Developed in the 1970s by Dr. Marsha Linehan, Dialectical Behavioral Therapy (DBT) is an effective treatment for people with serious self-harming behaviors or those with complex or severe mental disorders.
DBT has also been successful with many substance abusers as addiction can be viewed as a self-harming behavior. Addicts often suffer numerous negative consequences from their substance use such as relationship issues, losing jobs, health problems or getting into trouble with the law. In fact, continuing to use despite negative consequences is one of the markers of addiction.
One of the cores of DBT is “radical self-acceptance” while also understanding the need for personal change. There are four basic features of DBT: mindfulness, interpersonal relations, emotion regulation, and distress tolerance.
- Mindfulness: Taken from the practice of Zen Buddhism, mindfulness is about focusing on the present moment only and being accepting of the here and now, without judging the experience.
- Interpersonal Relations. Here individuals are taught how to set limits and boundaries in their relationships with others so they can better establish and sense of self and self-efficacy.
- Emotional Regulation: This module in DBT teaches how to identify, regulate and experience emotions without becoming overwhelmed and acting on impulse. Overall, the focus is on decreasing feelings of vulnerability while increasing positive experiences.
- Distress Tolerance: This element focuses on developing skills to cope with crises when emotions become overwhelming but the person can’t resolve the situation immediately (i.e., a death, loss of a job). The goal is to get through the crisis without making it worse by impulsive actions and decisions such as drinking or getting high.
In substance abuse treatment, DBT’s goal is for complete abstinence (change), while also offering the idea that a relapse, should it occur, doesn’t mean the addict can’t ultimately maintain sobriety (acceptance). DBT can be seen as a crossroads between never giving up on abstinence from drugs and nonjudgmental, problem-solving responses to relapse.
DBT treats a relapse or slip as a problem to solve, not proof that someone can’t get clean and sober. Instead, the focus is on creating a behavioral analysis of the events that led to and followed the drug and alcohol use, and figuring out what can be learned and applied to future situations. It’s hoped that this approach lessens the intense negative emotions and thoughts that many people feel after a relapse. These negative thoughts, if left unchecked can create huge problems in reestablishing abstinence. (“What’s the point? I’m a failure. I can’t do this. I give up. I might as well keep using.”).
Clients often present with complex issues when they enter drug and alcohol treatment and DBT is one of the many tools we can use to help individuals get clean and sober and find happiness in their lives.
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