Dialectical behaviour therapy (DBT) is a modified type of cognitive behavioural therapy (CBT). Its main goals are to teach people how to live in the moment, develop healthy ways to cope with stress, regulate their emotions, and improve their relationships with others.
DBT was originally intended to treat borderline personality disorder (BPD), but it has been adapted to treat other mental health conditions. It can help people who have difficulty with emotional regulation or are exhibiting self-destructive behaviours such as disordered eating and substance abuse.
DBT has evolved to become an evidence-based psychotherapy approach that is used to treat many conditions including during addiction. Settings in which DBT are often used include:
- Group therapy where patients are taught behavioural skills in a group setting.
- Individual therapy with a trained professional where a patient’s learned behavioural skills are adapted to their personal life challenges.
- Phone coaching in which patients can call the therapist between sessions to receive guidance on coping with a difficult situation they are currently in. This can be helpful during rehab and aftercare.
There are several strategies and techniques that are used in DBT.
One important benefit of DBT is the development of mindfulness skills. Mindfulness helps you focus on the present or “live in the moment”. This helps you pay attention to what is happening inside you (your thoughts, feelings, sensations, and impulses) as well as using your senses to tune in to what’s happening around you (what you see, hear, smell, and touch) in nonjudgmental ways. This is an excellent facilitator for recovery.
Mindfulness helps you slow down and focus on using healthy coping skills when you are in the midst of emotional pain. The strategy can also help you stay calm and avoid engaging in automatic negative thought patterns and impulsive behaviour.
These skills help you accept yourself and your current situation. DBT teaches several techniques for handling a crisis, including:
- Improving the moment
- Thinking of the pros and cons of not tolerating distress during recovery
Distress tolerance techniques help prepare you for intense emotions and empower you to cope with them with a more positive long-term outlook.
Interpersonal effectiveness helps you to become more assertive in a relationship (for example, expressing your needs and being able to say “no” to someone offering you drugs) while keeping a relationship positive and healthy. You will learn to listen and communicate more effectively, deal with challenging people, and respect yourself and others.
This strategy lets you navigate powerful feelings in a more effective way. The skills you learn during addiction treatment will help you to identify, name, and change your emotions.
When you are able to recognize and cope with intense negative emotions (for example, anger), it reduces your emotional vulnerability and helps you have more positive emotional experiences during recovery.
Factors Influencing Cost
The cost really depends partly on logistical factors, like which part of the country you’re in and how much your insurance will cover. Some providers offer payment plans or sliding scale rates that are based on income and ability to pay.
There are several other factors that affect the cost of DBT.
Funded vs Private
In government-funded addiction treatment facilities, DBT may be provided at no additional cost. There may be long waiting lists for these programs, but they should be investigated anyway. The cost of privately provided DBT varies widely from one provider to the next based on the other factors mentioned in this article. Note that across most of Canada, therapy services including DBT are not covered by provincial health plans.
Mode of Delivery
DBT can be delivered in a variety of ways, such as in person one-on-one, in person in a group setting, or via phone or online. Some of these are more expensive to deliver than others, and the cost may reflect that. Some people may choose a combination of one-on-one and group therapy, and this will impact the cost as well.
Stage of Treatment
When used as an addiction treatment, dialectical behaviour therapy is divided into four stages:
- Stage 1: At the beginning of addiction treatment, the most serious and self-destructive behaviours are the first things addressed. These may include self-injury or suicidal behaviours.
- Stage 2: Next, addiction treatment moves on to address issues that affect a person’s quality of life, such as their interpersonal effectiveness, emotional regulation skills, and ability to tolerate distress.
- Stage 3: The next step is to focus on issues related to self-esteem and interpersonal relationships.
- Stage 4: At this point, addiction treatment is focused on helping people get the most out of their lives, including finding ways to experience greater happiness, strengthen their relationships, and pursue their life goals during recovery and beyond.
Some of these stages are more intense than others. The sessions may be longer and more frequent early on in treatment as more intensive support is required. Later in treatment, when therapy is more focused on post-rehab support, the cost may drop.
Therapist Training and Experience
As with many things, the extent of training the therapist has undergone and the years of experience they have makes a big difference to the cost. A DBT specialist is likely to charge more than a general therapist who uses a range of modalities. Someone with more experience will be more in demand, and therefore more expensive, than a therapist who is newer to the practice.
What is Being Treated
Though developed with borderline personality disorder in mind, DBT is also an effective treatment for:
- Bipolar Disorder
- Eating disorders such as anorexia nervosa, binge eating disorder, and bulimia nervosa
- Generalized anxiety disorder (GAD)
- Major depressive disorder, including treatment-resistant major depression and chronic depression
- Non-suicidal self-injury
- Obsessive-compulsive disorder (OCD)
- Post-traumatic stress disorder (PTSD)
- Suicidal behaviour
Some people need help with one of these things, others may need support for several of them. Since treatment is customized based on individual needs, this can affect the cost.
DBT as Part of Addiction Treatment
If you are struggling with addiction and you are wondering if DBT will be an effective treatment method for you, call Addiction Rehab Toronto for an assessment. We will evaluate your symptoms, treatment history, and therapy goals to see if DBT might be a good fit.
We offer customized addiction treatment plans that utilize a variety of treatment methods. Many of our clients have benefited from the inclusion of group or individual DBT. The therapy that is recommended for you will be based on your unique needs and challenges. Contact us for more information.