It’s often the role of the addiction treatment community to embrace the cutting edge in treatment research. Because addicts are a population notoriously difficult to treat with long-term success, new and different theories and treatment strategies must be considered as new ways to approach potential therapeutic solutions for addicts.
One of these relatively new treatments for addiction is a science called Dialectical Behavior Therapy (DBT), thought of as a way to address common behaviors of patients with Borderline Personality Disorder when it was first suggested in 1987. More recently, DBT is being used to treat substance abusers, a population that shows considerable similarities to patients with Borderline Personality Disorder.
We’re going to talk about what DBT is, how it works, and how patients struggling with Borderline Personality Disorder and those struggling with addiction share similarities that allow both groups to be excellent target populations for the success of DBT.
When it was developed in the late 1980s, DBT was intended to target suicidal and parasuicidal patients, most of whom had a condition called Borderline Personality Disorder (BPD). BPD is a psychological disorder marked by swings in mood, self-image, and behavior. Because people with BPD often change their mindset on themselves and their actions, the condition often goes hand-in-hand with feelings of self-loathing and suicidal tendencies.
BPD is also notoriously difficult to treat. Efforts to change patients’ behavior or views of themselves are often met with distress. In turn, patients with BPD usually shut down, become unreceptive to traditional treatment strategies, and drop out of treatment altogether. This is because patients with BPD often have difficulty accepting the aspects of their lives that they cannot change in the present. This contributes to a sense that their life isn’t worth living, which is why suicide and BPD often are correlated.
DBT is now considered the “Gold Standard” in treating patients with borderline personalities, due to the high success rate the treatment has had in a patient group that has traditionally been so hard to treat. This is why the same strategies have been applied more recently to other groups that share similarities in the way they see themselves and their resistance to traditional treatment methods: the addiction community.
To understand how DBT is used to treat addicts, we have to first fully understand what it is. The theory behind DBT is in the name of the therapy: “dialectical”. The term in this instance means the convergence of two sides or opposites. The word can also refer to a conversation, as in ‘dialect’, but this is not the intent of the term here. There is plenty of conversation in Dialectical Therapy, but at the root of it is ‘opposing ideas’. There is not just one set of ‘opposites’ that Dialectical therapy addresses, there are many. A rudimentary example of opposites would be: You tried your hardest at creating a paper airplane, and you need to get better at making them. These two (dialectical) ideas may create some conflict in the mind, and may create anxiety about failure. DBT acknowledges both of these ideas, accept them and creates a plan to move forward. In short, DBT teaches patients to accept themselves and give themselves value while acknowledging the need for growth to meet their goals.
DBT uses multiple strategies aimed at helping a person develop a life that they feel is worth living. The therapy teaches people with suicidal tendencies and complex personality disorders how to develop positive motivations and better greater distress tolerance. This is done through five different treatment objectives with a strategy to complete both. According to resources created by Dr. Marsha Linehan, PhD, ABPP, who is responsible for developing the therapy in 1987:
The first objective of DBT is to help patients develop the skills to change their circumstances and help them develop a higher view of themselves. This is achieved through DBT Skills Training.
This step is focused on using individual psychotherapy to help apply the skills they’ve developed to real-world goals.
The next step in DBT is to ensure that clients are using the skills they’ve developed through DBT Skills Training and actually applying them to the motivations they’ve built in therapy. This takes place using phone coaching and in-person coaching.
After the client is deemed to be able to react to obstacles in life using the skills and coping methods they’ve learned in the first three steps of DBT, ongoing case management is used to provide structure and help the client become independent.
DBT takes a unique approach to the actual professionals handling the therapy, by ensuring that they receive sufficient support to handle the responsibilities of managing patients with serious disorders. This is done through the use of a DBT Consulting Team.
Patients treated with DBT are encouraged to keep a diary where they can write down daily thoughts and identify their emotions. There are also worksheets to help manage emotions and behavior outside of therapy, as well as distress management tool called chain analysis.
DBT can also be separated into four modules:
Dialectical Behavior Therapy has been proven effective in treating the following disorders:
The common thread between the disorders that DBT is used to treat is how patients struggling with these conditions view themselves. These conditions are accompanied by a feeling of worthlessness. DBT was developed as a response to the shortcomings of Cognitive Behavioral Therapy (CBT) in certain types of patients, namely, patients who may have suicidal ideation.
CBT is considered the gold standard in the treatment of anxiety, but when Dr. Linehan tried to apply it to her patients with suicidal tendencies (most of which suffered from what we know now as BPD), patients were discouraged by cognitive behavioral therapy’s reliance on change. DBT was then developed to incorporate the idea of self-acceptance and improving one’s view of their worth in CBT, which became a much more effective way of treating patients in extreme distress.
The reason that DBT is so effective is its comprehensive approach in combining the promotion a positive self-identity with the tools to change for the better. It’s an easier treatment to digest because it uses a step-by-step process that’s less abstract than many other treatment methods. According to Dr. Linehan’s resources:
In stage 1, patients feel miserable and out of control. With addicts, this means the complete lack of control over their substance use and doing anything possible to stay under the influence.
As DBT begins to work, patients enter stage 2: quiet desperation. In addicts, their habits are no longer life-threatening but they still struggle with their self-worth. (this may be the time of withdrawal from substances).
In stage 3, patients begin to rebuild. Addicts are clean but still need to begin forming habits, behaviors, and worldviews that support ongoing recovery. In stage 3, these habits and behaviors are formed. This where the dialectical challenge of acceptance and change is fulfilled.
Stage 4: Whenever possible, Dr. Linehan suggests that patients find a deeper meaning and motivation in their life—something that gives their life intrinsic value. For addicts, this is the reason why many support groups and recovery programs are based on spiritual themes.
Dialectical Behavior Therapy fills in where standard treatments fail, and for addicts who feel invalidated by repeated attempts and failures to recover from their disorder, DBT can literally save lives. This is one of the many advanced therapeutic solutions offered at New Light Medical, making us an industry-leader in recovery from addiction.
If you or a loved one are addicted to drugs and alcohol, it’s never too soon to get help. For a consultation, contact New Light Medical today.