The Development of Dialectical Behavior Therapy
Dr. Linehan gained her insights through personal experience. She personally struggled with mental illness. Though not a substance abuser, she found herself trapped in a downward spiral. Shame, self-loathing and self-harm seemed inescapable for her.
She was diagnosed with schizophrenia at the age of 17. She attacked herself regularly, burning herself with cigarettes and cutting herself. She was treated with many powerful drugs but nothing changed.
Dr. Linehan describes having an epiphany. She felt transformed. She began to accept herself as she was. She referred to this as “radical acceptance.” She began to accept life the way it was, not how she thought it should be. She saw the need to change, despite –and because of– reality. Although these seemed like opposites, it started to make sense. As mentioned, this blending of opposites is called dialectics.
Dr. Linehan saw self-harming behavior in a new light. It now made sense and had a purpose. Over time she saw a need for tools to handle the feelings that led to self-harm. She developed a treatment for suicidal clients with a compulsion to injure themselves. Today these clients are often diagnosed with Borderline Personality Disorder (BPD.)
Clients with BPD suffer violent mood swings, unstable relationships, and poor self-image. They often act impulsively. There have feelings of abandonment. Many clients with BPD harm themselves. There are often multiple suicide attempts.
Dr. Lineman believes these clients can learn to deal with emotions and difficult life issues. This lessens mental anguish, and the desire to cause harm to themselves. DBT provides tools to create a productive and meaningful life.
Radical acceptance rests on letting go of the illusion of control and a willingness to notice and accept things as they are right now, without judging … Acceptance is the only way out of hell. – Dr. Marsha Linehan
Compulsive Patterns of Self-harm
Self-harm is an injury done to oneself, often by cutting or burning. It is a sign of intense feelings or anxiety. It is not the same as a suicide attempt. Acts of self-harm do not indicate a desire to end one’s life. People use it to express intense feelings or anxiety. It allows them to feel some control when everything else seems out of control.
Self-harm can be associated with Borderline Personality Disorder. It is also seen with bipolar disorder, depression, anxiety, eating disorders, substance abuse, and other conditions.
Self-harm might follow a sequence like that of drug or alcohol addiction. For example, a person may feel anxiety. The self-harm causes release. This is followed by shame, leading to anxiety. There is more self-harm. This may seem the only way to relieve the feelings.
DBT helps the client understand their triggers and change the decision-making process that leads to self-harm.
Substance Abuse is a Self-Harming Behavior
Substance abuse and addictions are like the compulsive patterns of self-harm; repetitive and harmful. In early stages, drugs and alcohol may seem to make things better. There are feel-good moments. Those good feelings wear off. The pressure builds and the cycle is repeated again and again. Eventually, it becomes a compulsion. Despite negative consequences, the person continues to use. Even a short escape from pain and discomfort seem worth the negative consequences.
Many studies show a strong connection between BPD and substance abuse.
DBT in Addiction Treatment
DBT pushes for immediate abstinence from drugs and alcohol. But it also recognizes that relapses may occur. This doesn’t mean the client can’t achieve recovery. Instead, DBT emphasizes a problem-solving approach to relapse. This includes techniques to reduce the danger of overdose or other negative consequences.
In DBT, relapse is a learning opportunity. Therapists guide the client to see what led to the substance abuse and what happened afterward. This knowledge can be applied to future situations. This is sometimes referred to as “failing well.”
My first week in treatment I didn’t think I was going to make it. I didn’t think rehab was going to work for me. But then I started to learn about DBT and things changed for me. I could understand my addiction and what I had to do if I wanted to survive. – Former Executive Client
When DBT is used in addiction treatment, the therapist and client agree to an abstinence pledge. This is for a relatively short time so it will not be overwhelming to the client. The pledge is renewed when the time ends.
Clients are taught strategies for dealing with triggers to use drugs or alcohol. This helps identify tools to cope with difficult situations ahead of time.
DBT: The Four Tenets
In DBT, therapists help clients develop practical skills for processing stress and emotion. There are four strategies for improving stress tolerance and regulating emotion:
People with substance abuse or other mental health issues spend a lot of time distracting themselves. They think about the past or worry about the future.
Mindfulness means becoming focused on the present moment. Accepting what is happening without judging the experience. Maybe even being curious about it!
If communication or conflict resolution skills are in short supply, problems increase.
DBT shows how to set limits to safeguard self and others. Clients learn to say no while maintaining their self-respect. This helps the client gain confidence. Clients learn to have fulfilling relationships through effective interactions with others.
It is difficult to maintain perspective when flooded with strong emotions. Over-reacting is common.
Emotion regulation means taking a step back. Clients learn to identify and regulate emotions without becoming overwhelmed. It also shows how to regulate emotions through simple life changes like getting enough sleep, eating a healthy diet, and avoiding drugs and alcohol.
It is difficult to cope with situations that cannot be immediately solved, such as an illness, death, job loss, etc. There is an urge to change things immediately. Using drugs or alcohol is an example of an unhealthy reaction.
Distress tolerance means moving toward acceptance: learning to tolerate the stress rather than escape from it.
Components of DBT
The four components of DBT allow several therapists to work together. This makes it easy to provide different modes of therapy. Clients receive continuous support. Phone coaching is readily available for difficult times. Together these components improve the client’s motivation to complete a treatment program. The components are:
- Skills training. The group is set up classroom style. The therapist teaches a topic. Homework is assigned. Sessions last two hours and meet two to three times per week.
- Individual therapy. One-on-one therapy addresses past and present client issues. The therapist may or may not be the same. Sessions are weekly and last about an hour.
- Phone coaching. Therapists are available to assist with issues that happen when the client is away from the treatment center. The therapist guides the client through the available options. The client makes the decision.
- Therapist consultation. Therapists attend individual or group consultation. This is a support system for the therapist. The therapist may discuss clients and their progress. They also discuss their own reactions. The support system helps the therapist care for their clients.
The Dialectical Behavior Therapy therapists at Executive Recovery Centers have been trained personally by Dr. Linehan.
Goals of DBT
- Moving from out of control behavior to being in control. The client feels miserable and their behavior is out of control. DBT pushes a stop to the substance abuse while also understanding that if a relapse should occur recovery is still possible.
- Shifting from avoiding feelings to experiencing feelings. At this point, the patient’s behavior is in control, but they continue to suffer. They may be suffering in silence. This step encourages the patient to experience their feelings.
- Building a normal life and solving common problems rather than dealing with extremes. Patients learn strategies for dealing with potential problems. There is no way to completely avoid unhappiness. The goal is to develop a balance between normal happiness and normal unhappiness.
- Transitioning from feeling disconnected to feeling a sense of connection to the world. This provides the patient with the opportunity to find deeper meaning and move towards a life that is worth living.
Benefits of DBT at Executive Recovery Center
Dialectical Behavior Therapy is evidence-based. It has helped individuals suffering from BPD, substance abuse, and eating disorders, just to name a few. It is effective in treating co-occurring disorders. There are often disorders like depression along with substance abuse.
Clients using DBT often begin to accept life as it is, not how they think it should be based on unrealistic or unearned idealism. Ones outlook on life may encounter changes changes, despite reality, due to a better ability to re-focus and re-frame personal perceptions. This blending of opposites is dialectics.
Clients learn to deal with emotions and life issues. Patterns of compulsive behavior are treated with simple but effective techniques. DBT provides tools to create productive, meaningful life.
Dialectical Behavior Therapy has been shown to work when used as part of a personalized treatment plan. Individuals learn to manage their illness. They go on to live a clean and sober life. DBT helps patients get to the root of their addiction. DBT is shown to be effective in the treatment of substance abuse, addiction, and mental health. Take part in this results-oriented treatment at Executive Recovery Centers. Our therapists have been trained by the founder of DBT. We implement the program just as she intended. The results are impressive.
Anonymous Poem from a Client:
I’ve been here 30 days, they said time will fly; it’s like I just said hello, now I’m saying goodbye.
I’ve enjoyed the classes and having group with everyone here, I hope I can survive at home without having a beer.
I’ve learned a lot here, things I didn’t know I could see; I even learned something from Adam & Adrian – DBT.
I made a lot of friends here I hope for life, but still pray for me when I am returned home with my wife.
I love all you and I wish you all the best, but just remember one day at a time, because you will be put to the test.
May God be with you, this I’ll pray, and may each one of you find your way.
Whatever Your Go-To, We Can Help
This therapeutic technique is shown to help those with addictions to all drugs: Alcohol, Opioids, Heroin, Benzodiazepines, Crack, Cocaine, Crystal Meth, Prescription Painkillers … you name it. Our program is different from the traditional 12 step programs, but don’t worry, it will fit in seamlessly with them.
Don’t wait, call today. Start your new life now.
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