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Dialectical Behavior Therapy

In order to help you overcome your addiction, your therapist will spend some time getting to know you and trying to understand how your mind works and what goals you might have in life.

While some people have relatively straightforward addiction issues that can be treated with comparatively straightforward addiction therapies, there are some people who have underlying mental health issues that serve to feed and nourish the addictions they’ve developed. These people might need specialized versions of therapy, specifically designed to address these important, significant mental health issues.

People with borderline personality disorder, for example, might not succeed in a standard therapy programs for addiction. Instead, their therapists might provide them with a tailored program consisting of dialectical behavior therapy. It might sound frightening or complicated, but if you’re provided with this therapy, you might find that it allows you to truly understand your mental health issue and gain control, possibly for the very first time in your life.

Could It Be Me?

While only a mental health professional can truly diagnose borderline personality disorder, there are some red flags that might indicate that the condition could be impacting your life. Answering “yes” to questions like this should prompt you to talk to your therapist a bit further about the condition:

  • I idealize others when I meet them, but later I feel as though these people don’t really care about me.
  • I have a hard time controlling my anger.
  • I feel sudden shifts in the way I view myself and others.
  • I am always afraid that others will leave me.
  • Many of my romantic relationships have been intense, but they’ve also been unstable.
  • I sometimes engage in reckless behavior, such as binge eating, gambling or having sex with strangers.
  • Sometimes, I think suicide is a good option for me.

Source: Psych Central

Understanding Borderline Personality Disorder

While dialectical behavior therapy could be helpful for almost anyone, it is specifically designed to help people who have borderline personality disorder (BPD). This means many people get this therapy every year in their addiction treatment programs.

According to the National Institute of Mental Health, about 1.6 percent of American adults have BPD in a given year. Many of these people develop subsequent addictions as they attempt to cope with this mental illness.

BPD can cause you to feel intensely emotional. In fact, it’s likely that your friends and family members often accuse you of being high strung, hard to talk to, or just “touchy.” It’s hard for you to trust people, because you often believe that people don’t really understand you. It’s deeply isolating to live like this, day in and day out, and substance use might be a method you use to calm your mind and reduce the anxiety you feel on a daily basis.

In addition, BPD is associated with reckless behavior. As your emotions shift, you might become intensely happy and you might celebrate with substances. Or, conversely, you might make impulsive decisions to quit your job or move to a new community, and then you turn to substances to help numb the pain of that poor decision.

In a standard addiction therapy session, the therapist pushes the patient to accept poor decisions made in the past and change the way the person thinks and behaves in the future. While this might be helpful for some people, to you, this might seem like an attack. Therapists who push you to change might not accept you as you are now, and this could make you feel extremely angry or isolated. Dialectical behavior therapy uses a different approach that you might find more acceptable.

The Founder of Dialectical Behavior Therapy

This form of therapy was created in the 1980s and 1990s by Marsha Linehan and other researchers at the University of Washington. Dr. Linehan realized that her BPD patients felt attacked and threatened in standard therapy, causing them to shut down or leave therapy altogether. This new form of therapy, Dr. Linehan felt, would allow patients to accept life as it is while understanding that life should change in order to improve. Patients would learn to live in the moment, while also looking toward the future. By combining Eastern medicine with concepts from standard psychology, Dr. Linehan felt she could reach her patients.

Source: The New York Times

Beginning With Mindfulness

In our modern culture, people are praised for the ability to do two or more things at the same time.

Those who can multitask are seen as efficient and more successful. While this might be true in the business world, doing two things at once can be incredibly damaging in personal relationships. It can also be hard on mental health. Consider this situation: Your spouse is telling you how loved you are, right now, in this moment. Instead of listening to the words, however, your mind is thinking of all of the betrayals you’ve felt in the past week and all of the hurt you’ve experienced. Instead of feeling loved, you feel angry and isolated. You’ve lost the ability to focus on the positive things happening in your life right now. This is just one way in which multitasking can be dangerous.

In an article produced by the Linehan Institute, the author writes, “Whatever your attention is on, that’s what life is for you at any given moment.”

Mindfulness techniques attempt to help you to focus on the moment you’re living right now and find the good in that moment. In therapy, you learn how to focus your mind on the sensations you are experiencing in the moment. You might call this staying present, or you might even call it meditation. In essence, you’re attempting to block out memories of the past or worries about the future, and you’re staying in one moment, right now. Next, you’ll learn how to stay in the moment without judging it. You will observe it objectively, without allowing your fears or your emotions to take over.

A Mindfulness Exercise

Try this quick exercise in order to experience mindfulness on your own:

  1. Sit with your feet on the floor and your back straight.
  2. Watch your thoughts as they pass. Don’t try to push specific thoughts or eliminate others. Just watch them go by.
  3. If your mind wanders and you notice you’re planning the future, stuck on one thought or beginning to feel anxious, pull your mind back to watching thoughts.
  4. When five minutes have passed, take a deep breath and congratulate yourself on completing the exercise.

Source: the Linehan Institute

Understanding Therapy

In your one-on-one sessions with a therapist, you might learn more about mindfulness and how it can be applied in your life. Your sessions might also revolve around teaching you how to tolerate disappointment and distress. In the past, when you’ve been faced with a challenging situation, you might have felt your emotions slide out of control, forcing you to feel angry, hostile or even violent toward yourself or others. Distress tolerance techniques might include mindfulness, allowing you to observe the situation without becoming swept away by emotion, but your therapist might also give you other techniques to try.

Some therapists encourage their patients to soothe themselves using a technique called IMPROVE:

  • Imagery: Imagine a positive outcome for this situation.
  • Meaning: Find the deeper meaning in the feelings you have.
  • Prayer: Pray, meditate or chant.
  • Relaxation: Breathe deeply and soothe yourself.
  • One focus: Stay in the present and concentrate what you are doing now.
  • Vacation (brief): Step away for a short period of time to collect yourself.
  • Encouragement: Tell yourself you’ll make it through this.

In each session, you’ll learn more about regulating your emotions, living in the moment and accepting yourself as you are. You’ll also learn more about how you can make positive changes in life. Between sessions, you’ll keep a daily record of how you’re feeling and your quality of life. Those records will help your therapist understand more about the skills you’ve learned, and the skills you might need to know more about.

Coaching Calls

If you’re going through therapy in an inpatient program, you’ll have access to staff all of the time, 24 hours per day. But, if you’re using an outpatient program, you might be living at home, away from your therapist, and sometimes you might need help outside of your therapy sessions. Coaching calls can help. If you feel as though you’re about to make a mistake and do something rash or harmful to your overall recovery, you’ll call your therapist and talk it over together. This can be a lifeline that can keep you moving forward with your therapy, no matter what happens.

The Power of Groups

Working with your therapist might be both helpful and powerful, but it doesn’t allow you to practice your skills in the real world. After all, your therapist is there to support you and root for you, and not everyone in the outside world is so focused on you and your recovery. You’ll need to practice working with real people, so you’ll understand how to apply your skills in these somewhat unpredictable situations. That’s why dialectical behavioral therapy provides group meetings, typically one per week. Here, you’ll work with other people who also have BPD, and together, you’ll focus on one type of skill you’ve learned in your individual sessions.

You might focus on:

  • Mindfulness
  • Tolerating distress
  • Solving problems
  • Communication skills

Through discussions, role-play exercises and small-group sessions you’ll learn how others apply the skills they’ve picked up in therapy, and you’ll have the chance to practice your own techniques on someone else.

The Role of Family Therapy

It’s likely that your relationship with your family isn’t as strong as you’d like it to be. Mental illness and addiction can make it hard for you to communicate, and you might have a history of poor interactions with those you love. In family therapy, your family will have the opportunity to learn more about BPD, and you’ll have the chance to learn how to communicate with those you love a bit more effectively.

An Effective Therapy

Dialectical behavior therapy is so often used with BPD because it’s been proven so very effective in helping people to overcome the disease. For example, according to a study published in the Journal of Consulting and Clinical Psychology, of people who had BPD and a binge eating disorder who were given dialectical behavioral therapy, 89 percent stopped binge eating. This is a remarkable outcome, as it demonstrates that the therapy was able to help these people to control their mood swings and regulate their destructive behavior.

A similar study was published in the journal Drug and Alcohol Dependence, but here, the authors examined people who had both BPD and an addiction to opioids. People who received dialectical behavioral therapy maintained their reductions in drug use through 12 months of treatment, while those who received other forms of treatment actually increased their drug use during the last four months of treatment. Again, this seems to indicate that the therapy can be helpful in regulating destructive cycles.

If you have BPD, this might be the right type of therapy for you. Learning more about how to regulate your emotions, communicate your thoughts and control the urge to cause yourself harm could make a big difference in your quality of life and your long-term health.