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Developing DBT Skills

DBT Skills Can Produce Lasting Addiction Recovery

The two most significant issues in treating addiction are getting the addict to acknowledge that they have a problem and need help to recover and relapse during the recovery process.

Pinpointing treatment methodologies and helping the addict to prevent future relapses whenever possible is the ultimate treatment goal, which is commonly tied to mental health issues.

Almost 8 million American adults suffer from both substance abuse and mental health disorders simultaneously, according to the Substance Abuse and Mental Health Services Administration (SAMHSA).

The good news is that recovery is achievable as evidenced by the success of many AA, CA, and NA 12 step members as well as treatment success at addiction rehabilitation centers using other protocols including Dialectical Behavior Therapy (DBT), which has proven exceedingly effective.


What is DBT?

DBT is a therapy developed in the 1980’s by Marsha Linehan, Ph.D. as an offshoot of Cognitive Behavioral Therapy (CBT) that combines the premises of CBT with the practice of Radical Acceptance.

Originally developed to help patients suffering from self-destructive impulses like burning and cutting, Linehan quickly discovered its effectiveness in her treatment of borderline personality disorder. Even patients whose conditions had in the past been considered untreatable were responding to DBT. It quickly brought new hope for the treatment of many other diseases, especially those characterized by self-destructive behavior such as substance abuse.

DBT has proven so effective in treating addiction; it has been adopted by many treatment centers and mental health professionals as a way of helping patients rewire their thinking, improve their ability to cope with emotions, and ultimately change their behavior.

How Does DBT Work?

DBT zeroes in on breaking the flow of negative thought patterns and the resulting behavior using four main modalities including balancing emotions, practicing mindfulness, developing healthy interpersonal skills, and increasing tolerance for stress.

The gist is that all thoughts, emotions, and behaviors are learned and therefore can be unlearned in a nurturing and supportive environment.

What makes DBT different from CBT is the focus on validation that leads to self-acceptance. Linehan found that CBT principles combined with validation and self-acceptance were keys to effectively disrupting and redirecting previously self-destructive behavior into positive thoughts, emotions, and behaviors.


Essential DBT Skills

DBT is comprised of four main skill groups that each have skill subsets. When all four main groups of skills are learned and utilized, the individual can experience significant recovery. The amazing thing about DBT is that even when one or two skills are practiced, the patient’s life can show signs of improvement. That is indeed a testament to its effectiveness, particularly as it applies in the treatment of addiction.

The four skill groups mentioned below go deeper and require consistent effort on the part of the patient as well as positive feedback and nurturing from the practitioner during treatment.

#1 Mindfulness – Mindfulness is defined as, “a mental state achieved by focusing one’s awareness on the present moment, while calmly acknowledging and accepting one’s feelings, thoughts, and bodily sensations, used as a therapeutic technique.”

There’s a lot of talk in spiritual circles today about the practice of mindfulness often associated with the stereotypical meditator sitting with legs crossed in the lotus position.

But meditation can happen anytime, anywhere, in any position or while walking, eating, or doing other activities. It is merely the practice of focusing the mind while existing, so one can choose to meditate, or be mindful, at any time.

In DBT, core mindfulness is the process of learning how to master the mind instead of allowing the mind to run the show. It is taught by using the what skills – observe, describe, and participate and the how skills – non-judgmentally, one-mindfully, and effectively. These are broken down into more bite-size skills as follows:

  1. Observe – Developing this skill allows the patient to notice what is within their immediate reality without reaction.

  2. Describe – Verbalizing the current experience of what is happening at the moment. What is the patient feeling emotionally and physically?

  3. Participate – Mindfulness by definition requires conscious participation in the process – it is a choice to focus one’s full attention on the present activity.

  4. Non-judgmentally – Understanding and knowing in their core being that there is indeed nothing good or bad; that there is always a balance of the two. Gray areas; the opposite of black and white thinking.

  5. One-mindfully – A state of being consciously in the present moment; not worried about the future or caught up in the past.

  6. Effectively – To be effective in the practice of mindfulness, it is most useful to focus on those thoughts or emotions that produce positive results.

Practicing mindfulness skills can help the addict to avoid relapse by providing them tools to find their center, feel calm regardless of what is transpiring, notice and evaluate emotions and triggers as they arise, pause before reacting, and to condition thoughts to remain in the present moment.

Situations that may have felt utterly overwhelming in the past can be right-sized by the application of mindfulness tools thereby avoiding a common trigger for substance abuse.

Of course, while learning and practicing these skills, relapse is always possible as it takes time and patience to retrain the mind and learn new behaviors. However, in DBT relapse is viewed as another opportunity for compassionate self-acceptance and acceptance of where the patient is in the present in their recovery process.

There is no judgment of relapse being a good or bad event, it just is.


#2 Distress Tolerance

In DBT, distress tolerance skills are learned and practiced helping the addict cope and survive a perceived or actual crisis.

What do I mean by the perceived crisis? There are situations where the person incorrectly perceives they are in a crisis based on past, real, traumatic event that occurred in their life that the current event is now triggering. This is not to minimize the validity of the person’s feelings in the face of a current event, only to aid in right-sizing the fact to its correct proportion when there is a distortion of perception happening.

This is also not to say that there can’t be actual new crisis events in an addict’s life, in fact, addiction and hitting bottom, unfortunately, creates new crises as a consequence of the addiction, such as loss of job, health, spouse, and sometimes freedom (incarceration).

Learning skills to increase distress tolerance can help the addict refrain from relapsing into addictive behaviors that led them to the crisis in the first place. There are far too many distress tolerance skills in DBT to go into within the scope of this article. It is possible to write entire essays on each distress tolerance skill.

However, most DBT practitioners recognize five main skill categories in this area including the

A.C.C.E.P.T.S. acronym, self-soothing using the five senses, the I.M.P.R.O.V.E. acronym, pros and cons, radical acceptance.

A.C.C.E.P.T.S. is a process of distracting the mind through activities, comparisons, contributing, emotional opposites, pushing away, thoughts, and sensations.

I.M.P.R.O.V.E. the moment skills include imagery, meaning, prayer, relaxation, one thing or day at a time, vacation, and encouragement.

Radical acceptance is a popular and powerful skill utilized by many recovery treatment centers as well as spiritually based groups for recovery and overall well-being.

#3 Emotion Regulation

The purpose of emotion regulation is for the patient to begin to understand their emotions, reduce their emotional vulnerability, and decrease emotional suffering. It is a practice in allowing emotions to be what they are, while simultaneously self-monitoring what is appropriate to express and how to express feelings healthily in any given situation.

When discussing healthy emotional boundaries, the focus tends to shift towards how we allow others to treat us, which is an essential part of the process. For the addict, however, it is critical to include how they treat others and how practicing healthy emotional boundaries serves to protect and enhance their lives as well as of those with whom they interact.

More clear boundaries include not accepting verbal abuse, learning to say no when you mean it, and the like. Less visible boundary issues include limiting time spent with energy vampires and maintaining needed personal space. When we have trouble regulating our own emotions, we may overshare with unsafe parties, causing ourselves harm. We may also cause damage to others by becoming verbally abusive and not respecting their emotional or physical boundaries.

The resulting negative consequences may include isolation, ridicule or shaming, loss of employment, or even imprisonment. It’s essential to the recovery process to understand that not only is emotional regulation paramount to the addict’s safety and emotional well-being, but also to those around them.

In DBT, there are several tools used to learn and practice emotional regulation:

  1. Interpreting Emotions – Many theories state there are only 5-10 core emotions, everything else is a learned perception of these. Understanding this helps with the other tools for emotion regulation.

  2. Describing Emotions – Focuses the patient on verbally expressing the quality of the emotions they are experiencing, noticing other emotions triggered by the original feeling, and body sensations or action urges prompted by them as well.

  3. Understanding the Functional Purpose of Emotions – In DBT, emotions serve three primary functions: to communicate and influence others; to strategize and prompt action; to garner self-approval.

  4. Decreasing Susceptibility to Negative Emotions – Simple practices like making sure the addict gets enough sleep, exercise, and eats healthy, can aid in preventing uncontrolled emotional swings.

  5. Directing Focus to Positive Emotions – This can be done through daily gratitude lists which eventually will lead to an increased awareness of present-moment positive experiences throughout the person’s day.

  6. Allowing Emotions to Come and Go – The practice of not getting stuck in negative emotions but also understanding that all feelings come and go, including joy and happiness and that this is a normal part of life.

  7. Acting Opposite of Emotions – Not to be confused with stuffing or avoiding emotions, this practice is used to stop self-harming behavior in its tracks by having the addict take what 12 step groups often refer to a “contrary action” at the moment they would generally practice addictive behavior.


#4 Interpersonal Effectiveness

In DBT, interpersonal effectiveness is merely the ability to interact with others in a healthy and productive manner. The skills used to learn and practice interpersonal effectiveness aid in decreasing the resentments that can build toward others when they don’t meet the addict’s expectations, presenting the addict with another excuse to use.

The interesting part in learning this skill is the awareness and realization that in most cases, the addict is upset or resentful of another person’s behavior, personality, or being, without ever having effectively communicated to the person their expectations, wants, and/or needs in the first place and then later reacting when their needs aren’t met. This is all done quite unconsciously.

There are three main categories of interpersonal skills – objectivity, relationship, and self-respect effectiveness.

Objectivity effectiveness teaches the addict to respond and engage more thoughtfully, deliberately, and effectively with others.Relationship effectiveness skills focus on learning to be gentle, interested, validating, and easy-going when interacting with others.Self-respect effectiveness teaches the addict to be fair, make apologies when appropriate, and to live in integrity.

These skills move the addict from unconscious to conscious interactions with others, builds self-esteem, and prevents unnecessary resentments from arising that can lead to relapse.

What Next?

You can recover from substance abuse addiction with the right tools and support. It is essential that you understand that success evades those who try to go the recovery path alone.

Whether you choose a qualified DBT practitioner, an addiction recovery center, or a 12 step fellowship, it is critical that you come out of hiding, become vulnerable, admit you need help, and seek it.

The commitment to recovery with appropriate support and your willingness to learn new life skills to help prevent relapse are the keys to your ultimate recovery success.

Do you need help with your Addiction Recovery program or treatment?

If you want to understand DBT skills and include them in your recovery program, you can get in touch with the Hotline at our Recovery Center where trained and experienced professionals are available to assist you in every way. The staff at Chateau Recovery is always available to help you with all of your questions regarding addiction recovery and treatment.  Call anytime.

Chateau Recovery Center 375 Rainbow Lane
Midway, UT 84049, USA

If you or someone you love has questions concerning the rehabilitation process, call our free helpline Phone: +1 888-971-2986 for more information. Calls are always confidential, private, and secure.

DBT Addiction Skills with Dr. Marsha Linehan

Learn DBT skills that have been used in the treatment of individuals with a variety of addictions.

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