What Is DBT?

Dialectical behavior therapy (DBT) is an evidence-based psychotherapy that can benefit people struggling with addiction. Psychologist Marsha Linehan originally developed DBT for people with borderline personality disorder (BPD) who struggled with suicidal thoughts. DBT has robust evidence for effectiveness for people struggling with depression, anxiety, self-harm, interpersonal distress, and addiction.

DBT is a specific form of cognitive-behavioral therapy (CBT) since it focuses on the interactions of thoughts, feelings, and behaviors. DBT is one of the “third wave” psychotherapies based on behaviorism and cognitive therapy principles, and it has become one of the most well-known evidence-based psychotherapies.

DBT focuses on how mental health problems are driven by difficulties regulating emotions. In other words, DBT helps people learn to change and control their emotions and behaviors to address their mental health and interpersonal issues.

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What Are Dialectics?

DBT is a specific form of cognitive-behavioral therapy that emphasizes the importance of “dialectics,” or opposites that can both be true. It uses a dialectical worldview that focuses on the wholeness of reality and the interrelatedness of parts of our experience. For example, DBT may focus on a behavior driven by a specific thought and then identify the overlooked pieces and ways that behavior impacts other parts of the person’s life.

In DBT, one of the most important dialectics, or sets of opposing ideas that are both true, is that people can accept themselves as worthy as they are and recognize their need to change their thoughts and behaviors to improve their quality of life.

Another important dialectic is that reality is based more on process and change, not content and structure. Thus, the main goal of DBT is to help people get more comfortable with change since the self and the world are in constant states of transition. DBT skills are divided into acceptance skills and change skills.

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Primary Skills In DBT

The primary goals of DBT are to help people navigate strong emotions, stress, and relationships in healthy and helpful ways. Four skill sets are emphasized in DBT:

  • Mindfulness
  • Distress tolerance
  • Emotion regulation
  • Interpersonal effectiveness

Importantly, these skill sets are meant to be learned and practiced in tandem with the understanding that they all relate to each other. Learning one set and not another doesn’t work as well as learning them all together.


Focusing on the present is a very effective coping strategy, and mindfulness is a process of using skills to stay grounded in the moment. Emotions like anxiety, sadness, and anger can appear when our thoughts are focused on the past, future, or hypothetical present.

Mindfulness skills help you take control of your thought processes to refocus on the present moment, which can help relieve distressing emotions. DBT emphasizes the importance of the wise mind that balances the reasonable mind, driven by logic, and the emotional mind, driven by emotions. DBT uses this concept to describe a person’s thoughts and behaviors.

Distress Tolerance

Sometimes, we still experience emotional or physical distress, pain, or suffering, no matter which coping skills we use. The goal of recovery from addiction and mental health problems is not to prevent all suffering but instead to be able to cope with pain and suffering without turning to alcohol, drugs, or other unhealthy strategies.

DBT helps people learn new ways to tolerate distress, which can help them stay sober even when life is hard. DBT helps people understand their bodily reactions to stress, accept the reality of difficult emotions, and learn healthy ways to self-soothe and get comfortable being uncomfortable.

Emotion Regulation

We all experience a range of emotions, and sometimes we can get overwhelmed with intense or mixed emotions. Part of effective coping involves regulating your own emotional state, and there are many strategies for building that skill.

Emotion regulation skills are an integral part of DBT and are critically important for people in addiction recovery. DBT builds emotion regulation skills by improving emotional awareness, changing emotional responses with specific strategies, and reducing vulnerability to being driven purely by the emotional mind.

Interpersonal Effectiveness

Many people in recovery report relationship problems, and many have a long history of unhealthy or abusive relationships. Since relationship distress is a risk factor for recovery setbacks or relapse, improving interpersonal effectiveness can improve addiction recovery and quality of life.

DBT focuses on teaching healthy interpersonal skills, including boundaries and communication. DBT skills for interpersonal effectiveness include clarifying priorities, relationship effectiveness, and self-respect effectiveness.

Is DBT A Good Fit For You?

DBT is particularly helpful for people struggling with addiction and borderline personality disorder, and it is also a good fit for people with anxiety, depression, eating disorders, impulsivity, anger management deficits, and turbulent relationships.

If you think DBT might be a good fit, ask yourself these questions.

  • Have you been diagnosed with borderline personality disorder?
  • Have you struggled with thoughts of ending your life?
  • Do you often find yourself in toxic or abusive relationships?
  • Do you find it hard to deal with emotions without alcohol or drugs? Do you avoid your thoughts and feelings?
  • Do you have trouble sitting with strong or unpleasant emotions?
  • Do you sometimes feel like emotions drive your choices more than your thoughtful decisions?

If you answered yes to some or all of these, DBT could be a good fit for your long-term recovery.

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DBT For Addiction Treatment

People with alcohol and drug use disorders usually have comorbidities or additional mental health problems that interact with their substance use. Recovery from alcohol and drug use disorders is influenced by other mental health problems and social stressors; however, research shows that DBT can decrease substance abuse and increase the ability to cope with mental health problems and social stressors.

From a DBT perspective, substance use can be viewed as ineffective coping, a consequence of distress intolerance, and potentially a form of self-harm. Many people who struggle with addiction have underdeveloped emotional control and deficits in distress tolerance. Alcohol and drugs are often used to numb, distract, or avoid difficult emotions.

The main goal of addiction treatment and recovery is to improve coping skills, and DBT is an excellent option for learning ways to navigate life without relying on alcohol or drugs.

Many inpatient treatment centers offer DBT in their treatment programs, and DBT treatment plans often consist of individual counseling and group sessions. For more information on inpatient treatment options, contact a treatment provider today.

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