Finding Balance Through Dialectical Behavior Therapy (DBT)

The 4 Modules of Dialectical Behavior Therapy

In the classroom-like setting of a DBT group, clients learn very specific subject matter. While there are several texts on the topic, most facilitators work from the first or second edition of Dr. Linehan’s original DBT workbook.⁴ As your therapist guides you through it, you’ll cover four distinct modules.

Note: Although these textbooks are readily available, clients are advised against beginning this work on their own. Even with proper supervision, this therapy can be very challenging and even triggering. If you’d like to begin going through Dr. Linehan’s assignments in depth, it’s very important that you do so in the context of a DBT group.

Mindfulness

Mindfulness teaches you to be present in the moment, accepting reality as it is. As simple as this sounds, it can be a powerful practice with wide-reaching impacts. Research has found that mindfulness techniques can reduce stress,⁵ and may even alleviate some symptoms of depression and anxiety. During this module, DBT clients may practice meditation, breathing exercises, and other strategies that help them stay connected to their emotional experience.

Emotion Regulation

Some people are more emotionally sensitive than others. That’s neither good nor bad. In some circumstances, it can be an extremely positive thing, allowing you to feel joy or excitement more deeply than others might. In difficult situations, however, it can make you more vulnerable to emotional distress. This may lead to unhealthy coping mechanisms, which can be especially dangerous for people healing from substance use disorders.

People with a history of substance use sometimes also struggle with emotion regulation⁶ caused by neurochemical imbalances. These symptoms may or may not be alleviated by medical detox. Even after your body begins to heal, you might find that your emotional experience is different than it was before you began recovery.

Learning to regulate your emotions can help you navigate the natural ups and downs of life, without getting lost in any one experience. This can be extremely important as you work through your triggers and develop healthier responses to various stimuli.

Interpersonal Effectiveness

Any mental health diagnosis can have an impact on your relationships. This is extremely common for people with substance use disorders. As you begin recovery, you will likely start the hard work of healing those relationships, while also building new ones that support a more sustainable lifestyle.

The skills you learn in this module will help you strike a balance in your interactions with other people. You’ll find ways to interrupt unhealthy dynamics by asking for what you need, setting clear boundaries, and stepping away when that’s the best possible choice. In a healthy relationship, people don’t compete to see whose needs are more important. DBT offers practical communication strategies that empower you to respect yourself and the people around you at the same time.

Distress Tolerance

We all encounter hardship. Life can get better, and it can get easier, but it will never be perfect. Even when you make the best possible choices, you may still encounter difficult circumstances that are outside of your control. Distress tolerance teaches you to approach these situations mindfully, without engaging in self-destructive behavior.

These tactics can be especially helpful for people who are healing from trauma. By centering yourself in your body, you can sometimes interrupt intrusive thoughts and flashbacks. DBT at Futures Mental Health Program, for example, is designed to help clients through stressful experiences. This treatment approach “focuses on the mind, body, and ability to utilize skills during challenging times.” These strategies can be helpful not only for people with substance use disorders, but for those healing from a wide variety of other diagnoses.

Who Can Benefit From Dialectical Behavior Therapy?

While DBT isn’t right for everyone, it can help clients with many different emotional experiences. Research has found that it’s especially beneficial for people with certain diagnoses.

Borderline Personality Disorder (BPD)

This treatment approach was originally developed for people with Borderline Personality Disorder (BPD). While it has been adapted for use with many additional diagnoses, its subject matter is particularly relevant to this population.

BPD is a highly stigmatized diagnosis, and it can be difficult to find the help you need and deserve. Even the act of researching your symptoms can sometimes be counterproductive, due to an overabundance of misinformation. It’s important to choose your sources wisely, and connect with professionals who specialize in working with people like you.

It’s also important to note that BPD is strongly associated with PTSD and complex PTSD (c-PTSD).⁷ Even now, researchers sometimes struggle to distinguish between the two diagnoses. One study found that “over 71% of those with BPD had trauma.”⁸ Despite the associated stigma, you are not to blame for your emotional experience. That’s true of any diagnosis. DBT acknowledges those with BPD as whole people, with unique needs, goals, and values. You, like everyone, have the right to heal.

PTSD and Complex PTSD (c-PTSD)

Perhaps because of its similarities to borderline personality disorder, DBT is also a very effective treatment for PTSD.⁹ Clients who attend rehab to heal from trauma, or to heal from co-occurring disorders, may benefit from this type of treatment.

Mindfulness, in particular, can be an extremely effective way to work through dissociative episodes. Learning to accept and regulate emotions may also help clients navigate triggers and either avoid or safely weather flashbacks.

Dr. Monika Kolodziej, Program Director of McLean Fernside, says,

“One of the first steps to recovery from trauma is to be safe today. So teaching skills related to mindfulness, interpersonal communication, self-care, [and] having a good routine every day is a form of trauma-informed treatment.”

Substance Use Disorders

Substance use disorders are often related to trauma. In some cases, clients turn to substance use due to pre-existing PTSD; in other cases, the act of substance use causes clients to experience new trauma. As Dr. Kolodziej explains:

“Providing trauma-informed care is very important. And what that means is being sensitive to the possibility that someone who comes in for treatment for substance use issues also has a trauma history.
We know that from many years of research, and by virtue of knowing what severe substance use entails.”

Because of these similarities, clients in recovery from substance use may similarly benefit from DBT to clients with PTSD.

Even if you don’t have a history of trauma, substance use may cause neurochemical imbalances,¹⁰ effectively dysregulating your reward system. This can have a drastic impact on your behavior and your ability to tolerate extreme emotions. Whatever your past experience has been, your time in rehab is an opportunity to learn or relearn healthy coping mechanisms. By practicing these skills in a protected environment, you may become better equipped to use them after you complete an inpatient program.

Suicidal Tendencies

Clients with a wide variety of mental health concerns may experience suicidal tendencies. According to one study, it’s more effective to treat suicidality with a combination of medical therapy and DBT¹¹ than it is to use medical therapy alone. While more research is needed, this suggests that DBT may be helpful for people with other diagnoses as well.

Because this type of therapy teaches clients practical skills they can use long after completing rehab, it may be especially helpful for people with chronic conditions, such as treatment-resistant depression.

Dialectical Behavior Therapy for Ongoing Mental Health

If DBT works well for you, it can become a part of your daily life even after you complete a rehab program. It’s not uncommon for clients to return to DBT groups more than once, going over the curriculum from a fresh perspective. And whether or not you join a group a second time, there are many published resources—such as flashcards, workbooks, and textbooks—that you can simply keep on hand as reference materials.

Dialectical behavior therapy isn’t the right type of therapy for everyone. And even if it does meet some of your needs, it’s not a substitute for other forms of treatment, like medical detox. Joining a group is helpful for many people, but not all groups pair their clients with individual therapists. As productive as this approach can be, you’re likely to get the most benefit from doing DBT in combination with other modalities.

Remember that dialectical behavior therapy, like recovery itself, is a learning process. This is a set of long-term, practical strategies that can help you respond to a long-term emotional experience. It may take some time for you to see the benefits of DBT in your daily life. Fortunately, its lessons in mindfulness may help you learn to trust the process.

If you think this type of treatment might be the right fit for you, you can visit our list of rehabs that offer dialectical behavior therapy.

Frequently Asked Questions About Dialectical Behavior Therapy (DBT)