Psychotherapy, or talk therapy, is one of the primary techniques used for mental health treatment. Depending on your specific circumstances or needs, different types of therapy may be recommended. Cognitive Behavioral Therapy (CBT) helps to identify emotional, environmental, and social stressors or triggers that may lead to self-destructive behaviors, including negative visions of self-worth and substance abuse.
CBT teaches life skills and coping mechanisms in order to reverse these negative behavior and thought patterns and turn them into more positive ones.
Psychologist Marsha Linehan took CBT a step farther and modified it to create Dialectical Behavior Therapy, or DBT. It was initially formed as a treatment for suicidal patients and those suffering from bipolar disorder (BP).
Today Behavioral Tech, created by Linehan, reports that DBT is successfully used to treat many mental health disorders, including:
- Post-traumatic stress disorder (PTSD)
- Depression
- Substance abuse disorder (SUD) and dependency
- Eating disorders
When more than one disorder occurs in the same person at the same time, they are considered co-occurring disorders, and DBT may prove an effective treatment method for co-occurring disorders as well.
Dialectical Behavior Therapy Skills
The word “dialectical” refers to the integration of both change and acceptance when used in treatment models. DBT, therefore, is inherently accepting, validating people as they are, while also helping to facilitate some level of necessary change in order to promote recovery. One of the main premises of DBT is accepting thoughts and behaviors that may be uncomfortable instead of fighting against them. This allows you to realize that change is possible and can gradually be realized.
DBT encompasses four main modules or behavioral skills, as published by PyschCentral:
- Mindfulness
- Emotional regulation
- Distress tolerance
- Interpersonal effectiveness
The concept of mindfulness most likely stems from Eastern practices of meditation and yoga, and it focuses on recognizing bodily sensations and becoming more in tune with your physical self in order to become fully aware, centered, and present in the moment at hand. In strengthening the connection between mind and body and channeling your energies in a positive way, yoga can actually decrease stress levels.
A German study published by Harvard Health Publications reported a decrease in depression by 50 percent and anxiety by 30 percent for those studied who regularly practiced yoga for three months. Mindfulness can help curb self-destructive urges and reduce self-criticism, while encouraging better choices and less impulsive actions. Learning how to regulate your emotions and make positive changes is an important behavioral skill learned during DBT.
Stress is a part of everyday life, and everyone copes with it differently. Chronic stress leads to chemical changes in the brain. Researchers at the University of California, Berkley found that a connection exists between levels of stress and the potential for mood or anxiety disorders in the future. Learning how to cope with and manage stress effectively can help repair brain functions and aid recovery.
DBT requires that some levels of stress be accepted and pain should be tolerated instead of trying to change all distressing events. This is different than many models of therapy, as most call for the change of stressful circumstances instead of the toleration of them.
Methods Used During DBT
Dialectical Behavior Therapy has four main components in its standard form: group skills coaching, individual therapy sessions, phone sessions, and therapy for the therapist. The group skills portion of DBT teaches behavioral skills, typically in a classroom format, once a week for 2.5 hours. Homework is often distributed to be completed outside of the group before the next session.
Individual therapy sessions likely occur once a week and focus on individual motivations and coping with personal challenges and specific circumstances. The phone sessions are often optional and provide patients with an open line to their therapist anytime they may need help between sessions.
Therapists generally work together, and a therapist consultation team may meet once a week to further discuss treatment options and modify or enhance methods in order to ensure therapy is successful and relevant. This is essentially therapy for the therapist and helps keep medical professionals motivated and current with the most current methods and treatment options.
DBT utilizes a hierarchy in order to determine the most effective path of treatment. First, any and all self-injurious or life-threatening behaviors are addressed and redirected. DBT’s primary function is to reduce suicidal thoughts, tendencies, and behaviors. Next, DBT focuses on any behaviors that may get in the way or interfere with its effectiveness, such as missing sessions or showing up late. Collaboration is vital during DBT, and all parties need to be on the same page.
Behaviors that interfere with general quality of life are dealt with next during DBT and include mental health concerns, substance abuse, and other matters, such as relationship, employment, or housing status. Finally, DBT teaches new life skills and behaviors to replace old and ineffective ones in order to achieve positive goals. DBT starts with the behaviors that may be the most detrimental to one’s health and interrupt possible treatment.
Standard DBT treatment models last at least 24 weeks, although depending on specific and individual factors and circumstances, treatment may be extended up to a year or be shortened.
Benefits and Effectiveness of DBT
Bipolar disorder (BD) affects around 1.6 percent of the American adult population in a given year, as reported by the National Institute of Mental Health (NIMH). Bipolar disorder is characterized by intense mood swings, difficulties with interpersonal relationships, and suicidal thoughts and behaviors.
Around 80 percent of BD sufferers exhibit suicidal behaviors, and four to nine percent of these attempts will be successful, according to NIMH. DBT can help control these self-destructive behaviors and regulate moods.
The Journal of the American Medical Association (JAMA) Psychiatry reports that suicide attempts by those with BD were cut in half in a study where DBT was employed as the primary treatment method. Suicidal thoughts leading to hospitalization and medical risk in general were also lowered with DBT.
Approximately one-half of those suffering from a severe mental illness, including bipolar disorder, will also abuse substances, just as one-third of alcohol abusers and over half of all drug abusers also suffer from mental illness, according to the National Alliance on Mental Illness (NAMI).
Co-occurring disorders are common, therefore, and they may stem from an attempt to self-medicate or provide temporary relief from mental health symptoms. Substance abuse is likely to produce the opposite effect, however, and instead exacerbate mental illness symptoms as well as interfere with the treatment of mental health disorders and any necessary prescription medications. Mental illness also may complicate substance abuse and increase the risk factors and side effects associated with illicit drugs and/or alcohol abuse and dependency.
Co-occurring disorders can be complex and require specialized, simultaneous, comprehensive, and integrated care models wherein teams of medical professionals work together to treat both disorders.
Studies published in Addiction Science and Clinical Practice indicate that DBT can reduce substance abuse in those suffering from BD and may also be effective in treating other co-occurring serious mental health disorders and substance abuse disorders. Substance abuse is inherently a self-destructive behavior that may be a response to stress or trauma and utilized as a coping mechanism. DBT can retrain negative impulses and promote healthier alternatives.
DBT can provide you with the necessary tools to build a successful and healthy life. Black Bear Lodge understands the complexities surrounding co-occurring disorders, mental health disorders and substance abuse. Individualized treatment plans are tailored to each person’s specific needs and teams of medical professionals work together in an integrated fashion to provide evidence-based treatment models employing the most current research and scientific methods as well as years of clinical expertise.
Our admission coordinators can guide you through a confidential assessment and answer any questions you may have. Contact us today at 706-909-9811.
Dialectical Behavior Therapy for Managing PTSD
Post-traumatic stress disorder (PTSD) is a form of mental illness that results from actual or threatened danger. Examples of this can include experiencing natural disasters, physical, sexual, or emotional abuse, being involved in war or combat, hostage or kidnapping situations, and other criminal acts.
While these experiences are terrifying and impact different survivors in different ways, not everyone will develop PTSD after experiencing trauma. For many, the distress of trauma may fade, but for those struggling with PTSD the effects will only worsen over time.
Symptoms of PTSD
Anyone can develop PTSD at any age, and the signs of the disorder usually being within three months of the traumatic event.
Some of the symptoms of PTSD include the following:
- Re-experiencing the event; having vivid nightmares, flashbacks and memories
- The need to avoid any and everything similar to the event
- Isolation from others and avoidance of social interactions altogether
- Dissociative symptoms like depersonalization, psychic numbing or amnesia
- Having an increased arousal or hyper-vigilant state that can cause insomnia, anxiety issues, sensitivity to sensory stimuli, emotional liability, and difficulty concentrating
- Physical impairment such as a rapid heartbeat, shortness of breath, nausea, dizziness and gastrointestinal problems1
PTSD is a disease that torments patients because they cannot heal from the traumatic experience. Instead, the trauma terrorizes them, harming their health, relationships, lifestyle, and wellbeing. When PTSD goes untreated, patients may turn to drugs to medicate their symptoms. Using drugs or alcohol to cope with PTSD dramatically increases the risk of developing addiction. Drugs and alcohol combined with PTSD can worsen mental health issues and may prompt self-harm.
Treatment for PTSD
Dialectical behavior therapy (DBT) is a type of cognitive behavior therapy or talk therapy that was developed to treat borderline personality disorder, but is also used in conjunction with other treatments to heal mental health issues like depression, PTSD, and addiction.2
DBT focuses on changing a person’s thoughts and beliefs about himself which motivates the changing of behaviors. The main focus of DBT is to help patients learn skills that will decrease emotion dysregulation, self-destructive behaviors, and other unhealthy coping mechanisms.
DBT helps treat the symptoms of PTSD by:
- Addressing and removing dangerous behavior commonly seen among individuals with PTSD
- Developing a trusting relationship between therapist and patient(s)
- Teaching skills that regulate emotions or symptoms of PTSD through mindfulness concepts, interpersonal effectiveness skills and distress-tolerance skills
DBT helps patients analyze their emotional and psychological issues and teaches them to control their behavior. It encourages patients to identify their emotional experiences and manage them through the skills they learn and practice in therapy. DBT teaches mindfulness, interpersonal effectiveness, distress tolerance, and emotional regulation skills with real-life scenarios.
The goal is for patients to transfer these skills from therapy to real life and use them to cope with the symptoms of PTSD, anxiety and other mental and emotional health problems.3
DBT for PTSD
While PTSD is a devastating and painful, patients now have many options to treat the disorder. If you or a loved one is searching for treatment for PTSD, please call our toll-free helpline now at 706-909-9811. Our admissions coordinators are available 24 hours a day to answer your questions and help you find the right treatment options for your unique situation.
Whether you have questions or concerns, need information, or are ready to find treatment today, we can help. Call us now and begin your recovery journey.
Using Dialectical Behavior Therapy in Addiction Rehab
Therapy is a great place to make new goals and heal from the past. Therapists often gently challenge their clients to make positive changes, and this partnership may lead to a new level of insight that leads to true healing.
Sometimes people need healing before they can begin to make positive changes. In some cases, a person may have gone to several treatment programs, tried many therapists, and may still struggle to succeed. This can lead to a sense of hopelessness and avoidance. Individuals who have tried other methods but still feel overwhelmed by emotions and unhealthy behaviors may find success with Dialectical Behavior Therapy (DBT)
The DBT Model
DBT was developed in the 1980s by psychologist Marsha Linehan, based on her work with patients who had borderline personality disorder. Linehan and her team of researchers found that some clients just did not heal from traditional approaches to therapy. Through careful research and application, she modified a well-known and proven treatment, Cognitive Behavioral Therapy, in order to reach them and help them to heal.4
Identifying and Changing Unhealthy Behaviors
Dialectical Behavior Therapy involves learning new ways to build a life worth living. DBT functions in stages. Therapists first work closely with clients to help them build self-soothing skills to make emotions more manageable before working on their behavior changes and life goals. DBT is highly supportive and works with the client in a non-judgmental manner that understands how hard change can be, yet still challenges the client to reach his or her higher goals.
In DBT sessions, individuals partner with their therapists to identify the thoughts and assumptions that lead to poor behaviors in a non-judgmental environment. That’s similar to the steps taken in Cognitive Behavioral Therapy sessions. DBT practitioners help clients accept their own thoughts and feelings so that they may make changes from a calm and confident frame of mind.5
Meditation techniques play a big role in the efficacy of Dialectical Behavior Therapy, as participants are encouraged to notice mood changes or disruptive signals. Meditation techniques allow clients name and understand the changes they feel. Rather than being overwhelmed, they learn to accept the changes in a calm and understanding state. This can be a remarkable change for people who have been ruled by reactions.6
DBT also helps patients to build social skills, so they can engage with other people in relationships based on understanding, rather than hostility. Group work is a part of the DBT model. Group work helps clients learn and practice emotional regulation and skills in understanding the emotions of others.
“I also gave DBT a try,” writes Diana of Heroes in Recovery. “ I still practice DBT today, and credit it for making my life less stressful…DBT taught me how to experience and embrace life using all my senses. I remember riding in the car with a friend one afternoon, watching sunlight stream through the window. I felt it on my skin as I had a thousand times before. But this time was different. I was fully present in the moment. I felt a new kind of sunlight radiate through me, warming my heart. I still have some obstacles to overcome. My life is not perfect and will never be, and that’s okay because I am happier than I have ever been.”
DBT Specifics
Dialectical Behavior Therapy can be time-consuming, as patients who participate might be required to:
- Attend private sessions several times per week
- Participate in group skill-building sessions at least once per week
- Complete intensive homework assignments
- Keep journal entries each day
Dialectical Behavior Therapy can be completed on an outpatient basis, but it works very well during residential treatment, especially if the client desires rapid, healthy improvement. Group work and intensive personal counseling help each client build new approaches to emotion management, friendships, and work.
Developing Healthy Relationships
DBT is designed to help individuals build healthier relationships, communicate more effectively, and overcome conflicts with less stress and strain. Because DBT is such an intensive and rewarding type of treatment, it is vital for potential clients to choose a practitioner who is fully trained in DBT and works within a DBT treatment team
The Dialectical Behavior Therapy National Certification and Accreditation Association states that there is no specific credential a provider must have in order to provide this therapy, but voluntary accreditation does help providers demonstrate a profound commitment to this kind of care. Families might be wise to ensure that their providers have this certification.7
Healing with DBT
While DBT was originally created to help people with personality disorders, the Substance Abuse and Mental Health Services Administration suggests that it’s an appropriate therapy to provide to people who have a variety of mental health concerns, including:
- Suicidal thoughts
- Psychological adjustment difficulties
- Drug addictions
- Eating disorders
These are very different concerns, and not surprisingly, the length of time these people might need in order to heal can also vary dramatically. Some might need only a few weeks of sessions. Others might need months or even years.8
Studies demonstrate that people who participate in DBT tend to experience a profound level of healing. For example, in a study in the American Journal on Addictions, researchers found that people who had borderline personality disorders and addictions healed at a superior rate when given DBT, when compared to people who got treatment without DBT.9 Those given DBT were able to achieve greater reductions in drug use, and they were able to make greater gains in social skills when compared to their peers. This just shows how much value a DBT program might provide to a family in need.
Combining DBT with Other Therapies
While Dialectical Behavior Therapy might be just right for some people, there are others who may benefit from a different form of treatment. For example, some people with addictions explode and shut down in standard treatment programs because they haven’t made the internal decision to get sober. People like this might benefit from Motivational Enhancement Therapy rather than DBT, so they can develop the urge to really get sober and participate in therapy.
Some people also transition out of DBT into more standard Cognitive Behavioral Therapy programs. They might need the affirmations of DBT in the early part of recovery, but as they heal, they might be more prepared to participate in therapy sessions that move a little faster and involve a little more confrontation. Typical CBT sessions might work best for people like this.
Family therapy might also play a role in recovery for people in treatment.Families are often devastated by the impact of addiction and mental illness, and each family member might benefit from learning new coping skills. Family therapy sessions can uncover that trauma, and they might allow the family to develop new habits that are just a little more helpful.
Medication management might also aid the healing process for some people with addictions or mental illnesses. The aid of proven medications can sometimes help improve mental health, and medication therapy may sometimes allow people to feel just a little more control over their emotions and reactions.
At Black Bear Lodge, we utilize a number of therapies to help our patients, and our practitioners are adept at utilizing Dialectical Behavior Therapy to help patients in need. In our residential treatment facility, we provide counseling sessions and group work, and our around-the-clock staff coverage ensures that patients always have someone to talk to, should the need arise. If you’d like to know more about our model, please call 706-909-9811 and our admissions coordinators will be happy to help.
Sources
- 1 “Post-Traumatic Stress Disorder.” National Institute of Mental Health, U.S. Department of Health and Human Services, Aug. 2018.
- 2 “Dialectical Behavior Therapy.” Psychology Today, Sussex Publishers, Aug. 2018.
- 3 Tull, Matthew, and Steven Gans. “How Dialectical Behavior Therapy (DBT) Is Used for PTSD.” Verywell Mind, Verywellmind, 24 Apr. 2018.
- 4 An Overview of Dialectical Behavior Therapy. Psych Central. N.p., 17 July 2016. Web. Accessed 18 Sept 2017.
- 5 What is Dialectical Behavior Therapy? Behavior Tech. Web. Accessed 18 Sept 2017.
- 6 Choi-Kain, Lois W., Ellen F. Finch, Sara R. Masland, James A. Jenkins, and Brandon T. Unruh. 2017. What Works in the Treatment of Borderline Personality Disorder. Current Behavioral Neuroscience Reports 4 (1): 21-30.Web. Accessed 18 Sept 2017.
- 7 Dialectical Behavior Therapy National Certification and Accreditation Association. Frequently Asked Questions. Web. Accessed 18 Sept 2017.
- 8 Substance Abuse and Mental Health Services Administration. National Registry of Evidence-Based Programs and Practices. Web. Accessed 18 Sept 2017.
- 9 Linehan, M, Schmidt, H., Dimeff, L., Craft, J, Kanter, J, Comtois, K. Dialectical behavior therapy for patients with borderline personality disorder and drug-dependence. American Journal of Addiction. 1999. 8(4):279-92. Web. Accessed 18 Sept 2017.
