Along with withdrawal management and medication-assisted therapy, psychotherapy is one of the foundations of mainstream drug and alcohol rehab. Of the many psychotherapy approaches used, cognitive-behavioral therapy (CBT) is by far the most widely used and the most successful at bringing positive long-term outcomes for rehab patients.
However, within CBT, there are several other specialized approaches, one of which is Dialectical behavior therapy. Dialectical behavior therapy (also called dialectical-behavioral therapy or DBT) is a subtype of CBT that differs from its parent approach in a few key areas.
DBT was initially developed for psychiatric patients that were in danger of harming themselves and others. Today, it is a very common approach for patients with drug and alcohol use disorders.
Until fairly recently, DBT was not commonly used for individuals undergoing rehab for substance use disorder (SUD). However, the scale of the long-running American drug epidemic meant that drug rehabs often encountered violent or otherwise difficult patients far more frequently than they used to. This has led to DBT becoming more widely used in the past decade, including at drug rehabs in the Dallas area.
Below we’ll explain what dialectical behavior therapy is, the types of SUD cases it excels in, as well as some of its limitations.
Any discussion of DBT should be used with the understanding that it is a type of CBT. We had discussed the major differences between DBT and CBT in a previous post.
To explain briefly, using CBT tend to use a Socratic approach, which requires the patient to have decent control of their emotions and reasoning. DBT, on the other hand, is designed for patients who may have difficulty reasoning or regulating their emotions. In contrast to CBT, which primarily involves problem-solving, DBT aims to increase a patient’s tolerance of difficult problems.
Dialectical behavior therapy aims to improve the emotional resilience and regulation in patients that could not yet receive CBT and other similar types of therapy. When the patient can better tolerate difficult situations and control their emotions, the aim shifts to helping the patient change problematic behavior and thinking. The seeming contradiction of “acceptance” and “change” is where the “dialectical” part of DBT is derived.
DBT is not usually the first tool psychotherapists reach for in SUD treatment. It will generally only be used if the patient cannot yet benefit from other psychotherapy approaches. When the individual is more stable and less of a danger to themselves and others, regular CBT or other approaches may then be utilized.
DBT is designed and intended for patients who are suicidal or pose a threat to other people. It can also be used for individuals who have difficulty managing their emotions or have shown unusual or erratic behavior.
With the current shortage of mental health workers and the rising intensity of the American opioid and methamphetamine epidemics, clinicians at drug rehab centers are encountering these kinds of difficult cases more often. As a result, DBT has been used far more often in contemporary drug rehab settings than it has been in previous years.
Better mental health diagnostics has also resulted in DBT being applied more often. Cases of borderline personality disorder and other mental health conditions for which DBT is a first-line psychiatric treatment are now more easily identified in rehab settings. A general shift towards more holistic treatment approaches has also resulted in DBT being used more often in drug treatment facilities, particularly for dual diagnosis cases.
It can be difficult to generalize as different clinicians will reach for different tools, even when trying to implement the same approach. In any case, classic DBT as it was developed in the 1980s has five essential functions:
Modes for delivering dialectical behavior therapy may include one or a combination of the things below:
During these sessions, the most problematic behaviors will be identified and ranked according to priority. As the patient improves, less-important behaviors will then be addressed, perhaps with a shift to CBT or other types of therapy as needed.
Only your attending psychiatrist can say for sure. While self-attempting psychotherapy may seem harmless, it’s important to only do it under the guidance of a qualified mental health professional. Misapplied psychotherapy can be dangerous, and any therapy can have lasting negative effects when used in the wrong situations.
If you’re interested in trying out DBT or other types of psychotherapy, please consult a psychiatric professional. You can get in touch with our expert team at Dallas Drug Treatment Centers to find listings of North Texas drug and alcohol treatment centers that offer dialectical behavior therapy and other approaches. Good luck, and be well!