Dialectical Behavior Therapy Helps Suicidal Individuals and Addicts Recover

Dialectical Behavior Therapy (DBT) is a research-based, cognitive-behavioral treatment. It was originally developed by Marsha Linehan at the University of Washington, to help clients with the suicidal and self-harm behaviors often seen in Borderline Personality Disorder.

DBT has since been modified as a treatment for other complex and challenging mental disorders that involve emotional dysregulation, such as dual diagnoses, PTSD, eating disorders, drug addictions and severe mood disorders. Persons with these disorders often have great difficulty managing the emotional and relational crises of their lives because they lack the needed behavioral coping skills.

Using both acceptance and change strategies, DBT asks both patient and therapist to find a balance between accepting reality as it is and maintaining a strong commitment to change. Dialectics is the idea that two seemingly opposite truths can valid at the same time. Dialectical thinking challenges us to hold both black and white in our minds simultaneously, valuing each color equally. The resulting tension is a vehicle for change and transformation while seeking to synthesize the opposing poles of the dialectic.

DBT skills training use a systematic format to teach four sets of skills: mindfulness, interpersonal effectiveness, emotion regulation, and distress tolerance. It also requires a commitment that includes day-to-day skills. A commitment means very little, after all, if people do not have the tools to carry out the commitment.

DBT is now widely used for a variety of people including juvenile offenders and those with drug addictions. When used with people with substance use problems, DBT prioritizes goals on the basis of how big an obstacle each behavior is to the client’s quality of life. The first goal is usually to decrease the use of substances, then to alleviate the discomfort individuals face in adjusting to withdrawal and not using. The next step is to address urges and cravings, while avoiding likely relapse cues (drug users, crack houses, bars, etc.). Then there is work on eliminating or reducing behavior patterns that might lead to relapse (acting impulsively, for example). Finally, there is a focus on community reinforcement, the building of healthy behaviors, sober social connections, employment, and other protective factors.

The discipline of behaviorism taught that people could learn new behaviors, and that acting differently can eventually alter underlying emotions from the top down.