June 1, 2017

The Importance of DBT in a Recovery Program

What is DBT?

The Importance of DBT

Dialectical Behaviour Therapy (DBT) is a specific type of cognitive-behavioural psychotherapy that was developed during the late 1980’s, to help better treat borderline personality disorder. Since its development, it has been used to treat a wide variety of mental disorders with varying degrees. Dialectics, refers to the synthesis of two opposites, i.e. relating to the logical discussion of ideas and opinions related to opposing forces. Ultimately, the goal of DBT is to provide patients with a comprehensive treatment plan in aid of helping them to build a life worth living. Upon successful completion of a DBT program, the patient learns to envision, articulate, pursue and sustain goals independent of their history of uncontrollable behaviour. This is achieved through the dynamic process created by DBT to promote the opposition of two goals, namely: change and acceptance. The basic premise for DBT was that people who wanted to rather be dead, did not have the necessary skills to solve the problems that were causing their profound misery and suffering, and preventing them from building a life worth living.

History and Overview of DBT

Originally developed as an application to the standard behavioural therapy treatments in the 1970’s to treat chronically suicidal individuals, DBT has since been adapted for use in the treatment of patients who suffer from either or both severe substance use disorder (SUD), and borderline personality disorder (BPD). One of the most common dual diagnoses in substance abuse and mental health practices. The co-occurrence of SUD and BPD are the causes for some major disruptions, including: severe emotional dysregulation, increased likelihood of failed treatment, and the increased risk of suicide. Included in a DBT program are explicit strategies for overcoming some of the most difficult and challenging problems that complicate the treatment of both conditions. Those include both weak treatment engagement and retention. DBT’s primary treatment includes the following five essential functions:

* Improving patient motivation to change
* Enhancing patient capabilities
* Generalising new behaviours
* Structuring the environment
* Enhancing therapist capabilities and motivation

Much like many other behavioural therapies, DBT aims to classify and target behaviour hierarchically, with the goals of: decreasing imminently life-threatening behaviours, reduce and remove behaviours that interfere with their therapy, reduce behaviours which result in quality-of-life-degrading consequences, and increase behavioural skills in general. For substance -dependant individuals, substances are the highest order of priority to be targeted by DBT due to their regular interference of a patients’ regular quality life. Substance-abuse-specific behavioural targets include aspects such as:

* Decreasing abuse of substances
* Alleviating physical discomfort associated with withdrawal and abstinence
* Diminishing urges, temptations and cravings
* Avoiding opportunities or cues for potential abuse
* Reducing behaviours that are conducive to drug or substance use and/or abuse
* Increasing community reinforcement of healthy and acceptable behaviours

Change and Acceptance

The treatment offered through DBT attempts to unite the elements of change and acceptance. Balancing the desire to eliminate all painful experiences, including living itself, with the dual effort of accepting life’s inherent and inevitable pains is the ultimate goal here. Without this synthesis, the patient’s problems seem to converge and become overwhelming. The incorporation of this synthesis of change and acceptance allows the patient to work and focus on changing one set of problems, while temporarily tolerating the pain evoked by the others. This synthesis of the change and acceptance dialectic, is the one that is the most fundamental, and is consistent with the philosophical approach found in the Twelve-Step Programs, as is expressed in the Serenity Prayer.

“God, grant me the serenity to accept the things that I cannot change, the courage to change the things I can, and the wisdom to know the difference.”

The re-shaping and adjustment of behaviours is one aspect that is vital to the healthy recovery and maintenance of any past substance user and abuser. DBT aims to bring patients mentally in-line and in-tune with the processes and importance of acceptance and change, and the roles that they play in and around their day-to-day lives. Helping patients to build a life for themselves that they can see is worth living, while aiding with the challenges faced on a recovering addicts daily road of maintenance and sustained recovery is the intended end result.