Overview of Dialectical Behavior Therapy
- 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.
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).
Due to its effectiveness, it was later expanded to treating substance abuse and several other mental health disorders.1 DBT therapy is based on four main components: 1, 2
- Skills training
- Individual therapy
- Phone coaching
- Therapist consultations
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.
Where It's Used
DBT is offered through:
- Mental health programs
- Community treatment centers
- Inpatient rehab facilities
- School systems and some workplaces4
Addictions and Mental Health Disorders Treated by DBT
- Tobacco or nicotine
- Prescription pain medication
- Stimulants (e.g., methamphetamine, ecstasy)
- Hallucinogens (e.g., LSD)
- Illegal drug addiction (e.g., cocaine, heroin)
- Recreational drug addiction (e.g., marijuana)
- Eating disorders
- Post-traumatic stress disorder (PTSD)
How DBT Is Used to Treat Addiction
Dialectical behavior therapy 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.
Four Components of DBT
The four components of DBT therapy (skills training, individual therapy, phone coaching and therapist consultations) are conducted as follows.1,2
How Does DBT Differ From Cognitive Behavioral Therapy?
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.
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 Treatment
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
- Suicidal behavior
- Psychiatric hospitalizations
- Non-suicidal self-injuries
- Improving social functioning 7, 8
- 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
If you're looking for a program that uses dialectical behavior therapy or another type of therapy to treat substance abuse or dual diagnosis, call 1-888-319-2606Who Answers? to speak with a treatment support specialist.
For more information about DBT please visit the DBT-Linehan Board of Certification website.
1. Linehan, M. M., Schmidt, H., Dimeff, L. A., Kanter, J. W., Craft, J. C., Comtois, K. A., & Recknor, K. L. (1999). Dialectical Behavior Therapy for Patients with Borderline Personality Disorder and Drug-Dependence. American Journal on Addiction, 8, 279-292.
2. Verheul, R., Van Den Bosch, L. M. C., Koeter, M. W. J., De Ridder, M. A. J. , Stijnen, T., & Van Den Brink, W. (2003). Dialectical Behaviour Therapy for Women with Borderline Personality Disorder, 12-month, Randomised Clinical Trial in The Netherlands. British Journal of Psychiatry, 182, 135-140.
3. Allmon, D., Armstrong, H. E., Heard, H. L., Linehan, M. M., &.Suarez, A. (1991). Cognitive-Behavioral Treatment of Chronically Parasuicidal Borderline Patients. Archives of General Psychiatry, 48, 1060-1064.
4. Linehan, M.M. (2015). DBT Skills Training Manual: Second Edition. New York: Guilford Press.
5. Miga E, Karlson A, DuBose T. Financial cost-effectiveness of dialectical behavior therapy (DBT). PsyD Behavioral Tech, LLC. 2013; 1-8. http://behavioraltech.org/downloads/Financial-Cost-Effectiveness-DBT.pdf
6. Dimeff LA, Linehan MM. Dialectical behavior therapy for substance abusers. Addict Sci Clin Pract. 2008; 4(2):39-47.
7. Rizvi SL, Dimeff LA, Skutch J, Carroll D, Linehan MM. A pilot study of the DBT coach: an interactive mobile phone application for individuals with borderline personality disorder and substance use disorder. Behav Ther. 2011; 42(4):589-600.
8. Neacsiu AD, Rizvi SL, Linehan MM. Dialectical behavior therapy skills use as a mediator and outcome of treatment for borderline personality disorder. Behav Res Ther. 2010; 48(9):832-839.