Dialectical behavioural therapy

Dialectical behaviour therapy, or DBT, is a highly effective treatment commonly used in addiction rehab programmes to help individuals overcome their substance use disorders. DBT relies on a unique blend of cognitive-behavioural and mindfulness techniques to help you gain greater control over your thoughts and behaviours. Through the use of DBT, you can learn how to better regulate emotions, develop healthier coping strategies for stress and cravings and ultimately improve the overall quality of your life.

DBT therapy notes

What is DBT?

DBT is a type of talking therapy that aims to help those with addiction who feel their emotions deeply. It is a specific form of cognitive behavioural therapy (CBT) developed by University of Washington (USA) psychologist Marsha Linehan in the 1980s. Initially, Linehan developed DBT as a means of helping patients with borderline personality disorders to better 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 self-harming behaviours. 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. These goals also tie in with addiction recovery as so many individuals turn to substances as a way to cope with things they cannot change.

At the heart of DBT are the concepts of dialectics and acceptance. Dialectics refer to the idea that opposing elements can exist simultaneously in one system without destroying each other. Through the use of dialectics, DBT practitioners help individuals learn how to balance these opposing forces within themselves and in their external environments. The goal is not to eliminate negative emotions or experiences completely, but rather to develop skills that allow individuals to manage them more effectively. For example, when treating addiction with DBT you will learn to accept that stress is a part of life and can exist within you, without having the need to consume substances as a way to manage this stress.

The four modules of DBT

There are four main modules of DBT, allowing you to take the process step by step and focus your attention on one task at a time. The four modules include mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness all of which are crucial in addiction recovery.


Mindfulness is one of the foundational concepts of DBT. It refers to the practice of being present in the moment and paying close attention to your thoughts, feelings and experiences without judgement. This skill can help you better understand yourself and your emotions so that you can more effectively regulate them in difficult moments when addiction cravings or triggers arise.

Distress tolerance

Distress tolerance focuses on helping you to deal with difficult emotions and situations in healthier ways, outside of substance use. This involves recognising your emotional triggers and developing techniques for coping with intense feelings before they become overwhelming. Strategies for distress tolerance could include deep breathing exercises or mindful meditation practices as a means to avoid addiction relapse.

Emotion regulation

Emotion regulation helps you to develop a blueprint for understanding and managing your emotions so that you can feel more balanced in both mind and body. This module may require you to challenge unrealistic thoughts or reframe emotional experiences in a positive light. This allows you to step out of your addiction past and focus on a newer version of yourself.

Interpersonal effectiveness

Interpersonal effectiveness focuses on improving your communication skills and helps you to meet your needs while maintaining healthy relationships with others. Techniques like assertiveness training or active listening can help you to recognise common communication pitfalls that may inhibit honest conversations with others as well as show respect for their perspectives. By mastering these skills, you can improve your personal relationships that may have deteriorated as a result of your addiction.

Why is DBT effective in addiction treatment?

DBT’s effectiveness for substance and behavioural addiction treatment lies in its ability to help you gain control over your own thought patterns, rather than having your addiction lead the way. It allows you to pinpoint destructive thought patterns and use techniques learned in the four modules to channel your emotions in a positive direction.

This essentially prevents you from turning to substances or addictive behaviour as a way to cope with emotional turmoil. DBT can help you to stay focused on recovery, even when you are facing difficult emotions or urges related to your addictive behaviour.

DBT versus other therapies

Cognitive behavioural therapy (CBT) is an umbrella therapy under which DBT falls. Both CBT and DBT focus on helping you to change distressing thoughts or behaviours. These therapies do, however, have some key differences. These include:

  • CBT is focused on logic and rationale
  • CBT attempts to redirect negative thoughts
  • CBT is goal-oriented
  • DBT uses mindfulness techniques to accept the present situation
  • DBT aims to acknowledge and manage emotions
  • while you will work towards goals in DBT, it is not as rigid
  • DBT places high importance on relationships, including your DBT practitioner who you will work with collaboratively

Both CBT and DBT have their place in addiction treatment and have a valuable role to play in helping people overcome substance use disorders or behavioural or mental disorders. Depending on your situation and your individual needs, you may find that one is better suited to you, or you may use both CBT and DBT in conjunction with each other.

How is DBT combined with other therapies?

DBT is combined with several other addiction therapies at Liberty House, including a 12-step programme, group work and family therapy. These therapies all work to complement each other and support you in your recovery.

A great example of this is the amalgamation of DBT and the 12-step programme, as the core principles of DBT intersect with the main philosophies of 12-step work in many ways. Mindfulness is often viewed as the basis of DBT because the remaining three modules are built on it. Similarly, the 12-step philosophy includes three states of mind that are developed as you go through the steps. It encourages you to take an active role in always being mindful of your own state of mind.

Combining a number of different therapies during rehab treatment helps to produce optimal results for every single one of our clients. Ultimately, implementing a multimodal treatment approach when treating addiction not only improves clinical outcomes but also gives you more opportunities for recovery.

Frequently asked questions

What is DBT used to treat?
DBT has proven beneficial in treating a wide range of disorders, including not only substance addictions, but also eating disorders, obsessive-compulsive disorders, mental health disorders like anxiety, depression and PTSD, and borderline personality disorders. This means that the co-occurring issues that we so often see alongside addiction are also addressed during DBT sessions.
Will DBT work for me?
It is important to remember that everyone experiences addiction therapy differently – what resonates with one person may have no effect on another. DBT will likely work for you if you struggle to cope with your emotions and want to find a healthier way to manage stress. If you are ready to focus on positive changes and look to the present and future, rather than your past, DBT is likely to be effective.
How long does DBT take?
When you embark on DBT sessions during addiction treatment, you and your therapist will agree upon a target completion date, say three or six months down the line. This is generally open-ended and flexible, and will constantly be re-evaluated depending on your progress. Some of our clients complete DBT in a few months while others could continue for a year or longer after rehab.