DBT, Mental Health & Addiction
Sometimes someone comes into contact with treatment because their drug use got out of control only to discover their problem isn’t actually addiction, but rather, an untreated mental health issue. Often times the misuse of drugs and alcohol is an ardent attempt to quell the feelings of anxiety or lift the fog of depression. Sometimes it’s a way to disengage from the flashbacks of trauma. Sometimes it’s a way to close the door on a panic attack. However, many times, these modes of self-treatment go too far, and the claws of addiction sink in, creating another layer to uncover and treat. Still, once the addiction piece of the puzzle is treated, therein lies the deeper, more complicated issue of mental illness. What then?
At Visions, we have embraced the mental health component of treatment and are adding a mental health track to our existing treatment plan. We are utilizing a wider range of treatment methodologies and branching into the area of Dialectical Behavioral Training (DBT). DBT is a “comprehensive cognitive behavioral treatment developed by Marsha M. Linehan over the last 25 years,”[i] and has primarily been used to treat patients struggling with suicidal ideation, suicide attempts, a desire to self-harm, and self-mutilation. After discovering numerous problems with the traditional use of cognitive behavioral therapy (CBT) in treating this particular clientele, Linehan began to integrate validation strategies (also known as acceptance-based interventions) into her treatment methodology. By integrating these validation strategies, Linehan inevitably began empowering her clientele and creating an environment of acceptance, while also encouraging them to begin to recognize the need to consciously change negative behaviors. DBT has also become one of the more successful treatments for patients suffering from borderline personality disorder (BPD), a group typically resistant to the traditional use of CBT.
To illustrate some of the problems Marsha Linehan and her team encountered, here are the three issues they found to be the most troublesome with traditional CBT:
- Clients receiving CBT found the unrelenting focus on change inherent to CBT invalidating. Clients responded by withdrawing from treatment, by becoming angry, or by vacillating between the two. This resulted in a high drop out rate. And, obviously, if clients do not attend treatment, they cannot benefit from treatment.
- Clients unintentionally positively reinforced their therapists for ineffective treatment while punishing their therapists for effective therapy. In other words, therapists were unwittingly under the control of consequences outside their awareness, just as all humans are. For example, the research team noticed through its review of audio taped sessions that therapists would “back off” pushing for change of behavior when the client’s response was one of anger, or emotional withdrawal, or shame, or threatened self-harm. Similarly, clients would reward the therapist with interpersonal warmth or engagement if the therapist allowed them to change the topic of the session from one they didn’t want to discuss to one they did want to discuss.
- The sheer volume and severity of problems presented by clients made it impossible to use the standard CBT format. Individual therapists simply did not have time to both address the problems presented by clients – suicide attempts, urges to self-harm, urges to quit treatment, noncompliance with homework assignments, untreated depression, anxiety disorders, etc, AND have session time devoted to helping the client learn and apply more adaptive skills.[ii]
In addition to utilizing validation strategies, DBT also employs the use of mindfulness as one of the core concepts behind this therapy. Mindfulness is beneficial in the treatment of addiction and mental illness: it introduces the concept of non-judgmental observation, where we can observe our own actions and behaviors without criticism; Being mindful requires that we are engaged in present-time awareness: the here and now. This is where mindfulness is truly invaluable. If we are aware of our actions in the here and now, we are less likely to get caught in the destructive patterns of “what if? and “remember when?” In the practice of meditation, the act of “coming back to the breath” helps one stay in the present. Learning how to label emotions and feelings that may present themselves can help sufferers from getting lost in negative thought patterns. For example, if we are feeling scared or triggered, paranoid or angry, naming that emotion with non-judgmental observation will help us retain our present-time awareness.
In time, hopefully, the implementation of treatments such as DBT and mindfulness will help provide sufferers with some valuable tools for regulating emotion, distress tolerance and managing interpersonal relationships.