What Is Dialectical Behaviour Therapy, and Why Does It Work with Addictions and Mental Illnesses?
At Dunham House, most patients that seek help with addiction issues are not suffering solely from addiction. There's something underneath it, something that led them to seek solace in a substance abuse habit – it could be an anxiety issue, unresolved trauma, or unstable moods. Dual diagnosis treatment is precisely about addressing addiction in addition to other, underlying psychological disorders. Dialectical Behaviour Therapy (DBT) is one of the techniques we use in a residential environment for such clients.
Let's take a closer look at the origins, basic principles, and methods used in dialectical behaviour therapy. In some cases, it may prove to be highly valuable as an additional component of an evidence-based clinical approach.
Why Is DBT Needed, in the First Place?
It's essential to understand that DBT was designed to solve a particular problem – treating people who were labeled as "too difficult" by conventional Cognitive Behavioural Therapy (CBT). Patients suffering from borderline personality disorder were especially difficult to work with. Their problems included unstable emotions and impulses, erratic relationships, and inability to control their mood swings, and other traits of similar nature.
As we know, CBT focuses primarily on challenging negative and irrational thoughts. But how could that help patients who suffered from intense emotions, had trouble coping with them, and struggled to regulate them? These individuals did not lack cognitive insight; they lacked emotional skills.
Dr. Linehan, who created DBT, recognized that conventional therapy was ineffective for such clients, not because they could not benefit from it, but because it didn't offer anything that could address their core problems. Her approach included a range of new concepts, among which the key one was dialectics.
A dialectical approach presupposes holding two contradicting truths at the same time. In this case, these would be the following statements:
I'm doing the best I can. | I still need to change.
The ability to accept these two facts simultaneously creates a unique approach, where a client accepts themselves as they are while understanding that change is inevitable and necessary
How Does Addiction Therapy Connect With DBT?
Emotional dysregulation is one of the key factors of addiction. It's not the actual reason for substance abuse – but for some people, it might be. The overwhelming anxiety that causes discomfort during social interaction, depressive state that makes simple tasks exhausting, uncontrollable anger or numbness resulting from trauma – these are issues that require treatment.
Numerous studies prove that the treatment of mental disorders and substance abuse disorders is most effective if done concurrently rather than sequentially. That makes dialectical behaviour therapy a good match for treating patients with comorbid addictions and various forms of psychological disorders. DBT helps patients learn to manage uncomfortable emotions without resorting to a drink or drug, break the vicious cycle of self-hatred associated with addiction, cope with all-or-nothing thinking, and fix their damaged relationships.
As mentioned above, DBT is highly useful in the context of dual diagnosis therapy because it covers so much ground. That makes it well-suited to longer, residential rehabilitation programs that allow for extensive training and implementation of new skills in real-life scenarios.
Four DBT Skill Modules in a Nutshell
DBT involves the acquisition of four distinct yet interrelated modules, developed progressively and practiced during each step of the recovery process. Namely, DBT teaches people how to:
1. Develop mindfulness
Mindfulness is the first step in dialectical behaviour therapy. In essence, it is a technique that allows one to observe their thoughts and feelings without automatically reacting to them. It is especially important during early recovery, when the ability to recognize emotions, accept them, and postpone the action is crucial.
2. Tolerate distress
Learning how to cope with crisis situations is one of the most crucial elements of DBT. When people feel overwhelming stress, the only thing they see in front of them is a bottle of alcohol, a drug stash, or some other way to numb the pain. DBT skills teach them alternative ways to cope with acute crises.
Those may include self-soothing and grounding techniques, or radical acceptance, which means accepting reality as it is regardless of whether one likes it or not. It does not imply resignation to the current circumstances but accepting them as inevitable.
3. Regulate emotions
One of the common traits of patients suffering from addiction and mental illnesses is lack of self-awareness regarding emotions. It could manifest as difficulties identifying emotions, comprehending their meaning and purpose, or recognizing the need to change certain aspects of their lives.
This module aims to improve the emotional intelligence of a patient so that they gain full control of their moods, learn when they need to change something in their lives, and when to accept things as they are.
4. Become more skilled in interpersonal interactions
Interpersonal problems are another aspect of borderline personality disorder addressed in DBT. The therapy aims to teach clients how to initiate and maintain healthy relationships with others, negotiate successfully and assertively while still respecting others' needs, and become better listeners and communicators.
All four DBT modules complement each other; they are not mutually exclusive but should be practiced simultaneously for best results.
How Dialectical Behaviour Therapy Can Be Conducted in Residential Treatment
While traditional outpatient DBT consists of individual therapy sessions once a week and skills training groups, DBT can be practiced more intensively and extensively in a residential treatment center.
At Dunham House, we conduct extensive therapeutic sessions on a regular basis, and skills acquired through DBT are practiced on many occasions. Patients are provided with a structured schedule for a certain period of time, which facilitates skill building.
The biggest advantage of residential treatment compared to outpatient care in the case of dual diagnosis is that there's a limited number of stressors. At home, one has to constantly fight the temptation of using a substance despite being committed to recovery.
Moreover, residential settings allow patients to apply their newly acquired skills in real-world scenarios and practice them further under the guidance of clinicians. In some cases, the treatment of comorbid conditions requires continuous assistance on the part of the clinical staff.
Recovery from addiction is never linear – patients tend to experience ups and downs. DBT helps them cope with emotional issues and continue moving forward.
How to Identify the Patients Suitable for DBT
The initial concept of DBT revolved around the treatment of borderline personality disorder. Today, however, the body of research in the area suggests that the therapy is effective in managing other disorders as well. Those include depression, PTSD, eating disorders, substance abuse disorder, and numerous issues related to youth mental health.
As a result, DBT is currently used in conjunction with CBT as a comprehensive treatment program for patients with co-occurring disorders. However, it does not imply that every patient needs dialectical therapy.
Each client is assessed individually and the treatment plan tailored to their specific needs. If a clinician finds DBT beneficial for a certain patient, it becomes an integral element of their rehabilitation program.
What Does Science Have to Say About the Efficacy of DBT?
It's crucial to remember that DBT is not another fad in psychology. It is one of the most widely researched psychotherapeutic practices, which has undergone numerous empirical trials. Results of studies prove its efficacy in reducing self-harming and suicide risks among BPD sufferers, as well as decreasing drug cravings in addicted individuals. The latter is particularly important for patients with co-occurring disorders.
For instance, a study published in the Journal of Consulting and Clinical Psychology reveals that women suffering from BPD and substance abuse disorders experienced significant improvement in their symptoms after going through DBT. Similar results are recorded for other disorders in several scientific publications.
The skills-based nature of the therapy implies that the benefits persist even after the end of the treatment itself, which adds another value to it.
Recovery from addiction is not only possible but feasible when approached right. DBT can be an excellent addition to the evidence-based treatment of various psychological issues.
Dual Diagnosis Treatment Program at Dunham House
We are proud of our expertise in dual diagnosis therapy at Dunham House. Our team uses dialectical behaviour therapy along with other evidence-based approaches to address the issues of our patients.
If you are searching for evidence-based addiction treatment programs for someone you care about, please feel free to contact us.
Dunham House
About Dunham House
Located in Quebec's Eastern Townships, Dunham House is a residential treatment centre specializing in addiction and providing support to individuals with concurrent mental health challenges. We are the only residential facility of our kind in Quebec that operates in English.
Our evidence-based programs include a variety of activities such as art, music, yoga, and equine-assisted therapy. In addition to our residential services, we offer a full continuum of care with outpatient services at the Queen Elizabeth Complex in Montreal.