Dialectical-behavioral therapy (DBT) combines cognitive and behavioral therapies to teach people healthy ways to handle painful emotions through acceptance and change. Originally developed in the 1970s by Marsha Linehan, PhD, to treat borderline personality disorders, DBT emphasizes skills like taking an emotional timeout, being present in the moment using all five senses, evaluating pros and cons and thinking about logical consequences in order to treat behavioral issues. Because borderline personality disorders often co-occur with substance abuse disorders, DBT has been adapted in recent years for the treatment of drug and alcohol addiction.
Treating Addicted Teens
Addiction is a disease characterized by impulsivity. When it occurs in already impulsive teenagers, addiction can be particularly difficult to treat. Instead of turning to drugs and alcohol, DBT uses four skill sets – interpersonal effectiveness, emotional regulation, distress tolerance and mindfulness – to improve people’s coping skills. Because a primary lesson of DBT is managing emotions and impulsive behaviors, it is a natural fit in the addiction arena. Through DBT, teens learn how to increase awareness, control self-defeating thoughts and handle the stresses and urges that will likely be with them the rest of their lives.
“You can’t avoid discomfort in life. But you can learn to accept it, learn from it and move on,” says Laurie Wilmot, LCSW, a therapist at SageWalk, a therapeutic wilderness program for troubled teens aged 13-17. “If teens are feeling angry, sad, hurt or frustrated, DBT shows them it’s okay to feel negative emotions without acting out in negative ways. In adolescence, feelings become cluttered so quickly – it’s helpful to have a specific set of skills that help teens sort through their emotions and determine the best way to respond.”
DBT is also easy to understand and implement, which makes it a good match for teens struggling with substance abuse. Mirroring the 12 steps, DBT offers a succinct and understandable approach that puts a label on each skill so that teens have practical things they can do in the moment to make the situation better. As teens master specific skills, they are more aware of problem behaviors, are able to think before they act and feel confident in their ability to deal with conflict in healthy ways.
“DBT creates a mental map of how to cope in a given situation,” says Wilmot. “If a parent is yelling at you, you can use radical acceptance or breathing exercises. If you’re stressed or anxious, you’ll know to use imagery. If you’re angry, take a timeout and find a healthy distraction. Whatever the situation, teens can assess their emotion, tie it to a DBT strategy and call upon a specific skill to handle the stresses of daily life.”
DBT Takes to the Wilderness
Some of the most cutting-edge treatment programs have begun incorporating DBT into their approach for combating drug or alcohol addiction. SageWalk, the Wilderness School, is licensed by the State of Oregon as an outdoor youth program, a private school and a chemical dependency treatment program and has intensively trained its therapists on utilizing DBT skills in the wilderness.
Wilderness programs like SageWalk have always integrated cognitive-behavioral therapies, the Stages of Change by Prochaska and DiClemente, the 12 Steps and other methodologies into their treatment of drug and alcohol addiction. But SageWalk is one of the first programs of its kind to introduce DBT concepts into the wilderness setting.
“DBT is a great tool to help teens learn life skills in the wilderness,” says Meghan Flaherty, a therapist at SageWalk. “By taking kids out into the wilderness where they are exposed to the elements and a new set of peers, we can figure out how each teen deals with stressful situations. In the field, our staff can call out problematic behaviors and provide specific instruction on healthier ways to resolve problems right on the spot.”
At SageWalk, therapists utilize DBT skills to walk each student through a chain analysis of problem behaviors. If a teen acts out, yells at the field staff or refuses to participate, a therapist begins an immediate chain analysis by asking detailed questions about what triggered that behavior and what techniques he or she could have used to respond differently.
“In traditional talk therapy, kids sit down with a counselor one hour a week and try to understand why they have a problem. But these teens also need practical, real-life skills that will actually solve those problems. And that’s where DBT comes into play,” states Sandy MacDonald, Clinical Director at SageWalk.
Sharing Skills with Parents
According to dialectic theory, problems happen when people see the world in polar opposites – right or wrong, all or nothing, using or not using. DBT seeks to bring all extremes to a balanced center and to help teens find a middle ground. The theory holds true, not only with substance-abusing behaviors, but also in the way teens interact with their parents.
Through family workshops at SageWalk, parents learn the same DBT skills their child has been practicing in the field. They are taught that rather than simply saying yes or no, they can open a dialogue about the rationale behind a given rule or opinion. Rather than the parent being right and the child being wrong, or vice versa, they can share opinions and negotiate outcomes that are beneficial to the entire family. Using DBT, parents and teens learn to take a break when they are angry and find ways to avoid making difficult situations worse.
“DBT teaches emotionally reactive teens to step off the emotional roller coaster and find the middle path,” explains Trudy Godat, a therapist at SageWalk. “In our program, parents are learning the same skills as their teens, so when their child returns home, they’re speaking the same language.”
A Lasting Impact
DBT is more than a therapeutic approach – it is a set of life skills that can be applied by anyone, at any age, in any situation. Long after their wilderness experience, teens are still using the skills they learned at SageWalk to create healthy relationships, resolve conflicts and abstain from drugs and alcohol.
For some teens, DBT is so useful that formal instruction continues after camp ends. Laurie Wilmot shares the story of a young, intellectually gifted boy who arrived at SageWalk with very few behavioral issues but severe patterns of OxyContin abuse. A highly sensitive child who was diagnosed with depression, his identity was wrapped up in being a depressed, drug-abusing teen.
As part of his individualized treatment program, the therapists at SageWalk introduced him to the DBT skills of mindfulness and distress tolerance, and he gradually began to make progress. But after he returned home, he relapsed and began seeing a well-known clinical therapist recommended by SageWalk who specialized in dialectical-behavioral therapy. For months, no one heard how this boy was progressing, whether he had returned to his former ways or was thriving in his new environment, until Wilmot received a letter from the boy’s family.
She learned that he had successfully graduated from high school, was about to start college and was making excellent progress with his DBT therapist. This once-depressed, drug-addicted teen did his senior project on “Sixty Days in the Wilderness” and how SageWalk had changed his life.
As Wilmot looked over his graduation picture and skateboarding photos, she said, “I was reminded once again how much the work we do really matters.
About the Author:
Meghan Vivo is a writer who joined Aspen Education Group after working at a publishing company specializing in alternative health and wellness. A former corporate and immigration attorney, Meghan graduated from Syracuse University College of Law, magna cum laude, in 2003, and has been pursuing her passion for writing ever since. Contact Meghan at firstname.lastname@example.org.