Mental illnesses, including addictions, are often tied to changes in brain chemistry. Cells don’t produce enough of specific key substances tied to motivation and reward, or portions of the brain that should be active are suddenly inactive. That’s why medications are often part of the treatment program for mental illness. By using these tools, treatment teams hope to alter faulty chemistry and broken connections, so the brain can work at an optimal level. But sometimes, just changing the way a person thinks can transform the way the mind works.
That’s the foundation for dialectical behavior therapy (DBT). This innovative therapy aims to help people examine their thoughts, opinions, and reactions. Therapists also help their clients to transform the way they respond to those inner signals. Sometimes, this therapy delivers changes that medications just can’t touch, and it all starts with the power of the conscious mind.
How DBT Works
DBT uses a two-pronged approach, according to an overview in PsychCentral.
The first component involves one-on-one psychotherapy sessions, run by someone with in-depth training in DBT principles. In the early part of the therapy process, the therapist is simply attempting to form a connection with the patient. The two talk, share, and connect. They come to trust one another, and that allows the patient to feel both accepted and validated. With those feelings in place, people often feel much more ready to work on healing. They have the strength to do so.
The second component involves group therapy sessions, in which people learn skills involving:
- Regulating emotions
- Interpersonal communication and connection
- Tolerance of distress
- Acceptance of reality
The skills-training portion of therapy is seen as vital. In a study in JAMA of 99 women who received either DBT with skills training or DBT without that component, those with skills training had superior levels of recovery. While talking with a therapist one on one is incredibly helpful, it’s clear that people need the opportunity to really beef up and practice skills, if they’d like to harness the full power of DBT.
Whether people are working in individual sessions or in skills-based sessions, they’re attempting to accept their thoughts and feelings as present, understandable, acceptable, and ignorable. It’s this component that sets DBT apart from other treatment approaches.
In traditional therapy sessions, people are encouraged to identify “bad” thoughts and feelings, and eliminate them from their mental repertoire. But for some people, the idea of bad thoughts can feel like a judgment, as though their own minds are bad and their opinions are invalid. People like this may close down in therapy sessions, as they may feel judged and shunned. They may not get any benefit from therapy as a result.
A key component of DBT, per the National Alliance on Mental Illness (NAMI), involves the use of a “wise mind.” The idea is that thoughts and feelings can appear for a variety of reasons, and none of them are necessarily bad. But the wise mind can help people to understand which thoughts and feelings should be acted on. The wise mind acknowledges everything and accepts everything, but it doesn’t act upon everything.
When people become adept at applying CBT techniques, they have the ability to stop a negative impulse before it grows too powerful. When people feel their breathing rates rise in a stressful situation, for example, they can acknowledge that shift and use meditation or visualization to soothe the distress. If they feel compelled to lash out with self-directed anger due to a mistake made at work, they can use progressive muscle relaxation techniques to help gain perspective and calm. Through the use of therapy and homework, these skills can become ingrained and habitual. And in time, there are fewer distressing thoughts and behaviors to realign.
What DBT Treats
NAMI reports that most people who participate in DBT have a diagnosis of borderline personality disorder (BPD). People like this have a history of large, inexplicable emotional responses to stimuli that others can ignore. They seem to be running on a high setting all the time, and they may find it hard to keep their opinions and their impulses under control.
The emphasis on acceptance in DBT is of particular help to people like this, as they may feel consistently judged by the people around them. They may even judge themselves harshly but feel unable to change. By learning to accept the way their mind works, and accepting the help of others, people with BPD may transform their lives with DBT.
Without therapy, people with BPD are at high risk for suicidal behavior. DBT has the proven ability to assist with suicide prevention. In a study of the issue in the journal JAMA Psychiatry, researchers found that women with BPD who had DBT were half as likely to make a suicide attempt, when compared to women with BPD who did not get DBT. Acceptance and skills training is vital for this audience, researchers say, and DBT can bring that about.
Other Uses for DBT
In addition to assisting with suicide prevention, the Substance Abuse and Mental Health Services Administration suggests that DBT has the ability to assist with and/or prevent:
- Non-suicidal self-injuries
- Drug use
- Eating disorders
- Psychosocial adjustment disorders
When treatment teams provide DBT to people with these sorts of problems, they may shift their approaches and lessons just a little bit.
For example, people with drug addictions may spend a shorter time period in the relationship-building portion of DBT. They may not have long histories of poor interpersonal relationships, so they may come to trust the treatment team quicker than would someone with a long history of BPD. In addition, people with a history of drug use may need assistance with spotting drug cravings, so the skills portion of training might be recast to include information on the people, places, and things that tend to drive people to relapse to drugs.
For some people, DBT is absolutely the right therapeutic choice. They enjoy developing close relationships with counselors, and they appreciate the emphasis on real-world skills. By participating in DBT rather than another form of therapy, they may pick up the lessons they need, and they may stay enrolled in treatment for a longer period of time, when compared to people who get another form of therapy.
DBT may also be particularly useful for people with drug addictions, as suicidal behavior is often a part of the addiction spectrum.Some drugs of abuse, including cocaine and heroin, can block the brain’s normal pleasure signals. After years of abuse of these drugs, people may be physically unable to experience pleasure or joy. Their brain cells just aren’t working as well as they should. And as the depression deepens, people may be tempted to use the drugs they’ve abused to end their lives.
DBT’s emphasis on acceptance and skills could help people to spot suicidal behavior for what it is: a symptom of ongoing addiction. That could keep people engaged in treatment, working toward an active recovery. They’ll understand what’s going on, and they’ll be more likely to handle that issue with soothing techniques, instead of acting on impulses that could harm them.
It’s important to note that while some people with other disorders benefit from DBT, it’s not a proven intervention for those additional disorders. That’s a point made by researchers writing for Psychiatry (Edgmont). That means DBT might not be provided to everyone who enters a facility for care. It might not be the right approach for everyone at all times.
In general, this is a call that therapy teams make. During assessment, they determine what seems to be impacting a person who comes in for care, and they pull together a treatment approach that seems right for that person at that time.
Making DBT Work
If treatment teams do decide that DBT is the right approach, people in therapy will need to do a bit of work in order to ensure that the therapy moves as smoothly and effectively as it possibly can. That often means being mindful of the lessons learned in therapy, so they can be applied on a regular basis.
In an article in The New York Times, a man with treatment-resistant depression outlines how that might work. He went through many different therapies for his mental illness before he was provided with DBT. The treatment helped this man to overcome crippling depression that was keeping him from enjoying his life and surroundings. Even now, years into therapy, he works to apply those lessons. He identifies his feelings, he uses approaches to correct them, and he keeps reading up and studying DBT techniques. He works the program, every day, to keep his depression at bay. He’s an active part of his recovery team.
People who want to recover from addiction will need to use this active, engaged approach. They’ll need to know just what works and what doesn’t, and they’ll need to stay involved with finding solutions for the very real problems they’re facing.
People ready to get involved can start their healing journey at The Recovery Village. Treatment teams apply DBT to people in need, and they enhance that healing with holistic alternative therapies that can be a remarkable help. Interested parties can call 352.771.2700 to find out more.