If you suffer from addiction, you probably understand what it means to feel lost, angry or afraid. Sometimes it might be extremely hard to deal with emotions or cope with loss, or to successfully manage pain. Oftentimes our behavioral patterns can define how we are perceived by others and how we will react in certain situations. Sometimes when we suffer from an addiction we begin to doubt that our emotional reactions are permissible and other times our reactions may be over the top.
This emotional rollercoaster can be unhealthy and with Dialectical Behavior Therapy, or DBT, you’ll learn that it’s necessary and even healthy to allow yourself to have emotions.
At The Bluffs, DBT can also teach you how to better control your reactions when necessary. Our highly trained professionals teach mindfulness, distress tolerance, emotion regulation and interpersonal effectiveness to help a patient learn to deal with life on life’s terms. This can be crucial, especially if you’ve been using drugs or alcohol to numb your senses. “There is increasing evidence that DBT skills training alone is a promising intervention for a wide variety of both clinical and nonclinical populations and across settings”.
A History Of Dialectical Behavior Therapy
In the late 1970s, Dialectical Behavior Therapy was first used by behavioral psychologist Marsha M. Linehan to treat suicidal adult women with Borderline Personality Disorder (BPD). Originally Linehan and her team of researchers were curious to see if Cognitive Behavior Therapy (CBT), which had grown in popularity in the world of psychology, would be effective in treating BPD. When Linehan attempted to use the practice of CBT to treat her subjects, she and her team were met with a few unexpected problems:
- Clients receiving CBT found the unrelenting focus on change inherent to CBT to be invalidating. Clients responded by withdrawing from treatment, by becoming angry, or by vacillating between the two. This resulted in a high dropout rate. If clients do not attend treatment, they cannot benefit from treatment.
- Clients unintentionally positively reinforced their therapists for ineffective treatment while punishing their therapists for effective therapy. For example, the research team noticed through its review of taped sessions that therapists would “back off” pushing for change of behavior when the client’s response was one of anger, emotional withdrawal, shame, or threats of self-harm. Similarly, clients would reward the therapist with interpersonal warmth or engagement if the therapist allowed them to change the topic of the session from one they did not want to discuss, to one they did want to discuss.
- The sheer volume and severity of problems presented by clients made it impossible to use the standard CBT format. Individual therapists simply did not have time to both address the problems presented by clients (suicide attempts, self-harm, urges to quit treatment, noncompliance with homework assignments, untreated depression, anxiety disorders, and more) and have session time devoted to helping the client learn and apply more adaptive skills.
Dialectical Behavior Therapy For Substance Use Disorders (SUDs)
Since the early days DBT has become the most popular treatment modality for suicide prevention and borderline personality disorder; however it has also become widely used for eating disorders, post-traumatic stress disorders, depression and substance use disorders.
“Because many such patients have substance use disorders, the authors developed DBT for Substance Abusers, which incorporates concepts and modalities designed to promote abstinence and to reduce the length and adverse impact of relapses. Among these are dialectical abstinence, ‘clear mind,’ and attachment strategies that include off-site counseling as well as active attempts to find patients who miss sessions” (U.S. National Library of Medicine).
Why Do We Use Dialectical Behavior Therapy?
At The Bluffs, our qualified addiction medical staff and professionals care about your well-being. Dialectical Behavior Therapy is one of the keystones of our treatment that can help to divert your negative beliefs into positive ones. It has also been proven to ensure that you’ll remain in treatment—because unless it’s court ordered you can leave rehab any time you choose to.
The sad truth is “treatment dropout is one of the major problems encountered by treatment programs; therefore, motivational techniques that can keep patients engaged will also improve outcomes. By viewing addiction as a chronic disease and offering continuing care and monitoring, programs can succeed, but this will often require multiple episodes of treatment and readily readmitting patients that have relapsed” (National Institute on Drug Abuse).
What Are The Priorities Of DBT?
Our team at The Bluffs has several main priorities to help you along in your recovery and to ensure that you don’t use drugs while giving you the best treatment that we can. Each treatment modality works because the terms of treatment are clear-cut and followed. Generally patients come into rehab with the intent to treat a single problem, which in many cases is substance abuse or addiction. But the further they get into therapy the more problems that are revealed. As therapists “peel back the emotional layers”, they can get a better understanding of where these problems arise from.
With DBT our therapists are able to dissect a multitude of problem behaviors that can hinder you from getting well and then treat those behaviors in order of importance and safety. The treatment targets in order of priority are:
- Life-threatening behaviors: First and foremost, behaviors that could lead to the client’s death are targeted, including all forms of suicidal and non-suicidal self-injury, suicidal ideation, suicide communications, and other behaviors engaged in for the purpose of causing bodily harm.
- Therapy-interfering behaviors: This includes any behavior that interferes with the client receiving effective treatment. These behaviors can be on the part of the client and/or the therapist, such as coming late to sessions, cancelling appointments, and being non-collaborative in working towards treatment goals.
- Quality of life behaviors: This category includes any other type of behavior that interferes with clients having a reasonable quality of life, such as mental disorders, relationship problems, and financial or housing crises.
- Skills acquisition: This refers to the need for clients to learn new skillful behaviors to replace ineffective behaviors and help them achieve their goals.
What Are The Stages Of DBT?
A lot of people start using drugs or alcohol experimentally but many end up using them to cope with trauma, emotional issues and other life occurrences. Just as a person likely went through stages of substance abuse to wind up with an addiction, they will go through stages to get out of the addiction as well. By using the four stages of treatment, DBT allows a therapist and a client to work together from one goal to the next. Each goal/stage paves the way for the next. These are the stages of Dialectical Behavior Therapy:
- Stage One, the client is miserable and their behavior is out of control: they may be trying to kill themselves, self-harming, using drugs and alcohol, and/or engaging in other types of self-destructive behaviors. When clients first start DBT treatment, they often describe their experience of their mental illness as “being in hell.” The goal of Stage 1 is for the client to move from being out of control to achieving behavioral control.
- Stage Two, they’re living a life of quiet desperation: their behavior is under control, but they continue to suffer, often due to past trauma and invalidation. Their emotional experience is inhibited. The goal of Stage 2 is to help the client move from a state of quiet desperation to one of full emotional experiencing. This is the stage in which post-traumatic stress disorder would be treated.
- Stage Three, the challenge is to learn to live: to define life goals, build self-respect, and find peace and happiness. The goal is that the client leads a life of ordinary happiness and unhappiness.
- Stage Four, finding a deeper meaning through a spiritual existence. Linehan has posited a Stage 4 specifically for those clients for whom a life of ordinary happiness and unhappiness fails to meet a further goal of spiritual fulfillment or a sense of connection to a greater whole. In this stage, the goal of treatment is for the client to move from a sense of incompleteness towards a life that involves an ongoing capacity for experiences of joy and freedom.
Five Critical Functions Of Dialectical Behavior Therapy
Every mental health program has a primary function, whether it’s to help you understand why you drink so much, help you see why you react a certain way or to help you reach any of the goals previously listed. At The Bluffs we use the five functions of Dialectical Behavior Therapy as used by Marsha M. Linehan:
- It is typically the individual therapist who maintains the client’s motivation for treatment, since the individual therapist is the most prominent individual working with the client.
- Skills are acquired and strengthened, and generalized through the combination of skills groups and homework assignments.
- Clients capabilities are generalized through phone coaching (clients are instructed to call therapists for coaching prior to engaging in self harm), in vivo coaching, and homework assignments.
- Therapists’ capabilities are enhanced and burnout is prevented through weekly consultation team meetings. The consultation team helps the therapist stay balanced in his or her approach to the client, while supporting and cheer leading the therapist in applying effective interventions.
- The environment can be structured in a variety of ways. For example, the home environment could be structured by the client and therapist meeting with family members to ensure that the client is not being reinforced for maladaptive behaviors or punished for effective behaviors in the home.
Life After Dialectical Behavior Therapy
When you live each day unable to control your emotions or with a belief that crying is an overreaction or sign of weakness, you can fight your body and mind’s natural reaction to life. Using drugs and alcohol to cope with these emotions is another unhealthy reaction that you may come across. With behavioral treatment programs like DBT, you can feel human again. You can can remember how wonderful it feels to laugh and to truly be happy.
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We have emotions for a reason and if we go through life trying to mask them or drown them out, we are not only living a lie, but hurting ourselves and potentially others in the meantime. There will undoubtedly be things in life that will be hard to deal with—perhaps loss, disapproval or rejection. Recovery, much like life as a whole, isn’t always easy. With DBT, you can remember what it’s like to cry because you’re sad. It can also help us find a life of happiness and self-respect. We can also learn what it means to show emotion when necessary.
Modalities Used With DBT
Behavioral therapy alone is not always sufficient to treat an addiction, or substance use disorder and people aren’t suddenly cured after rehab. Recovery takes work—hard work. Not everyone will be successful and some people might even relapse. To help prepare you with the tools for a successful recovery, The Bluffs also offers the following treatment programs:
- Medication-Assisted Therapy
- Motivational Interviewing
- Group Therapy
- Family And Peer Support
- Outdoor And Recreational Therapy
- Inpatient Treatment
- Relapse Prevention
- Aftercare Support
The Bluffs—Utilizing Dialectical Behavior Therapy For Wellness
Every one of us has a different past; some harder than others… it’s part of the human condition. Sometimes, along our journey in life, we come to road blocks. Some of which may be an addiction or substance abuse, and they can make life seem unbearable. At The Bluffs we’re here to help you out of the darkness and back onto the right path.
Contact us today to learn more about Substance Use Disorders and Dialectical Behavior Therapy for treatment. There’s no better victory than against addiction—we want to fight for you because you’re worth it!
- National Institute on Drug Abuse — Principles of Drug Addiction Treatment: A Research-Based Guide
- The Linehan Institute — What is Dialectical Behavior Therapy?
- U.S. National Library of Medicine — Dialectical Behavior Therapy for Substance Abusers