What Is Dialectical Behavioral Therapy and How Does It Work?

Dialectical behavioral therapy (DBT) is a treatment that was developed to target symptoms of borderline personality disorder (BPD) and has since been expanded to treat several mental health disorders and has since been adapted with promising results in managing other mental health issues—including substance use disorders.¹ This article discusses DBT, how it works, and how it can help treat addiction.

What Is Dialectical Behavioral Therapy?

Dialectical behavioral therapy (DBT) is an evidence-based treatment that evolved from approaches created by Marsha Linehan to help treat suicidal women dealing with a variety of psychosocial issues.¹

Somewhat unique from many other forms of behavioral therapies, DBT adopts a dialectical philosophy as the basis of its therapeutic approach. This philosophy acknowledges that two opposite truths are valid and can exist at the same time.¹

At the core of DBT is the idea that patients must work on accepting themselves and their current situation while also striving for change. Acceptance and change strategies are constantly being presented and applied in sessions to help the patient create a life they find worth living.¹

DBT Approach to Acceptance and Change

DBT therapists use mindfulness training to help patients grow their acceptance of themselves, the world and those around them. Mindfulness is taught and applied in both individual therapy and skills groups. ¹

Mindfulness helps patients learn to observe the present moment without judgment, describe it, and fully participate in it.¹ Through mindfulness practice, the patient can learn to accept their experience and place their attention on one thing at a time, for example a particular behavior.¹

The dialectical philosophy acknowledges that, without acceptance, change strategies are unlikely to be effective. In sessions, therapists continually work with patients to help them achieve “radical acceptance” (the acceptance of the experience without resisting it) and tolerate their distress. Therapists also validate the patient’s own experiences and emotions.

However, there is much more to DBT than acceptance. In fact, a complete focus on acceptance may be harmful, as those with BPD, suicidal thoughts, or other serious issues require significant changes to experience improvements in their lives.¹  DBT therapists balance these acceptance-based approaches with change-based solutions (e.g., changing thoughts, modifying environments, etc.).¹

How Does DBT Work?

DBT bears many similarities to CBT (cognitive behavioral therapy); however, it has 5 unique functions of treatment.¹

Function 1: Enhancing Capabilities

DBT assumes that individuals who have BPD (or another mental health challenge that could benefit from DBT) have a skills deficit in certain key areas, such as emotional regulation, distress tolerance, or interpersonal functioning.¹

Therapists works with patients to improve their skills. For example, in the case of a patient who cannot handle distress, the therapist may help them learn to sit with uncomfortable emotions and avoid making crisis situations worse. Another patient who has interpersonal problems may learn new skills to effectively navigate their relationships.¹

Function 2: Generalizing Capabilities

Function 1 works on growing skills; function 2 works on applying those skills. Therapists will assign “homework” that encourages the patient to practice the skills learned in therapy in their daily lives. Skills are also applied in therapy sessions.¹

Function 3: Strengthening Motivation and Decreasing Dysfunctional Behaviors

This function focuses on increasing the patient’s motivation for change and decreasing harmful behaviors.

During individual therapy sessions, a patient and their therapist will review a “diary card,” which is a personal inventory card the patient fills out to track their goals (e.g., abstaining from self-harm or reducing substance use). The therapist uses this “diary card” to prioritize issues to focus on during DBT sessions. Behaviors that threaten the patient’s life will be given top priority .¹

Function 4: Enhancing and Maintaining Therapists’ Abilities

Working with people with BPD or other serious mental health challenges can be highly rewarding; however, it can also test the resolve of the clinician, for instance if the patient behavior regularly interferes with the therapy or if the patient is frequently in serious crisis (e.g., repeatedly attempting suicide).¹

To address these challenges, DBT therapists meet weekly to provide each other peer support, validation, and encouragement and to provide a setting for continued skills practice.¹

Function 5: Structuring the Environment

An essential component of DBT is structuring the environment to promote positive behaviors and reduce problematic ones.¹

The therapist structures the treatment environment but also helps the patient structure their own environments in helpful ways. For example, the therapist may help the patient learn to modify their social circles if they reinforce substance use. ¹

What Does Dialectical Behavioral Therapy Treat?

DBT was originally developed to treat people with BPD and people who are chronically suicidal.¹ BPD is a mental health disorder that is characterized by:²

• A pattern of high-volatility relationships with family and friends.
• Unstable self-image.
• Emotional reactivity and intense mood swings.
• Impulsivity in areas that are self-damaging (e.g., having unsafe sex, excessive spending, and reckless driving).
• Ongoing efforts to avoid abandonment (real or perceived), such as by ending relationships quickly to avoid rejection.
• Chronic suicidal thoughts/behaviors, or behaviors of self-harm (e.g., cutting).
• Intense anger that is disproportionate to the trigger (and difficulty controlling it).

DBT has been adapted for use in the treatment of various other mental health disorders as well.^3,4 Research has shown that DBT may be an effective part of treatment for those struggling with:^1,4,5

• Depression. 
• Anxiety.
• Eating disorders.
• Substance use disorders.

Dialectical Behavioral Therapy in Addiction Treatment

DBT, when used in the treatment of addiction (substance use disorders), promotes abstinence from drugs and alcohol and attempts to minimize the harm associated with relapse.⁵

DBT applies the philosophy of acceptance and change to abstinence. The dialectical approach to abstinence is that substance use needs to stop immediately with the understanding that relapse may occur and that it does not mean the patient can’t continue working toward the goal of recovery.⁵

If relapse does occur, the therapist responds nonjudgmentally and works to help the patient get back on track. DBT accepts that relapse is a part of recovery and works to change what is possible to reduce the risk of negative outcomes (e.g., overdose).⁵

Is DBT Covered by Insurance?

Yes. DBT is covered by many insurance plans. Under the Mental Health Parity and Addiction Equity Act, passed in 2008, insurance companies and group health plans must provide some coverage for mental health and addiction treatment services.

Your insurance may have limits on the percentage of care it will cover or the amount of money it will pay per year. To find out how much of the cost of treatment your policy will cover, it may be beneficial to contact your insurance provider.

Finding Dialectical Behavioral Therapy for Addiction Treatment Near You

At Desert Hope, DBT is one of the many therapy types we utilize as part of our comprehensive approach to substance use and co-occurring disorders.

Desert Hope offers comprehensive inpatient rehab in Las Vegas as well as other levels of addiction treatment, such as outpatient rehab. To learn more about inpatient drug or alcohol rehab or to verify your insurance coverage for rehab, call to speak to an admissions navigator.

You can also start the admissions process by filling out the confidential online insurance verification form. If you don’t have insurance or need help paying for rehab, there may be payment options available to you, such as scholarships, grants, or loans. Call Desert Hope today to get your questions answered and begin your recovery journey immediately.