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Dialectical Behavior Therapy (DBT): Definition, Application, Technique and Worksheets.

    Dialectical Behavior Therapy for Addiction Treatment

Many people in the tumult of active addiction have a very negative self-image. They may think of themselves as weak or out of control. If they are children of addicts, they may have a great deal of resistance and shame about their condition and be resistant to asking for help. If any of this sounds familiar, read below to learn about what dialectical thinking is and how dialectical therapy may be able to help on your road to recovery. 

Definition of Dialectical Thinking  

It’s important to understand the basis of dialectical thinking to understand how useful it can be. Dialectical thinking is the process of maintaining polar opposite viewpoints about a situation, themselves or other people in their life. 
For example, a non-dialectical thinker may believe that love is the same thing as control. They may have grown up with caregivers who were rigid about safety and may have limited their choices as a child in an effort to protect them. As they become adults, they may be drawn to partners or friends who are extremely controlling because control, for them, equals love and safety. At the same time, they may also become aware that their relationships are unhealthy and they are not happy. This challenges their worldview, creating stress.
When life circumstances have shattered a non-dialectical thinker’s black-and-white worldview, they no longer trust their own choices. In this case, the non-dialectical thinker may turn to drugs or alcohol to escape a world that doesn’t work as they understand it should.

What Is Dialectical Behavior Therapy?

Dialectical behavior therapy, or DBT, is based on cognitive behavioral therapy (CBT). It was initially developed by Dr. Marsha Linehan and her colleagues as a way to help those who have bipolar disorder. Since then, this approach has worked successfully with clients struggling with the intensity of self-examination required during CBT sessions and for clients with substance use disorders. Therapists help clients develop more dialectical thinking to help ease negative emotions that come from unbalanced, all-or-nothing thinking or disputes with other people.
The first step in putting DBT to work is to identify the troubling conditions in your life and to become aware of your thoughts about them. For many suffering from underlying depression, anxiety, or other mental health concerns, this dive into self-examination can be painful to face. The conflict between their black-and-white, non-dialectical thinking and the reality of life can cause significant stress. Clients must be paired with a professional therapist for DBT to be effective.

The Steps of DBT

The first step in DBT therapy is to gain control over destructive behaviors. Understanding why you drink, use drugs, or attempt suicide is important; however, detox and the removal of the tools of self-harm must come first. 
Marriage counseling session

Detox is very hard on the body and mind. Monitored detox is the safest choice for those who are trying to take care of themselves by abstaining from drugs and alcohol.

You may need to move from supervised detox into inpatient rehab as part of your process. As you regain behavioral control and are protected from self-harm, you can move forward in DBT therapy.

The second step or stage of DBT is to examine your emotional health. The self-destructive act of using drugs or alcohol is an indication that your emotional well is toxic; it is at least likely that your self-talk is not supportive. You may also be suffering from a traumatic emotional response to events from your past. 

During the second step, your therapist will help you to validate and understand these emotions and trauma responses. You may be encouraged to participate in mindfulness therapies, meditation, and journaling to help you better understand how to escape these extremely emotional memories and find a way to be present in the moment.

During the third stage of your DBT therapy, you can start to work in group settings. For those who have worked through a severe trauma response or experience, the normative state of heightened emotion can be incredibly exhausting. Your goal during the third step is to step away from emotional reactions triggered by life events without having to dull yourself with drugs or alcohol. 

Ordinary moments of happiness can be captured and reviewed. You can start to work, both in group and in your private therapies, on self-care projects that provide contentment. Depending on your unique life experiences, you may have issues with self-esteem or question your worth. During DBT, you will learn to take simple pleasure in small actions and build a place of peace within yourself without falling back into isolation.

In a drug rehab program, this may mean helping another person in a group manage an emotional response. It can also mean knowing when to step back from someone who isn’t ready for help. Knowing how to draw boundaries that allow you to respect your emotional safety is a critical element in any form of therapy.

Young grumpy couple at marital counseling therapy

The fourth stage of DBT therapy is to own and respect your sense of self. If you found that you didn’t ask for help with your addiction because you were ashamed of being an addict, the fourth stage can help you embrace yourself as a whole human being.

Of course, going through detox, rehab, and DBT therapy will not make you completely healthy. Without any bumps or rough edges, there is no way to be a healthy human being. Instead, you embrace yourself as someone who is effectively incomplete. You cannot be perfect, but you will not stop enjoying your life because of those imperfections.

As a recovering addict, this means that you may begin isolating yourself or becoming rigid in your thinking. DBT therapy can help you know when to reach out to a friend, a therapist, or a group. When you feel emotional storms brewing, you can put the tools you learned to work to calm the waters.

Skills You Will Take from DBT

Your DBT sessions will give you several skills that will help you manage daily life. Developing mindfulness and awareness about your patterns and responses is a critical first step.
You will learn to focus your attention on what matters in the here and now. If a sound or behavior triggers you, you will learn to assess it for what it is rather than the emotion it brings up. For example, if you are a survivor of a physically abusive relationship, you may have a panic reaction to loud noises. Knowing that your office neighbor is rather noisy can help you prepare for the feelings of fear and panic that can arise when someone starts bumping things around.
If you face a stressful event and feel cravings for drugs or alcohol that start to eat away at your resolution to become healthy, you will be able to rebalance. No matter your current mood, you will learn to make wise choices by building the skills necessary to dial back your response.

Understanding your triggers is the key to self-management of your emotions. Once you know what your triggers are, you can start to make good choices rather than just reacting. If your former reaction to hearing someone shouting was to burst into tears or find a quiet area to numb yourself with drugs or alcohol, you could create a mental bridge of consideration. On this bridge, you will have the mental space to decide: 

  1. Who is shouting?
  2. What are they shouting about?
  3. Am I or someone I care about in danger?

Once you have made the assessment that there is no danger and have your emotions under control, you will be able to decide how to handle the situation and others like it. 

You will also learn that other people’s problems are not always your responsibility. This is not to say that you will learn to be uncaring or cold. However, you can learn to let other people have their emotional reactions to life circumstances without putting your own emotional health in a dangerous spin.

Close-up of woman's hands during counseling meeting with a profe

You may also need to stop trying to save others in your friendships. Too often, those who struggle to control their emotions find solace in helping someone who is in a deeper crisis than they are. After detox and rehab, you may find that former friendships and romantic relationships developed around drug and alcohol use. Unfortunately, some individuals in your life may have substance use issues that you may have to distance yourself from. DBT therapy can help you accept that the value you bring to the table as a human being is enough, and you do not need to fix everyone else in your life to gain feelings of self-worth. You will be able to fully embrace your humanity as a package worthy of loyalty and support.

    Seeking Help

    A DBT approach to getting sober and healthy may benefit you. Some of the benefits may include:
  • Improving your motivation to change for the better as you begin your recovery journey.
  • Identifying triggers that could lead to substance use.
  • Reducing behaviors that may contribute to a decision to use drugs or alcohol.
  • Creating healthy relationships with friends, family, and others that support your success.
White Light Behavioral Health, located in Columbus, OH, offers DBT as part of our treatment approach. Our therapists do not believe in punishing clients for the problems that brought them into treatment. Instead, we assume you are doing the best you can, and a professional’s role is to continue working to help you achieve your goals.
Ryan Wakim MD
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Dr. Wakim is a board-certified psychiatrist with a passion for and expertise in addiction, mood disorders, trauma-related disorders and the subspecialty of interventional psychiatry. He obtained his medical degree from West Virginia University where he also completed his residency training, finishing as chief resident. Dr. Wakim co-founded and served as the CEO of Transformations leading to a successful merger with Shore Capital in May 2021. He is purpose driven towards improving the standard of and removing stigma related to behavioral healthcare. Dr. Wakim enjoys golf, traveling and time spent with his two dogs, Lulu and Rayna.

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If you or a loved one is grappling with addiction, don’t face it alone. White Light Behavioral Health is here to guide you on the path to recovery. With a compassionate team and a proven approach, we’re dedicated to helping you reclaim your life. Reach out to White Light Behavioral Health today and take the first step towards a brighter, addiction-free future. Your journey to healing begins with a single call. Please reach out to us today at (844) 297-3995 to book your appointment! And start your healing journey at our convenient facility.

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