality disorder (BPD).3

Over the years, Dr. Linehan and other collaborators expanded upon CBT through the use of dialectics, where therapists can alternate a client’s focus on change and acceptance. Dialectics also help both the therapists and the clients avoid focusing on negative behaviors, thoughts or feelings that can hinder progress.1, 2

Core DBT Principles

Due to its effectiveness, DBT therapy techniques expanded to treating substance abuse and several other mental health disorders.1 The four components of DBT therapy (skills training, individual therapy, phone coaching and therapist consultations) are conducted as follows.1,2 

The four DBT modules include:

  • Skills training

Skills training includes group sessions that enhance your ability to change negative behaviors. A therapist leads the sessions and teaches you life skills. You are also required to complete homework assignments. The group meets weekly for about 2.5 hours for 24 weeks. The sessions may be periodically repeated if you need to be in the program for up to one year.

  • Individual therapy

The individual therapy sessions emphasize helping you stay motivated to continue your treatment and teaching you how to apply the skills you are learning to actual events and daily challenges you face such as avoiding drug-seeking behavior. The individual sessions are once a week for the duration of the program and run simultaneously with the group meetings.

  • Phone coaching

Phone coaching with DBT therapists are available to offer you live coaching when you are facing a difficult situation, such as a relapse. More specifically, you can call your therapist outside of normal session time to receive coaching when you are in dire need of help.

  • Therapist consultations

Therapist consultation is actually a platform for the therapists who are offering dialectical behavior therapy. The consultation team helps DBT therapists remain competent and stay motivated to work with clients who typically have difficult-to-treat disorders such as substance abuse. The support helps ensure that they will be able to provide the best possible treatment.

Where DBT is offered:

  • Mental health programs
  • Community treatment centers
  • Inpatient rehab facilities (DBT residential treatment centers)
  • Hospitals
  • School systems and some workplaces4

Addictions and Mental Health Disorders Treated by DBT:

  • Alcohol
  • Tobacco or nicotine
  • Prescription pain medication
  • Opiates
  • Stimulants (e.g., methamphetamine, ecstasy)
  • Depressants
  • Antidepressants
  • Hallucinogens (e.g., LSD)
  • Illegal drug addiction (e.g., cocaine, heroin)
  • Recreational drug addiction (e.g., marijuana)
  • Eating disorders
  • Depression
  • Post-traumatic stress disorder (PTSD)

If you’re interested in DBT treatment for you or your loved one, call for help finding a treatment program.

DBT and Substance Abuse Treatment

Dialectical behavior therapy for substance abusers focuses on:

  • Decreasing the abuse of different types of substances (e.g., alcohol and/or drugs).
  • Reducing painful withdrawal symptoms.
  • Diminishing cravings, temptations and urges to abuse substances.
  • Avoiding situations that cue substance abuse.
  • Increasing community support by helping you establish new friendships.
  • Encouraging you to engage in recreational or vocational activities that support abstinence.

How Does DBT Differ From Cognitive Behavioral Therapy?

In Dr. Marsha Linehan’s experience comparing CBT vs. DBT therapy, CBT didn’t offer as much flexibility with allowing clients to first come to terms with why their addiction was so harmful before trying to engage them in activities that would promote the motivation to change. This could potentially lead to higher dropout rates prior to treatment completion.

CBT also focused mainly on individual therapy. This strategy often failed to address the wide array of emotional and physical problems that people suffering from BPD or substance abuse generally presented.

So how is DBT different from CBT? The four components of DBT allow several therapists to work together. This makes it easier to provide multiple modes of therapy such as group sessions, individual sessions and phone coaching.1,2 These are critical aspects that help clients receive continuous support and at-the moment coaching, which improves their level of motivation to complete the program successfully.

Cost of DBT Therapy

The cost for dialectical behavior therapy varies depending on the treatment facility and whether you have insurance that will cover this form of treatment. On average, the cost for a one-year DBT program is a little over $6,000, with skills group sessions costing about $1,900+ and the individual sessions costing about $4,800+.5

Some facilities provide services for a monthly fee, while others may require a single payment at the beginning of each session. In addition, some fees are nonrefundable once they have been paid even if you discontinue the program.

If you have health insurance, you should contact your provider to ask whether substance abuse treatment is covered by your plan, before contacting a treatment center.

DBT Effectiveness in Treating Addiction

Research shows that DBT is effective at:

  • Reducing substance abuse
  • Treatment dropout rates
  • Depression
  • Anger
  • Suicidal behavior
  • Psychiatric hospitalizations
  • Non-suicidal self-injuries
  • Improving social functioning 7, 8

These same studies also show that DBT dramatically improved the outcomes of individuals who were suffering from co-occurring disorders such as borderline personality disorder and substance abuse or eating disorders and substance abuse. The effectiveness of this form of therapy is due to the development of behavioral skills such as:
  • Mindfulness – being aware of one’s actions.
  • Interpersonal effectiveness – learning how to say no and still maintain self-respect as well as important relationships with other people.
  • Distress tolerance – learning how to cope with difficult situations.
  • Emotional regulation – gaining control over emotions that led to destructive decisions in the past.

The completion of a DBT program alone is showing promise in helping people successfully overcome addiction.7, 8

What to Look for in a Therapist

Working with a licensed therapist is an important factor that improves the chances you will complete a program successfully. Here are a few things to look for in a therapist:

  • Degree – Be sure that the professional has obtained a master’s or doctoral degree in counseling, psychology, etc., from an accredited college or university.
  • Training – Make sure they are trained to work with groups and individuals who have various behavioral, emotional and mental issues and disorders.
  • Licensure – Most licensed therapists have to pass a state exam and will typically display their degree in their office.
  • DBT experience – Asking a therapist about the number of years he or she has actually offered DBT also helps provide an indication of how much experience a therapist has at providing this form of treatment.

Where to Get More Information

For more information about DBT please visit the DBT-Linehan Board of Certification website.