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How Does Dialectical Behavioral Therapy Work?

Dialectical behavioral therapy (DBT) treats patterns of self-injury through practical techniques, strategies, and skills. Originally, this therapeutic approach was developed to treat people with borderline personality disorder. Someone with this disorder may display a tendency to engage in self-harm, which includes suicide attempts and self-mutilation.

DBT is also applicable to substance abuse, which the National Institute on Drug Abuse (NIDA) defines as “a chronic, relapsing disorder characterized by compulsive drug seeking, continued use despite harmful consequences, and long-lasting changes in the brain.”

Thus, when someone engages in a pattern of drug or alcohol abuse, they may be actively engaging in self-harm. Therefore, DBT aims to encourage clients to embrace two seemingly opposing goals: change and acceptance.

To find out more about the history and inner workings of DBT, read on.

What Is DBT?

DBT was founded by Marsha M. Linehan. Confined to a seclusion room in a Connecticut clinic by the age of 17, Linehan attacked herself by “habitually burning her wrists with cigarettes, slashing her arms, her legs, her midsection, using any sharp object she could get her hands on” (according to a 2011 New York Times article).

When Linehan was eventually discharged over two years later, doctors summarized Linehan as “one of the most disturbed patients in the hospital.”  Afterward, she moved to Chicago and lived at a YMCA. She became a devoted Catholic and started taking night classes at Loyola University. While praying at an on-campus chapel, she had an epiphany:

“One night I was kneeling in there, looking up at the cross, and the whole place became gold.  And suddenly, I felt something coming toward me,” she said. “It was this shimmering experience, and I just ran back to my room and said, ‘I love myself.’ It was the first time I remember talking to myself in the first person. I felt transformed.”

That moment of self-acceptance led her to develop DBT.

In 1972, Linehan earned a PhD in social and experimental psychology. When she started treating patients, she began seeing the importance of radical acceptance, which is one of the bedrocks of DBT. She developed DBT for her patients who felt compelled to hurt themselves.

Thus, DBT incorporates aspects of cognitive behavioral therapy (emotion regulation and reality testing) with radical acceptance and distress tolerance. DBT also adopts the principle of mindfulness, which is a Buddhist concept.

Essentially, DBT helps individuals struggling with substance abuse disorders achieve self-acceptance as they acknowledge their need to change.

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The Core Principles Of DBT

DBT helps patients identify and build on their personal strengths as a way to increase their self-confidence. It allows people to identify the behavior patterns and beliefs that make their lives difficult. DBT is also collaborative, in that it encourages patients to work out their issues in collaboration with therapists.

DBT asks people to complete homework assignments, to roleplay new ways of interacting with others, and to practice skills (such as soothing yourself when upset). These skills are taught in weekly lecture and reviewed in weekly homework groups. The individual therapist helps the person learn and apply these DBT skills.

Unlike other psychotherapies, DBT offers four modes:

Mindfulness is at the base of all DBT skills. Patients learn to accept and tolerate the emotions they feel, especially as they challenge habits or beliefs and confront uncomfortable situations. Though mindfulness is a Buddhist concept, this principle is devoid of religious and metaphysical elements in DBT. Instead, therapists urge patients to become more aware of their environments via the five senses

Interpersonal Effectiveness involves the ways patients interact with the people around them. They’re taught how to ask for what they need, how to say “no,” and how to deal with interpersonal conflict

Distress Tolerance involves accepting and finding meaning in distress. Distressing events can include the death of a loved one, the loss of a job, or an illness. By utilizing this tactic, patients learn to accept a distressing event without imposing judgment on it. The goal of distress tolerance is developing the capability to recognize the impact of a negative event without becoming overwhelmed or intimidated by it

Emotion Regulation teaches people in recovery how to identify, regulate, and feel emotions without being overwhelmed by them and letting them trigger impulsive behavior. Therefore, patients with borderline personality disorder are taught to regulate the potentially dangerous emotions they experience, such as anger, frustration, depression, and anxiety

How DBT Treats Addiction

DBT is an abstinence-based approach that “pushes for immediate and permanent cessation of drug abuse (change) while also offering the idea that a relapse, should it occur, does not mean that the individual cannot achieve the desired result (acceptance)” (as stated byThe Fix).

While DBT mandates abstinence, it also aims to provide nonjudgmental, problem-solving solutions to relapse. Specifically, it treats a lapse into substance abuse as a problem to solve, rather than evidence of patient inadequacy or treatment failure. If a patient slips, the therapist rapidly shifts to helping the patient fail well. In other words, the therapist guides the patient in making a behavioral analysis of the events that led up to drug use and gleaning the lessons that can be applied to future situations.

One treatment goal is helping a patient quickly recover from a relapse episode.

DBT in Professional Treatment

If you or a loved one has an addiction to drugs or alcohol, professional addiction treatment will offer you access to evidence-based therapies such as DBT to aid in your recovery journey.

With relapse rates for drug and alcohol abuse between 40 and 60 percent, attempting to quit on your own is a risky proposition. Without access to evidence-based treatments designed to treat the manifold effects of addiction, withdrawal symptoms can push people to relapse.

In a professional treatment setting, you’ll undergo medical detoxification as a first step. In detox, the addictive substance and other toxins will be flushed from your body. During this medically supervised process, you’ll be administered medications to alleviate any painful or uncomfortable withdrawal symptoms.

Moreover, a licensed staff of addiction experts will collaborate with you to develop a treatment plan designed to address your specific needs. Residential treatment is recommended for severe addictions. With residential, you’ll stay at a facility away from home and gain access to DBT and other innovative therapies.

These additional therapies include:

Cognitive Behavioral Therapy, which addresses the negative thoughts and actions associated with addiction

Group Therapy, which provides patients with a supportive recovery community

Family Therapy, which focuses on the elimination of addiction and its impact on a family unit

Dual Diagnosis Treatment, which addresses a substance abuse disorder and an accompanying mental health issue in a patient

12-Step Fellowship Groups, which was pioneered by Alcoholics Anonymous founders Bill Wilson and Bob Smith

Holistic Therapy, which focuses on the whole person, including diet and mental health

Pharmacotherapy, which involves the use of medications to help wean users off of harmful drugs

Additionally, professional treatment can provide aftercare support by linking you to recovery communities such as 12-step programs.

Get Help for Your Addiction

Dialectical behavioral therapy is one of a multitude of evidence-based therapies available to you through professional treatment. Let us help you find a comprehensive, holistic program that treats the mind, body, and spirit.

For a free and confidential consultation with a specialist at California Highlands, call 855-935-0303 or contact us online now. These professionals are available around the clock to help you navigate your treatment options, verify your insurance, and answer any questions you might have.

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An Overview of Dialectical Behavior Therapy. (2018, October 08). from

Carey, B. (2011, June 23). Expert on Mental Illness Reveals Her Own Struggle. from

The Fix. (2019, January 03). DBT in the Treatment of Addiction. from

Psychology Today. (n.d.). Dialectical Behavior Therapy. from

NAMI. (n.d.). Borderline Personality Disorder. from

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