Dialectical Behaviour Therapy (DBT)

Dialectical behaviour therapy, or DBT, is a flexible talking therapy designed to help people who are struggling with very strong feelings. Originally created for people with borderline personality disorder, DBT has proven effective for addiction because many people drink, use drugs, or engage in addictive behaviours to cope with emotions they don’t know how to manage. In rehab treatment, DBT puts you back in charge of your emotions, giving you the time and techniques needed to stay in control and on the path to recovery.

dbt couple

What is dialectical behaviour therapy?

DBT is a form of cognitive-behavioural therapy with a focus on mindfulness, relationships, and emotion management. The word “dialectical” refers to finding balance between opposing ideas, like accepting yourself as you are while also working to change in positive ways. In DBT therapy for addiction recovery, this means that it’s okay to acknowledge your current struggles with drugs, alcohol, or addictive behaviours, without giving up on getting better.

What are the four components of dialectical behaviour therapy?

DBT teaches four sets of skills that all work together as a system. Here is what each component covers:

Mindfulness

Mindfulness means paying attention to the present moment without any judgment. When you’re struggling with addiction, your mind is often stuck in the past (regretting what you’ve done) or the future (worrying about what might happen). Focusing on this moment brings you back to right now.

DBT teaches mindfulness exercises you can use when substance cravings hit or your emotions spike. Instead of immediately reacting, being mindful means you notice what you’re feeling, where you feel it in your body, and what thoughts are running through your head. This pause gives you space to choose your response.

Distress tolerance

This skill is all about coping when things seem at their worst, so you don’t create bigger problems through your reactions. This is so important because when you’re at your lowest, your instinct might be to drink, use drugs, gamble, or engage in other behaviours that provide temporary relief but will only cause more damage.

DBT gives you alternative ways for getting through even the most difficult moments. These can include a variety of simple but effective things, like intense exercise or even holding ice cubes to distract yourself. The goal isn’t really to feel good, but just to get through the moment without relapsing.

Emotional regulation

This component teaches you to understand and manage how you react emotionally. Many people with drug or alcohol addiction struggle to identify what they’re actually feeling. You might just know you feel “bad” without being able to name whether that’s anger, sadness, or fear.

DBT helps you understand your feelings and take the sharp edges off them. You discover which situations trigger the strongest reactions, and with new and more measured responses, your emotions will start to become less overwhelming.

Interpersonal effectiveness

Alcohol and drug addiction devastate relationships. You may have lost the trust of your family, hurt people you care about, or never learned healthy ways of dealing with other people in the first place. Interpersonal effectiveness teaches you how to communicate, ask for what you need, set boundaries, and handle conflict without damaging important connections.

These skills are crucial in recovery because isolation and relationship stress are major relapse triggers. Better relationships mean a stronger support system, which can be a real difference maker in recovery.

Why is dialectical behaviour therapy used in addiction rehab?

If you can’t handle strong feelings, you are most likely to keep using substances or behaviours to regulate them for you. Traditional addiction counselling might tell you to avoid triggers and practice self-care. That is helpful, but it doesn’t teach you what to do when you’re already in crisis moments, and the urge to relapse is overwhelming. DBT gives you actual techniques to use in those moments.

DBT therapy also works well for people with co-occurring mental health conditions. If you have borderline personality disorder, complex trauma, depression with unstable emotions, or anxiety alongside your substance or behavioural addiction, DBT can help with both issues simultaneously.

DBT’s structured approach also suits the practical nature of effective addiction treatment, as you learn usable skills rather than just talk about your problems. Having a technique that you can use immediately for relapse prevention gives you a safety net even while you are still working through the deeper issues.

How is DBT delivered in rehab settings?

DBT in addiction treatment typically combines different formats to give you the full benefit of the approach:

Individual DBT therapy

In these one-on-one DBT sessions, your therapist will help you apply proven DBT skills to your specific situation. You will be able to work through issues too personal or complex for a group setting, and troubleshoot when techniques aren’t working as well as you hoped.

DBT group therapy

DBT group therapy for addiction recovery can show you that you’re not the only one who struggles with their emotions. Each session, your therapist will introduce new DBT skills, and the group will discuss how to apply them. You may also be set homework assignments between sessions and report back on what worked or didn’t.

DBT integrated into broader rehab programmes

DBT works best when woven throughout your treatment rather than existing as a separate weekly session. In complete treatment programmes, you may attend DBT groups several times per week, have individual DBT sessions, and practice skills during other activities. This integration can also continue through aftercare, with outpatient DBT group therapy helping you maintain skills after residential rehab programmes are finished.

What to look for in a rehab centre offering DBT

Not all programmes that claim to offer DBT actually deliver comprehensive dialectical behaviour therapy. You need to look for centres where therapists are specifically trained in DBT, and ask whether the programme includes all four components: mindfulness, distress tolerance, emotional regulation, and relationship skills.

You should also check if they offer both individual DBT sessions and skills groups. DBT is designed to include both formats, and you get less benefit from only one or the other. Find out how long the DBT component lasts, as learning skills that matter can take time. A couple of introductory sessions in a 28-day package won’t give you what you need, so look for rehab centres where DBT continues throughout your stay and possibly into aftercare.

Getting the right support

If overwhelming emotions are driving your substance abuse or compulsive behaviours, DBT could help you. Recovery.org can explain which programmes offer proper DBT training, how different approaches work, and how to get started with treatment. Contact us today, and we’ll help you find the right rehab centre and programme. With proper support and proven therapies like DBT, recovery and a new life are waiting.

Frequently Asked Questions

Who is DBT designed for?

DBT was originally created for people with borderline personality disorder who experienced unstable emotions and self-destructive behaviours. It has since been adapted for anyone who struggles with managing their emotions, including people with addictions, eating disorders, self-harming behaviours, or severe trauma.

What are the three C’s of DBT?

The three C’s of DBT are Catching, Checking, and Changing. This means noticing the moment an unhelpful thought or emotion shows up (Catching), taking a moment to question whether it is accurate or useful (Checking), and then choosing a healthier, more balanced response (Changing).

Is CBT or DBT more effective for treating substance misuse?

It depends on your situation. CBT works well for most people with addiction and has strong research evidence. DBT is particularly effective if you also struggle with very strong feelings, borderline personality disorder, self-harm, or complex trauma. Many people benefit from both approaches, as CBT helps you challenge the thoughts driving your behaviours, and DBT gives you skills for managing the emotions underneath.