What Is Dialectical Behavioral Therapy (DBT)? | What It Is and How It Works

Dialectical behavioral therapy (DBT) is an evidence-based subset of cognitive behavioral therapy (CBT) that addresses unwanted thoughts and behaviors, focusing on the development of acceptance and change through a variety of methods, including self-governed emotional regulation and meditation/mindfulness.

Dialectical behavioral therapy has grown and expanded to address negative and hindering ways of thinking, learned patterns of behavior that have been conditioned but unhelpful to us, and changing those ways of thinking and behaviors to help alleviate symptoms.

Dialectical behavioral therapy’s goals include teaching people how to live in the moment, developing healthy ways to cope with stress, regulating emotions, and improving a person’s relationships with others.

Dialectical Behavioral Therapy Skills

Generally, there are 4 skills taught in DBT:​

  1. Mindfulness: the practice of being fully aware and present in the here and now
  2. Distress Tolerance: tolerating pain/anxiety/distress in difficult situations without trying to change it/something outside of your control
  3. Interpersonal Effectiveness: how to ask for what you want, how to say no and set boundaries, and maintaining self-respect and relationships with others​
  4. Emotion Regulation: addressing and changing the emotions that a person wants to change

These skills can be worked on during individual therapy with a psychologist, or during group therapy sessions. In an individual therapy session, there are 2 specific functions of dialectical behavioral therapy.

One is to help enhance a person’s motivation to apply these skills outside of the therapy setting. 

The other is to help a person become their own self-regulator or “case manager”: someone who can manage their own physical and social environments. These 2 functions develop the structure a person needs to help address the distress in their life.

Cognitive Behavioral Therapy vs Dialectical Behavioral Therapy

Cognitive behavioral therapy (CBT) is a form of psychological treatment used to help cope with depression, anxiety disorders, alcohol and drug use problems, marital problems, eating disorders, and severe mental illness.

It was initially developed by psychologist Dr. Marsha M. Linehan to assist in the treatment of people who were dealing with extremely severe suicidal thoughts. 

The word “dialectical” is a philosophical term referring to two things that appear to be opposites but can actually both exist at the same time.

In the context of addiction treatment, dialectical behavioral therapy (DBT) views two things as contradictory-yet-essential for recovery: acceptance and change.

Additionally, dialects expand on the notion of validation. Dialectics is the idea that:

  • Everything is connected
  • Change is constant
  • Opposing forces can be brought together to find balance

CBT, however, is a larger overarching term that encompasses specific, modified versions of therapy.

Dialectical behavioral therapy shares many views and beliefs with cognitive behavioral therapy, noting that unwanted thoughts and behaviors are learned and reinforced. DBT includes a level of optimism that is not found usually in CBT. DBT conveys that:

  • People are doing the best they can in their current situation
  • They want situations to improve
  • People are capable of learning new behaviors to change their lives
  • The problems are not always the person’s fault, but it is their duty to resolve it

Dialectical Behavioral Therapy and Addiction

Over the years, DBT has been altered to address substance use disorders.

Studies show that DBT used specifically for substance abuse, called DBT-SUD, can reduce drug use in people with borderline personality disorder, a mental disorder characterized by unstable relationships, distorted self-image, and impulsiveness.

Although research involving the impact of DBT on drug use is limited, additional research could indicate DBT’s effectiveness in treating other substance-using populations.

Addiction is frequently fueled by self-destructive behaviors and dysfunctional emotions. The physical, mental, and emotional instability caused by chronic drug or alcohol use can aggravate these patterns even more. This damage can deplete a person’s health, destroy relationships, and hinder careers. 

Individuals who suffer from substance abuse often use to help develop coping skills and address their addiction. Some of the goals of dialectical behavioral therapy for substance abuse include:

  • Decreasing abuse of substances (illegal or legal drugs, alcohol)
  • Alleviating physical discomfort associated with withdrawal
  • Diminishing urges, cravings, and temptations to use and abuse
  • Avoiding triggers or opportunities to use, such as by cutting off relationships/encounters with people, locations, and things associated with drug abuse
  • Reducing behaviors conducive to drug abuse, such as momentarily giving up the goal to get off drugs and instead functioning as if the use of drugs cannot be avoided
  • Increasing community reinforcement of healthy behaviors, such as fostering the development of new friends, rekindling old friendships, pursuing social and work-related activities, and seeking environments that support abstinence

Therapy sessions help a person overcome negative, substance-abusing behaviors and damaging emotions.

Patients can learn positive behaviors to build a strong foundation for recovery success. Learning healthy ways to cope with stress or other hardships is important in successful long-term recovery.

Individuals with alcohol use disorder or addiction sometimes also struggle with behavioral issues like gambling problems, compulsive shopping and sexual behavior, and restrictive or binge eating.

Studies have shown that DBT may also be effective for these disorders because it provides individuals with skills that help them tolerate distress, improve emotion regulation capacity, and cultivate mindfulness.

Stages of Dialectical Behavioral Therapy for Substance Use Disorders

There are several stages of dialectical behavioral therapy that are specific to substance abuse disorders.

Stage One

During the beginning stage, a person with a substance use disorder will strive to gain control over their addiction, whether it’s alcohol or drug use, to achieve stability. A person will aim to interfere with their behaviors through therapy to begin managing stress. 

Stage Two

While in stage two, a person will learn to manage their behaviors, but emotional health is still an issue, resulting in suffering in silence.

They will begin to develop goals in therapy, targeting issues in their lives and relationships that have been strained. They learn to validate themselves and gain control over their emotions and facing their trauma.

Stage Three

At this stage, people who are using DBT may be struggling to achieve happiness. Therapists will help the person develop more self-respect and esteem to help achieve a better balance of their happiness.

Stage Four

Stage four is using DBT as a way to maintain emotional regularity and help a person feel a sense of purpose. 

DBT is a helpful modification of cognitive behavioral therapy and can be applied to a wide range of conditions, including depression, borderline personality disorder, post-traumatic stress disorder, bipolar disorder, and more.

It is just one of many kinds of therapies a person can try, and focuses on the here and now, validation, and boundaries for a better, more stable life.

Do you have experience with dialectical behavioral therapy? Let me know in the comments—I’d love to hear from you.

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