Dialectical Behavioural Treatment (DBT)

Among the many psychotherapeutic treatments offered at MHA addiction centres is a treatment known as dialectical behavioural treatment (DBT). We are thrilled to be able to tell our clients that our treatment centres now offer DBT to those patients for whom it is appropriate. DBT is proving to be a very effective treatment for certain kinds of patients who need help avoiding complete relapse once formal treatment has concluded.

DBT is a specific form of cognitive behavioural therapy (CBT) developed by University of Washington (USA) psychologist Marsha Linehan in the late 1980s. Linehan developed DBT as a means of helping patients with borderline personality disorder more easily deal with their reactions to certain kinds of psychosocial stimuli.

More specifically, Linehan employed DBT to treat patients suffering from chronic suicidal thoughts. Many of them had already made multiple suicide attempts and were known to engage in behaviours considered self-harming. Her goal was to help patients learn to accept things they could not change while at the same time finding a way to create a life they found worth living.

Since its development, DBT has proven very helpful for other conditions. It is a therapy that is now being used effectively to treat substance abuse and addiction, borderline personality disorder (BPD), depression, anxiety, obsessive-compulsive disorder (OCD), and other mental disorders involving interpersonal struggles.

Three main characteristics differentiate DBT from other kinds of behavioural therapies:

1. DBT Is Support-Based

DBT is designed to be supportive in every way. It helps patients identify their strengths, then uses those strengths to develop strategies to avoid relapse. Combining strengths and the individual successes achieved along the way helps the recovering addict feel good about what is happening.

2. DBT Is Cognitive-Based

A cognitive-based therapy identifies various thoughts, assumptions, emotions, and beliefs that tend to make it harder for a person to overcome his or her problems. Such identification allows patients to better understand who they are and how they think, so the strategies for avoiding negatives can be developed.

3. DBT Is Collaborative

Lastly, DBT is a collaborative therapy in that it encourages patients and therapists to work things out together. It is not therapy in which the patient speaks endlessly while the therapist does little more than write down notes. Rather, therapists and patients work together, interactively, to solve problems.

DBT’s Four Modules

One of the most exciting things about DBT from our perspective here at MHA is the fact that it is a programme divided into four modules. The module approach makes it possible to focus attention on one particular task at a time. This makes the therapy more easily targeted to the individual rather than simply placing all the patients in a given rehab centre into the same, broad-based treatment environment.

The four modules of DBT are:

1. Mindfulness

Linehan created DBT with mindfulness being one of its core elements. It is the first module because it is the foundation on which the other three are built. The principle of mindfulness is one of using various meditative exercises to teach patients to pay close attention to the present – i.e. living in the moment – while fully embracing one’s thoughts and emotions. There are two sets of skills learned in the mindfulness module: what (observing the current environment) and how (maintaining focus even when the current environment is not positive).

2. Distress Tolerance

The second module is known as distress tolerance. It naturally flows from mindfulness in that it uses the what and how skills to teach patients how to deal with stressful situations without falling back on previously negative behaviours. Distress tolerance teaches patients how to work through stressful situations through a variety of strategies to keep the mind focused on the positive.

3. Emotion Regulation

The third module is known as emotion regulation. This should be pretty easy to understand. The skills learned during emotion regulation help patients keep their emotions in check rather than allowing them to dictate the course of action. This is of particular importance to recovering addicts who are prone to temptations by way of their emotions.

4. Interpersonal Effectiveness

The fourth and final module is interpersonal effectiveness. In this module, patients learn skills that will govern their interpersonal relationships. They learn to identify their own needs and ask for help in meeting them. They learn to say no to people, circumstances, and behaviours that would be negative. They learn to positively and effectively handle interpersonal conflicts with others.