Our thinking patterns and habitual behaviors influence how we respond to situations and people. Before you can start to change the way you interact with the world, you need to learn skills that break down previously held beliefs that may no longer be helpful or healthy. Dialectic behavioral therapy (DBT) is one treatment you can use to alter your approach to recovery because it teaches you to look at your reactions in a new way. 

According to a 2008 research paper from the journal Addiction Science & Clinical Practice, multiple clinical trials concluded that DBT techniques altered to treat substance use disorder (SUD) “decreased substance abuse in patients with a borderline personality disorder.” They determined DBT could help anyone with severe co-occurring conditions that did not improve after using other evidence-based therapies.

Dialectical Behavior Therapy (DBT)


What is DBT?

DBT is an evidence-based psychotherapy that focuses on changing how you regulate emotions, react to distress, communicate, and connect with others. Therapists can use DBT in either one-on-one or group sessions. Initially, DBT was created by Dr. Marsha Linehan in the late 1980s as a form of cognitive-behavioral therapy (CBT) to treat borderline personality disorder (BPD), and it is currently still the only empirically supported therapy for treating BPD. As you go through DBT sessions, you will learn how to control your responses and challenge feelings and ideas in a positive way.

Opposite Action

One skill that you will learn in DBT is called “opposite action,” which consists of consciously acting in a way that is counter to how you feel in a given moment. You can use this to overcome negative behavioral habits and regulate your emotions. Below are several examples of how you might use opposite actions to respond to various common emotions. 

  • Anger: When you are angry, if you feel like yelling, attacking, or blaming someone, remove yourself from the situation or purposefully relax your body through meditation techniques and deep breathing exercises. 
  • Fear: You may want to avoid what you fear, but instead, using the opposite action skill, you would expose yourself to that fear in a controlled way. 
  • Shame: Sometimes, people feel shame that is not based on objective facts, and shame can keep them from interacting with others. One way to overcome this feeling is ensuring you face the fear and feelings of shame by reaching out and making social connections. 
  • Guilt: There are many reasons people can feel guilty that have no basis in reality. If guilt over something that was not in your control keeps you from doing something, with the opposite action, you would approach that situation in a controlled way and not avoid it. 

“Both-And” Thinking

Many people in recovery have a black and white, “either-or” way of thinking about behaviors, emotions, and relationships. With DBT, your therapist will help you adapt your way of thinking to “both-and” thinking. Instead of being forced to accept or choose between two sets of beliefs, you can instead combine aspects of both or introduce yourself to entirely new belief systems. Open discussions with your therapist can help you find unique and healthier ways of looking at your past and current decisions, behaviors, feelings, and thoughts.

4 Primary Focus Areas of DBT

There are four primary areas of focus in DBT. Your therapist will help you develop skills in these areas to manage chronic stress and cope better with subjects and emotions that are uncomfortable. 

  • Mindfulness: you will learn exercises and skills that will help you stay present in the moment.
  • Distress Tolerance: you will discover ways to face distressing emotions or situations, process them, and respond in a more stable way. 
  • Emotion Regulation: intense emotions can become overwhelming. You will learn how to regulate them so they will not interfere with your life. 
  • Interpersonal Effectiveness: you will learn tools for communicating effectively while maintaining and respecting personal boundaries. 

All four of these areas are especially useful for people with SUD because there is a connection between the ability to process and handle stress and successful long-term sobriety. DBT is helpful for anyone willing to dedicate their time and effort. If you put in the work over time, you will gain the skills needed to regulate your emotional responses, cope with stress, and communicate effectively. 

Who Would Benefit Most From DBT?

The person who created DBT designed this therapy to treat borderline personality disorder (BPD). However, there are plenty of other emotional and mental health conditions that can benefit from this treatment, including the following. 

  • Substance use disorder (SUD)
  • Eating disorders like bulimia, anorexia, and binge-eating
  • Depression
  • Bipolar disorder
  • Post-traumatic stress disorder (PTSD)

What sets DBT apart from other psychotherapies is the emphasis put on regulating emotions, improving social and communication skills, learning to cope with painful or distressing situations, and practicing mindfulness. Your therapist will use behavioral theory to explore your current mental and emotional wellbeing and find healthier patterns and routines to strengthen your recovery.

We are here for you

Moving forward in recovery means recognizing negative habits and beliefs and replacing them with something that will make you feel and act more positively. However, this is not an easy process, and it requires dedication. Your therapist can use DBT to help you understand how to accept things that are uncomfortable but necessary and guide you towards making changes in other areas. At White House Recovery and Detox, we believe the Serenity Prayer is a perfect example of DBT thought reframing. "God, grant me the serenity to accept the things I cannot change, the courage to change the things I can, and the wisdom to know the difference."