Dialectical Behavior Therapy (DBT) in Addiction
Counseling: Emotional Regulation and Distress Tolerance
Introduction
Addiction is a disease involving compulsively seeking rewards and relief
through the use of substances or engaging in unhealthy behaviors despite
repercussions. A core reason many individuals develop addictions is due to
difficulties regulating feelings and coping with distress that arises from life's
challenges. Research shows a significant relationship between emotion
dysregulation and substance use disorders (SUDs), with high rates of co-
occurring mood and anxiety disorders as well (Witkiewitz & Bowen, 2010).
For this reason, therapeutic approaches that teach emotional regulation and
distress tolerance skills have particular relevance for addiction counseling.
One such evidence-based model is Dialectical Behavior Therapy (DBT).
Originally developed by Marsha Linehan in the 1980s to treat borderline
personality disorder, DBT has since been adapted and studied for treating
SUDs with great success (Dimeff & Linehan, 2008). Its core aim is balancing
acceptance of oneself and reality with a commitment to positive change
through teaching mindfulness, interpersonal effectiveness, emotional
regulation, and distress tolerance skills. This paper explores how DBT
strategies addressing emotion dysregulation and maladaptive coping can
benefit addiction counselors and their clients working toward long-term
recovery maintenance through building psychological resilience and
balanced living.
Overview of DBT Model and Strategies
DBT is a cognitive-behavioral treatment approach rooted in Zen Buddhism,
dialectics, and biosocial theory. Its overarching philosophy balances
acceptance and change in a dialectical manner, recognizing both the need to
validate inner experiences while committing to behavioral improvements
through skills practice. Therapists follow a "validation and encouragement"
stance, accepting clients where they are without judgment while also
motivating adaptive changes (Lindenboim et al., 2007). Individual therapy
sessions interweave this dialectical approach with teaching core DBT skills
modules.
The first skills module targets core mindfulness practices to cultivate wise,
balanced awareness of present internal and external experiences. Tasks like
breathing, body awareness, and daily logging exercises train non-judgmental
focus and observation that counteract tendencies toward emotional
reactivity, avoidance, and lack of self-care.
The second module trains interpersonal effectiveness through strategies like
DEARMAN, GIVE, and FAST that respectively help clients assert needs
respectfully, clearly communicate boundaries, and navigate challenging
social situations effectively and respectfully. Related communication
trainings address building empathy, validation, and compromise in
relationships (Swales, 2009).
The third module targets distress tolerance by identifying primary and
secondary emotions, tolerating painful experiences through wise "riding the
wave" and coping ahead techniques, distracting with safe activities,
improving with self-soothing behaviors, and accepting reality rather than
fighting unchangeable factors.
Finally, the emotion regulation module provides tools for mindfulness of
emotions, reducing vulnerability factors, changing emotional states through
opposing behaviors, and taking wise actions guided by healthy emotions
rather than impulsivity (Swales, 2009).
All strategies are manualized to ensure treatment fidelity and teach skills in a
hierarchical, paced manner through individual therapy, weekly group skills
training, phone coaching for intersession practice, and therapist consultation
meetings (Lindenboim et al., 2007). Therapists further encourage daily diary
card tracking to reinforce new behaviors and problem-solve obstacles
(Dimeff & Linehan, 2008).
Benefits for Addiction Counseling
DBT's mechanisms for addressing emotion dysregulation and distress
tolerance through mindfulness, interpersonal effectiveness and adaptive
coping strategies directly translate to benefiting addiction recovery in
several ways:
Cultivating Emotional Awareness
Mindfulness practices increase clients' ability to notice internal triggers for
substance urges and situational factors contributing to maladaptive coping
without becoming overwhelmed or acting impulsively. This awareness
provides distance and choice.
Managing Strong Emotions
DBT techniques like riding emotional waves, opposite action, and thinking of
wise mind give clients tools to experience even difficult feelings without
defaulting to addictive behaviors by tolerating distress or changing
emotional states in healthy ways.
Improving Relationship Dynamics
Interpersonal effectiveness skills help navigate social challenges and set
boundaries constructively without slipping into codependency, enabling
clients to build fulfilling support systems key for long-term sobriety.
Coping with Cravings and Relapse Triggers
Distress tolerance strategies such as self-soothing, distracting with
alternative activities, acceptance, and coping ahead plans equip clients to
manage cravings, urges or setbacks without losing control or abandoning
recovery entirely.
Reducing Shame and Self-Criticism
The validating, non-judgmental philosophy of DBT, combined with building
self-esteem through skills mastery, counters typical addict self-loathing,
isolation and hopelessness, fueling courage for change.
Addressing Co-Occurring Disorders
Clients dually diagnosed with addictions and mood/anxiety issues directly
benefit from DBT interventions targeting underlying emotion dysregulation
maintaining all related problems.
In summary, DBT offers versatile transdiagnostic techniques addressing root
factors at the emotions-addictions interface through mindfulness, effective
communication, and adaptive coping strategies. These empower clients to
establish long-term wellness and balance in recovery.
Cultivating Mindfulness for Emotional Awareness
A primary way DBT builds emotional regulation is through cultivating
mindfulness—non-judging, present-moment awareness of internal and
external experiences. This metacognitive skill counters addiction-related
tendencies toward emotional avoidance, reactivity and lack of self-care. DBT
mindfulness practices include:
Observational Exercises
Clients notice thoughts/feelings passively without reaction through Body
Scan meditation, Pleasant Events daily logs, or Emotion Diary homework
logging triggers. This detachment interrupts addiction's automatic pilot and
compulsion cycles (Lindenboim et al., 2007).
Focus & Breath Awareness
Focusing mind on breathing or other external sensory anchors like music
pulls attention to anchoring physical sensations rather than
racing/ruminating thoughts sustaining craving-using cycles. Short- and long-
term breath practices help sustain wise mindfulness.
Distress Tolerance Strategies
Self-soothing behaviors like holding an ice cube, blowing bubbles, smelling
pleasant scents, or saying encouraging self-talk provide concrete
mindfulness tools for tolerating distressing triggers or lapses without
abandoning broader recovery efforts (Dimeff & Linehan, 2008).
Wise Mind State
This balanced perspective integrating reason and intuition gives clients
capacity to make clear choices guided by sobriety priorities rather than
emotions alone. Mindfulness maintains wise mind clarity during decision-
making.
The detached, non-reactive stance cultivated through mindfulness allows
clients to recognize addiction-related thoughts or urges arising without
immediately becoming overwhelmed or impulsively acting out self-
destructive patterns (Lindenboim et al., 2007). Instead, mindfulness creates
psychological space to choose constructive coping options. Over time, this
metacognition enhances emotion regulation abilities crucial for long-term
recovery success and well-being.
Improving Emotion Regulation Skills
While mindfulness fosters awareness, DBT directly teaches core strategies
for modulating emotions: opposite action, changing vulnerability factors,
urges surfing, ACCEPTS framework. When applied alongside counselor
guidance and group processing, these tools become empowering skills
clients own for long-term management of affective triggers maintaining
addictions:
Opposite Action
Deliberately acting opposite cravings/emotions by engaging in healthful
distracting activities like exercise or calling supports interrupts addiction's
automatic pilot processes. Over time, new response patterns replace harmful
ones (Lindenboim et al., 2007).
Changing Vulnerability Factors
Clients identify avoidant patterns exacerbating emotional vulnerabilities like
lack of sleep, isolation from supports, self-criticism, all-or-nothing thinking,
then take wise preemptive actions before distressing triggers arise (Dimeff &
Linehan, 2008).
Urge Surfing
Mindfully "riding the emotional wave" of cravings/triggers without reacting
teaches clients to detach from transient feelings and wait patiently for
intensity to naturally lessen on its own without acting out dysfunctional urges
(Lindenboim et al., 2007).
ACCEPTS Framework
This acronym guides clients moving through difficult emotions by Activating
wise mind, identifying Current thoughts/emotions kindly, evaluating
Pros/cons objectively, nurturing compassion for self with softer self-talk,
noting Thoughts are fleeting mental events, experiencing physical
Sensations fully with mindfulness, and committing to Self-care by tolerating
distress adaptively (Dimeff & Linehan, 2008).
Overall, enhancing clients' emotional intelligence and expanding skills
repertoires for balancing reason and feelings provides an arsenal against
addiction-related vulnerabilities. Over time, habitual thoughts like "I just
need to use to feel better" lose power as viable alternative responses are
practiced.
Developing Interpersonal Effectiveness
Another component crucial for sustained recovery is reducing dependency on
unhealthy relationships maintaining addictions while cultivating fulfilling
connections supporting well-balanced living. The DBT Interpersonal
Effectiveness module teaches constructive strategies including:
DEARMAN
This acronym guides assertively asking for what one wants respectfully while
maintaining self-respect and the relationship. Clients apply it to set
boundaries with enabling contacts (Lindenboim et al., 2007).
GIVE
Giving information clearly and validly, expressing wishes/feelings
respectfully, validating others and negotiating disputes constructively helps
clients navigate interpersonal challenges constructively.
FAST
Avoiding risky situations threatening safety/goals, thinking things through
considering priorities/limits, negotiating for win-win compromises, asserting
calmly and truthfully preserves solid recovery support systems over time
through balanced living principles (Dimeff & Linehan, 2008).
Validation/Empathy
Showing compassion for others without enabling harm and resolving
misunderstandings through validating different perspectives strengthens
fulfilling relationships integral for long-term recovery maintenance and
overall well-being.
Overall, equipping clients to meet interpersonal needs constructively without
codependency or enabling dysfunctional patterns provides critical relational
tools serving as protective factors buttressing recovery success over a
lifetime. DBT strategies foster socially supportive ecosystems nourishing
wellness.
Coping with Distress and Cravings
Perhaps the greatest test for newly recovering individuals is tolerating
unpleasant emotions and resisting craving-driven urges without losing
control. Core DBT strategies address this challenge:
Coping Ahead Plans
Proactively strategizing how to handle high-risk situations/emotions
beforehand using all learned skills increases clients’ sense of self-efficacy
and preparedness for challenges (Dimeff & Linehan, 2008).
Distracting with Opposite Emotions/Activities
Engaging in enjoyable hobbies, calling supports, self-soothing behaviors like
snapping a rubber band rides out cravings by shifting focus from addiction to
more productive outlets (Lindenboim et al., 2007).
Reality Acceptance
Letting go of desire to control unchangeable aspects of situations/feelings
allows clients to disengage from urges and make wise behavior choices
under stress (Dimeff & Linehan, 2008).
Self-Soothe with Five Senses
Soothing oneself through grounding sensory awareness exercises like deep
breathing, cool showers, music, tactile fidgets tolerates distress adaptively.
Wise Mind
Making decisions from balanced perspective considers priorities/values over
impulses, maintaining clarity under duress crucial for withstanding lapses
(Lindenboim et al., 2007).
Overall, distress tolerance skills strengthen clients to independently ride
emotional waves without relapsing by choosing constructive outlets
respecting recovery priorities. Over time, cravings lose power through
habituating new self-care patterns.
Conclusion
Addiction arises from complex interactions between biological, psychological
and social factors. Emotion dysregulation and maladaptive coping play
critical roles in both developing and maintaining substance dependence. For
these core reasons, therapeutic approaches like DBT directly targeting
emotional awareness, interpersonal effectiveness and distress tolerance hold
immense promise for empowering clients for long-term recovery success.
Through its dialectical philosophy balancing acceptance and change, DBT's
evidence-based techniques cultivate mindfulness, adaptive emotion
regulation and coping strategies serving as portable protective skills clients
can apply independently throughout their lifetime recovery journeys.
Whether facing relationship stressors, cravings and lapses or general life
challenges, these transdiagnostic DBT strategies bolster psychological
resilience against substance misuse. Overall, integrating such skills directly
addressing underlying vulnerabilities can greatly expand addiction
counselors’ toolbox for equipping clients with lifelong wellness tools.
Addiction is a disease involving compulsively seeking rewards and relief
through the use of substances or engaging in unhealthy behaviors despite
repercussions. A core reason many individuals develop addictions is due to
difficulties regulating feelings and coping with distress that arises from life's
challenges. Research shows a significant relationship between emotion
dysregulation and substance use disorders (SUDs), with high rates of co-
occurring mood and anxiety disorders as well (Witkiewitz & Bowen, 2010).
For this reason, therapeutic approaches that teach emotional regulation and
distress tolerance skills have particular relevance for addiction counseling.
One such evidence-based model is Dialectical Behavior Therapy (DBT).
Originally developed by Marsha Linehan in the 1980s to treat borderline
personality disorder, DBT has since been adapted and studied for treating
SUDs with great success (Dimeff & Linehan, 2008). Its core aim is balancing
acceptance of oneself and reality with a commitment to positive change
through teaching mindfulness, interpersonal effectiveness, emotional
regulation, and distress tolerance skills. This paper explores how DBT
strategies addressing emotion dysregulation and maladaptive coping can
benefit addiction counselors and their clients working toward long-term
recovery maintenance through building psychological resilience and
balanced living.
Overview of DBT Model and Strategies
DBT is a cognitive-behavioral treatment approach rooted in Zen Buddhism,
dialectics, and biosocial theory. Its overarching philosophy balances
acceptance and change in a dialectical manner, recognizing both the need to
validate inner experiences while committing to behavioral improvements
through skills practice. Therapists follow a "validation and encouragement"
stance, accepting clients where they are without judgment while also
motivating adaptive changes (Lindenboim et al., 2007). Individual therapy
sessions interweave this dialectical approach with teaching core DBT skills
modules.
The first skills module targets core mindfulness practices to cultivate wise,
balanced awareness of present internal and external experiences. Tasks like
breathing, body awareness, and daily logging exercises train non-judgmental
focus and observation that counteract tendencies toward emotional
reactivity, avoidance, and lack of self-care.
The second module trains interpersonal effectiveness through strategies like
DEARMAN, GIVE, and FAST that respectively help clients assert needs
respectfully, clearly communicate boundaries, and navigate challenging
social situations effectively and respectfully. Related communication
trainings address building empathy, validation, and compromise in
relationships (Swales, 2009).
The third module targets distress tolerance by identifying primary and
secondary emotions, tolerating painful experiences through wise "riding the
wave" and coping ahead techniques, distracting with safe activities,
improving with self-soothing behaviors, and accepting reality rather than
fighting unchangeable factors.
Finally, the emotion regulation module provides tools for mindfulness of
emotions, reducing vulnerability factors, changing emotional states through
opposing behaviors, and taking wise actions guided by healthy emotions
rather than impulsivity (Swales, 2009).
All strategies are manualized to ensure treatment fidelity and teach skills in a
hierarchical, paced manner through individual therapy, weekly group skills
training, phone coaching for intersession practice, and therapist consultation
meetings (Lindenboim et al., 2007). Therapists further encourage daily diary
card tracking to reinforce new behaviors and problem-solve obstacles
(Dimeff & Linehan, 2008).
Benefits for Addiction Counseling
DBT's mechanisms for addressing emotion dysregulation and distress
tolerance through mindfulness, interpersonal effectiveness and adaptive
coping strategies directly translate to benefiting addiction recovery in
several ways:
Cultivating Emotional Awareness
Mindfulness practices increase clients' ability to notice internal triggers for
substance urges and situational factors contributing to maladaptive coping
without becoming overwhelmed or acting impulsively. This awareness
provides distance and choice.
Managing Strong Emotions
DBT techniques like riding emotional waves, opposite action, and thinking of
wise mind give clients tools to experience even difficult feelings without
defaulting to addictive behaviors by tolerating distress or changing
emotional states in healthy ways.
Improving Relationship Dynamics
Interpersonal effectiveness skills help navigate social challenges and set
boundaries constructively without slipping into codependency, enabling
clients to build fulfilling support systems key for long-term sobriety.
Coping with Cravings and Relapse Triggers
Distress tolerance strategies such as self-soothing, distracting with
alternative activities, acceptance, and coping ahead plans equip clients to
manage cravings, urges or setbacks without losing control or abandoning
recovery entirely.
Reducing Shame and Self-Criticism
The validating, non-judgmental philosophy of DBT, combined with building
self-esteem through skills mastery, counters typical addict self-loathing,
isolation and hopelessness, fueling courage for change.
Addressing Co-Occurring Disorders
Clients dually diagnosed with addictions and mood/anxiety issues directly
benefit from DBT interventions targeting underlying emotion dysregulation
maintaining all related problems.
In summary, DBT offers versatile transdiagnostic techniques addressing root
factors at the emotions-addictions interface through mindfulness, effective
communication, and adaptive coping strategies. These empower clients to
establish long-term wellness and balance in recovery.
Cultivating Mindfulness for Emotional Awareness
A primary way DBT builds emotional regulation is through cultivating
mindfulness—non-judging, present-moment awareness of internal and
external experiences. This metacognitive skill counters addiction-related
tendencies toward emotional avoidance, reactivity and lack of self-care. DBT
mindfulness practices include:
Observational Exercises
Clients notice thoughts/feelings passively without reaction through Body
Scan meditation, Pleasant Events daily logs, or Emotion Diary homework
logging triggers. This detachment interrupts addiction's automatic pilot and
compulsion cycles (Lindenboim et al., 2007).
Focus & Breath Awareness
Focusing mind on breathing or other external sensory anchors like music
pulls attention to anchoring physical sensations rather than
racing/ruminating thoughts sustaining craving-using cycles. Short- and long-
term breath practices help sustain wise mindfulness.
Distress Tolerance Strategies
Self-soothing behaviors like holding an ice cube, blowing bubbles, smelling
pleasant scents, or saying encouraging self-talk provide concrete
mindfulness tools for tolerating distressing triggers or lapses without
abandoning broader recovery efforts (Dimeff & Linehan, 2008).
Wise Mind State
This balanced perspective integrating reason and intuition gives clients
capacity to make clear choices guided by sobriety priorities rather than
emotions alone. Mindfulness maintains wise mind clarity during decision-
making.
The detached, non-reactive stance cultivated through mindfulness allows
clients to recognize addiction-related thoughts or urges arising without
immediately becoming overwhelmed or impulsively acting out self-
destructive patterns (Lindenboim et al., 2007). Instead, mindfulness creates
psychological space to choose constructive coping options. Over time, this
metacognition enhances emotion regulation abilities crucial for long-term
recovery success and well-being.
Improving Emotion Regulation Skills
While mindfulness fosters awareness, DBT directly teaches core strategies
for modulating emotions: opposite action, changing vulnerability factors,
urges surfing, ACCEPTS framework. When applied alongside counselor
guidance and group processing, these tools become empowering skills
clients own for long-term management of affective triggers maintaining
addictions:
Opposite Action
Deliberately acting opposite cravings/emotions by engaging in healthful
distracting activities like exercise or calling supports interrupts addiction's
automatic pilot processes. Over time, new response patterns replace harmful
ones (Lindenboim et al., 2007).
Changing Vulnerability Factors
Clients identify avoidant patterns exacerbating emotional vulnerabilities like
lack of sleep, isolation from supports, self-criticism, all-or-nothing thinking,
then take wise preemptive actions before distressing triggers arise (Dimeff &
Linehan, 2008).
Urge Surfing
Mindfully "riding the emotional wave" of cravings/triggers without reacting
teaches clients to detach from transient feelings and wait patiently for
intensity to naturally lessen on its own without acting out dysfunctional urges
(Lindenboim et al., 2007).
ACCEPTS Framework
This acronym guides clients moving through difficult emotions by Activating
wise mind, identifying Current thoughts/emotions kindly, evaluating
Pros/cons objectively, nurturing compassion for self with softer self-talk,
noting Thoughts are fleeting mental events, experiencing physical
Sensations fully with mindfulness, and committing to Self-care by tolerating
distress adaptively (Dimeff & Linehan, 2008).
Overall, enhancing clients' emotional intelligence and expanding skills
repertoires for balancing reason and feelings provides an arsenal against
addiction-related vulnerabilities. Over time, habitual thoughts like "I just
need to use to feel better" lose power as viable alternative responses are
practiced.
Developing Interpersonal Effectiveness
Another component crucial for sustained recovery is reducing dependency on
unhealthy relationships maintaining addictions while cultivating fulfilling
connections supporting well-balanced living. The DBT Interpersonal
Effectiveness module teaches constructive strategies including:
DEARMAN
This acronym guides assertively asking for what one wants respectfully while
maintaining self-respect and the relationship. Clients apply it to set
boundaries with enabling contacts (Lindenboim et al., 2007).
GIVE
Giving information clearly and validly, expressing wishes/feelings
respectfully, validating others and negotiating disputes constructively helps
clients navigate interpersonal challenges constructively.
FAST
Avoiding risky situations threatening safety/goals, thinking things through
considering priorities/limits, negotiating for win-win compromises, asserting
calmly and truthfully preserves solid recovery support systems over time
through balanced living principles (Dimeff & Linehan, 2008).
Validation/Empathy
Showing compassion for others without enabling harm and resolving
misunderstandings through validating different perspectives strengthens
fulfilling relationships integral for long-term recovery maintenance and
overall well-being.
Overall, equipping clients to meet interpersonal needs constructively without
codependency or enabling dysfunctional patterns provides critical relational
tools serving as protective factors buttressing recovery success over a
lifetime. DBT strategies foster socially supportive ecosystems nourishing
wellness.
Coping with Distress and Cravings
Perhaps the greatest test for newly recovering individuals is tolerating
unpleasant emotions and resisting craving-driven urges without losing
control. Core DBT strategies address this challenge:
Coping Ahead Plans
Proactively strategizing how to handle high-risk situations/emotions
beforehand using all learned skills increases clients’ sense of self-efficacy
and preparedness for challenges (Dimeff & Linehan, 2008).
Distracting with Opposite Emotions/Activities
Engaging in enjoyable hobbies, calling supports, self-soothing behaviors like
snapping a rubber band rides out cravings by shifting focus from addiction to
more productive outlets (Lindenboim et al., 2007).
Reality Acceptance
Letting go of desire to control unchangeable aspects of situations/feelings
allows clients to disengage from urges and make wise behavior choices
under stress (Dimeff & Linehan, 2008).
Self-Soothe with Five Senses
Soothing oneself through grounding sensory awareness exercises like deep
breathing, cool showers, music, tactile fidgets tolerates distress adaptively.
Wise Mind
Making decisions from balanced perspective considers priorities/values over
impulses, maintaining clarity under duress crucial for withstanding lapses
(Lindenboim et al., 2007).
Overall, distress tolerance skills strengthen clients to independently ride
emotional waves without relapsing by choosing constructive outlets
respecting recovery priorities. Over time, cravings lose power through
habituating new self-care patterns.
Conclusion
Addiction arises from complex interactions between biological, psychological
and social factors. Emotion dysregulation and maladaptive coping play
critical roles in both developing and maintaining substance dependence. For
these core reasons, therapeutic approaches like DBT directly targeting
emotional awareness, interpersonal effectiveness and distress tolerance hold
immense promise for empowering clients for long-term recovery success.
Through its dialectical philosophy balancing acceptance and change, DBT's
evidence-based techniques cultivate mindfulness, adaptive emotion
regulation and coping strategies serving as portable protective skills clients
can apply independently throughout their lifetime recovery journeys.
Whether facing relationship stressors, cravings and lapses or general life
challenges, these transdiagnostic DBT strategies bolster psychological
resilience against substance misuse. Overall, integrating such skills directly
addressing underlying vulnerabilities can greatly expand addiction
counselors’ toolbox for equipping clients with lifelong wellness tools.
Addiction is a disease involving compulsively seeking rewards and relief
through the use of substances or engaging in unhealthy behaviors despite
repercussions. A core reason many individuals develop addictions is due to
difficulties regulating feelings and coping with distress that arises from life's
challenges. Research shows a significant relationship between emotion
dysregulation and substance use disorders (SUDs), with high rates of co-
occurring mood and anxiety disorders as well (Witkiewitz & Bowen, 2010).
For this reason, therapeutic approaches that teach emotional regulation and
distress tolerance skills have particular relevance for addiction counseling.
One such evidence-based model is Dialectical Behavior Therapy (DBT).
Originally developed by Marsha Linehan in the 1980s to treat borderline
personality disorder, DBT has since been adapted and studied for treating
SUDs with great success (Dimeff & Linehan, 2008). Its core aim is balancing
acceptance of oneself and reality with a commitment to positive change
through teaching mindfulness, interpersonal effectiveness, emotional
regulation, and distress tolerance skills. This paper explores how DBT
strategies addressing emotion dysregulation and maladaptive coping can
benefit addiction counselors and their clients working toward long-term
recovery maintenance through building psychological resilience and
balanced living.
Overview of DBT Model and Strategies
DBT is a cognitive-behavioral treatment approach rooted in Zen Buddhism,
dialectics, and biosocial theory. Its overarching philosophy balances
acceptance and change in a dialectical manner, recognizing both the need to
validate inner experiences while committing to behavioral improvements
through skills practice. Therapists follow a "validation and encouragement"
stance, accepting clients where they are without judgment while also
motivating adaptive changes (Lindenboim et al., 2007). Individual therapy
sessions interweave this dialectical approach with teaching core DBT skills
modules.
The first skills module targets core mindfulness practices to cultivate wise,
balanced awareness of present internal and external experiences. Tasks like
breathing, body awareness, and daily logging exercises train non-judgmental
focus and observation that counteract tendencies toward emotional
reactivity, avoidance, and lack of self-care.
The second module trains interpersonal effectiveness through strategies like
DEARMAN, GIVE, and FAST that respectively help clients assert needs
respectfully, clearly communicate boundaries, and navigate challenging
social situations effectively and respectfully. Related communication
trainings address building empathy, validation, and compromise in
relationships (Swales, 2009).
The third module targets distress tolerance by identifying primary and
secondary emotions, tolerating painful experiences through wise "riding the
wave" and coping ahead techniques, distracting with safe activities,
improving with self-soothing behaviors, and accepting reality rather than
fighting unchangeable factors.
Finally, the emotion regulation module provides tools for mindfulness of
emotions, reducing vulnerability factors, changing emotional states through
opposing behaviors, and taking wise actions guided by healthy emotions
rather than impulsivity (Swales, 2009).
All strategies are manualized to ensure treatment fidelity and teach skills in a
hierarchical, paced manner through individual therapy, weekly group skills
training, phone coaching for intersession practice, and therapist consultation
meetings (Lindenboim et al., 2007). Therapists further encourage daily diary
card tracking to reinforce new behaviors and problem-solve obstacles
(Dimeff & Linehan, 2008).
Benefits for Addiction Counseling
DBT's mechanisms for addressing emotion dysregulation and distress
tolerance through mindfulness, interpersonal effectiveness and adaptive
coping strategies directly translate to benefiting addiction recovery in
several ways:
Cultivating Emotional Awareness
Mindfulness practices increase clients' ability to notice internal triggers for
substance urges and situational factors contributing to maladaptive coping
without becoming overwhelmed or acting impulsively. This awareness
provides distance and choice.
Managing Strong Emotions
DBT techniques like riding emotional waves, opposite action, and thinking of
wise mind give clients tools to experience even difficult feelings without
defaulting to addictive behaviors by tolerating distress or changing
emotional states in healthy ways.
Improving Relationship Dynamics
Interpersonal effectiveness skills help navigate social challenges and set
boundaries constructively without slipping into codependency, enabling
clients to build fulfilling support systems key for long-term sobriety.
Coping with Cravings and Relapse Triggers
Distress tolerance strategies such as self-soothing, distracting with
alternative activities, acceptance, and coping ahead plans equip clients to
manage cravings, urges or setbacks without losing control or abandoning
recovery entirely.
Reducing Shame and Self-Criticism
The validating, non-judgmental philosophy of DBT, combined with building
self-esteem through skills mastery, counters typical addict self-loathing,
isolation and hopelessness, fueling courage for change.
Addressing Co-Occurring Disorders
Clients dually diagnosed with addictions and mood/anxiety issues directly
benefit from DBT interventions targeting underlying emotion dysregulation
maintaining all related problems.
In summary, DBT offers versatile transdiagnostic techniques addressing root
factors at the emotions-addictions interface through mindfulness, effective
communication, and adaptive coping strategies. These empower clients to
establish long-term wellness and balance in recovery.
Cultivating Mindfulness for Emotional Awareness
A primary way DBT builds emotional regulation is through cultivating
mindfulness—non-judging, present-moment awareness of internal and
external experiences. This metacognitive skill counters addiction-related
tendencies toward emotional avoidance, reactivity and lack of self-care. DBT
mindfulness practices include:
Observational Exercises
Clients notice thoughts/feelings passively without reaction through Body
Scan meditation, Pleasant Events daily logs, or Emotion Diary homework
logging triggers. This detachment interrupts addiction's automatic pilot and
compulsion cycles (Lindenboim et al., 2007).
Focus & Breath Awareness
Focusing mind on breathing or other external sensory anchors like music
pulls attention to anchoring physical sensations rather than
racing/ruminating thoughts sustaining craving-using cycles. Short- and long-
term breath practices help sustain wise mindfulness.
Distress Tolerance Strategies
Self-soothing behaviors like holding an ice cube, blowing bubbles, smelling
pleasant scents, or saying encouraging self-talk provide concrete
mindfulness tools for tolerating distressing triggers or lapses without
abandoning broader recovery efforts (Dimeff & Linehan, 2008).
Wise Mind State
This balanced perspective integrating reason and intuition gives clients
capacity to make clear choices guided by sobriety priorities rather than
emotions alone. Mindfulness maintains wise mind clarity during decision-
making.
The detached, non-reactive stance cultivated through mindfulness allows
clients to recognize addiction-related thoughts or urges arising without
immediately becoming overwhelmed or impulsively acting out self-
destructive patterns (Lindenboim et al., 2007). Instead, mindfulness creates
psychological space to choose constructive coping options. Over time, this
metacognition enhances emotion regulation abilities crucial for long-term
recovery success and well-being.
Improving Emotion Regulation Skills
While mindfulness fosters awareness, DBT directly teaches core strategies
for modulating emotions: opposite action, changing vulnerability factors,
urges surfing, ACCEPTS framework. When applied alongside counselor
guidance and group processing, these tools become empowering skills
clients own for long-term management of affective triggers maintaining
addictions:
Opposite Action
Deliberately acting opposite cravings/emotions by engaging in healthful
distracting activities like exercise or calling supports interrupts addiction's
automatic pilot processes. Over time, new response patterns replace harmful
ones (Lindenboim et al., 2007).
Changing Vulnerability Factors
Clients identify avoidant patterns exacerbating emotional vulnerabilities like
lack of sleep, isolation from supports, self-criticism, all-or-nothing thinking,
then take wise preemptive actions before distressing triggers arise (Dimeff &
Linehan, 2008).
Urge Surfing
Mindfully "riding the emotional wave" of cravings/triggers without reacting
teaches clients to detach from transient feelings and wait patiently for
intensity to naturally lessen on its own without acting out dysfunctional urges
(Lindenboim et al., 2007).
ACCEPTS Framework
This acronym guides clients moving through difficult emotions by Activating
wise mind, identifying Current thoughts/emotions kindly, evaluating
Pros/cons objectively, nurturing compassion for self with softer self-talk,
noting Thoughts are fleeting mental events, experiencing physical
Sensations fully with mindfulness, and committing to Self-care by tolerating
distress adaptively (Dimeff & Linehan, 2008).
Overall, enhancing clients' emotional intelligence and expanding skills
repertoires for balancing reason and feelings provides an arsenal against
addiction-related vulnerabilities. Over time, habitual thoughts like "I just
need to use to feel better" lose power as viable alternative responses are
practiced.
Developing Interpersonal Effectiveness
Another component crucial for sustained recovery is reducing dependency on
unhealthy relationships maintaining addictions while cultivating fulfilling
connections supporting well-balanced living. The DBT Interpersonal
Effectiveness module teaches constructive strategies including:
DEARMAN
This acronym guides assertively asking for what one wants respectfully while
maintaining self-respect and the relationship. Clients apply it to set
boundaries with enabling contacts (Lindenboim et al., 2007).
GIVE
Giving information clearly and validly, expressing wishes/feelings
respectfully, validating others and negotiating disputes constructively helps
clients navigate interpersonal challenges constructively.
FAST
Avoiding risky situations threatening safety/goals, thinking things through
considering priorities/limits, negotiating for win-win compromises, asserting
calmly and truthfully preserves solid recovery support systems over time
through balanced living principles (Dimeff & Linehan, 2008).
Validation/Empathy
Showing compassion for others without enabling harm and resolving
misunderstandings through validating different perspectives strengthens
fulfilling relationships integral for long-term recovery maintenance and
overall well-being.
Overall, equipping clients to meet interpersonal needs constructively without
codependency or enabling dysfunctional patterns provides critical relational
tools serving as protective factors buttressing recovery success over a
lifetime. DBT strategies foster socially supportive ecosystems nourishing
wellness.
Coping with Distress and Cravings
Perhaps the greatest test for newly recovering individuals is tolerating
unpleasant emotions and resisting craving-driven urges without losing
control. Core DBT strategies address this challenge:
Coping Ahead Plans
Proactively strategizing how to handle high-risk situations/emotions
beforehand using all learned skills increases clients’ sense of self-efficacy
and preparedness for challenges (Dimeff & Linehan, 2008).
Distracting with Opposite Emotions/Activities
Engaging in enjoyable hobbies, calling supports, self-soothing behaviors like
snapping a rubber band rides out cravings by shifting focus from addiction to
more productive outlets (Lindenboim et al., 2007).
Reality Acceptance
Letting go of desire to control unchangeable aspects of situations/feelings
allows clients to disengage from urges and make wise behavior choices
under stress (Dimeff & Linehan, 2008).
Self-Soothe with Five Senses
Soothing oneself through grounding sensory awareness exercises like deep
breathing, cool showers, music, tactile fidgets tolerates distress adaptively.
Wise Mind
Making decisions from balanced perspective considers priorities/values over
impulses, maintaining clarity under duress crucial for withstanding lapses
(Lindenboim et al., 2007).
Overall, distress tolerance skills strengthen clients to independently ride
emotional waves without relapsing by choosing constructive outlets
respecting recovery priorities. Over time, cravings lose power through
habituating new self-care patterns.
Conclusion
Addiction arises from complex interactions between biological, psychological
and social factors. Emotion dysregulation and maladaptive coping play
critical roles in both developing and maintaining substance dependence. For
these core reasons, therapeutic approaches like DBT directly targeting
emotional awareness, interpersonal effectiveness and distress tolerance hold
immense promise for empowering clients for long-term recovery success.
Through its dialectical philosophy balancing acceptance and change, DBT's
evidence-based techniques cultivate mindfulness, adaptive emotion
regulation and coping strategies serving as portable protective skills clients
can apply independently throughout their lifetime recovery journeys.
Whether facing relationship stressors, cravings and lapses or general life
challenges, these transdiagnostic DBT strategies bolster psychological
resilience against substance misuse. Overall, integrating such skills directly
addressing underlying vulnerabilities can greatly expand addiction
counselors’ toolbox for equipping clients with lifelong wellness tools.
Addiction is a disease involving compulsively seeking rewards and relief
through the use of substances or engaging in unhealthy behaviors despite
repercussions. A core reason many individuals develop addictions is due to
difficulties regulating feelings and coping with distress that arises from life's
challenges. Research shows a significant relationship between emotion
dysregulation and substance use disorders (SUDs), with high rates of co-
occurring mood and anxiety disorders as well (Witkiewitz & Bowen, 2010).
For this reason, therapeutic approaches that teach emotional regulation and
distress tolerance skills have particular relevance for addiction counseling.
One such evidence-based model is Dialectical Behavior Therapy (DBT).
Originally developed by Marsha Linehan in the 1980s to treat borderline
personality disorder, DBT has since been adapted and studied for treating
SUDs with great success (Dimeff & Linehan, 2008). Its core aim is balancing
acceptance of oneself and reality with a commitment to positive change
through teaching mindfulness, interpersonal effectiveness, emotional
regulation, and distress tolerance skills. This paper explores how DBT
strategies addressing emotion dysregulation and maladaptive coping can
benefit addiction counselors and their clients working toward long-term
recovery maintenance through building psychological resilience and
balanced living.
Overview of DBT Model and Strategies
DBT is a cognitive-behavioral treatment approach rooted in Zen Buddhism,
dialectics, and biosocial theory. Its overarching philosophy balances
acceptance and change in a dialectical manner, recognizing both the need to
validate inner experiences while committing to behavioral improvements
through skills practice. Therapists follow a "validation and encouragement"
stance, accepting clients where they are without judgment while also
motivating adaptive changes (Lindenboim et al., 2007). Individual therapy
sessions interweave this dialectical approach with teaching core DBT skills
modules.
The first skills module targets core mindfulness practices to cultivate wise,
balanced awareness of present internal and external experiences. Tasks like
breathing, body awareness, and daily logging exercises train non-judgmental
focus and observation that counteract tendencies toward emotional
reactivity, avoidance, and lack of self-care.
The second module trains interpersonal effectiveness through strategies like
DEARMAN, GIVE, and FAST that respectively help clients assert needs
respectfully, clearly communicate boundaries, and navigate challenging
social situations effectively and respectfully. Related communication
trainings address building empathy, validation, and compromise in
relationships (Swales, 2009).
The third module targets distress tolerance by identifying primary and
secondary emotions, tolerating painful experiences through wise "riding the
wave" and coping ahead techniques, distracting with safe activities,
improving with self-soothing behaviors, and accepting reality rather than
fighting unchangeable factors.
Finally, the emotion regulation module provides tools for mindfulness of
emotions, reducing vulnerability factors, changing emotional states through
opposing behaviors, and taking wise actions guided by healthy emotions
rather than impulsivity (Swales, 2009).
All strategies are manualized to ensure treatment fidelity and teach skills in a
hierarchical, paced manner through individual therapy, weekly group skills
training, phone coaching for intersession practice, and therapist consultation
meetings (Lindenboim et al., 2007). Therapists further encourage daily diary
card tracking to reinforce new behaviors and problem-solve obstacles
(Dimeff & Linehan, 2008).
Benefits for Addiction Counseling
DBT's mechanisms for addressing emotion dysregulation and distress
tolerance through mindfulness, interpersonal effectiveness and adaptive
coping strategies directly translate to benefiting addiction recovery in
several ways:
Cultivating Emotional Awareness
Mindfulness practices increase clients' ability to notice internal triggers for
substance urges and situational factors contributing to maladaptive coping
without becoming overwhelmed or acting impulsively. This awareness
provides distance and choice.
Managing Strong Emotions
DBT techniques like riding emotional waves, opposite action, and thinking of
wise mind give clients tools to experience even difficult feelings without
defaulting to addictive behaviors by tolerating distress or changing
emotional states in healthy ways.
Improving Relationship Dynamics
Interpersonal effectiveness skills help navigate social challenges and set
boundaries constructively without slipping into codependency, enabling
clients to build fulfilling support systems key for long-term sobriety.
Coping with Cravings and Relapse Triggers
Distress tolerance strategies such as self-soothing, distracting with
alternative activities, acceptance, and coping ahead plans equip clients to
manage cravings, urges or setbacks without losing control or abandoning
recovery entirely.
Reducing Shame and Self-Criticism
The validating, non-judgmental philosophy of DBT, combined with building
self-esteem through skills mastery, counters typical addict self-loathing,
isolation and hopelessness, fueling courage for change.
Addressing Co-Occurring Disorders
Clients dually diagnosed with addictions and mood/anxiety issues directly
benefit from DBT interventions targeting underlying emotion dysregulation
maintaining all related problems.
In summary, DBT offers versatile transdiagnostic techniques addressing root
factors at the emotions-addictions interface through mindfulness, effective
communication, and adaptive coping strategies. These empower clients to
establish long-term wellness and balance in recovery.
Cultivating Mindfulness for Emotional Awareness
A primary way DBT builds emotional regulation is through cultivating
mindfulness—non-judging, present-moment awareness of internal and
external experiences. This metacognitive skill counters addiction-related
tendencies toward emotional avoidance, reactivity and lack of self-care. DBT
mindfulness practices include:
Observational Exercises
Clients notice thoughts/feelings passively without reaction through Body
Scan meditation, Pleasant Events daily logs, or Emotion Diary homework
logging triggers. This detachment interrupts addiction's automatic pilot and
compulsion cycles (Lindenboim et al., 2007).
Focus & Breath Awareness
Focusing mind on breathing or other external sensory anchors like music
pulls attention to anchoring physical sensations rather than
racing/ruminating thoughts sustaining craving-using cycles. Short- and long-
term breath practices help sustain wise mindfulness.
Distress Tolerance Strategies
Self-soothing behaviors like holding an ice cube, blowing bubbles, smelling
pleasant scents, or saying encouraging self-talk provide concrete
mindfulness tools for tolerating distressing triggers or lapses without
abandoning broader recovery efforts (Dimeff & Linehan, 2008).
Wise Mind State
This balanced perspective integrating reason and intuition gives clients
capacity to make clear choices guided by sobriety priorities rather than
emotions alone. Mindfulness maintains wise mind clarity during decision-
making.
The detached, non-reactive stance cultivated through mindfulness allows
clients to recognize addiction-related thoughts or urges arising without
immediately becoming overwhelmed or impulsively acting out self-
destructive patterns (Lindenboim et al., 2007). Instead, mindfulness creates
psychological space to choose constructive coping options. Over time, this
metacognition enhances emotion regulation abilities crucial for long-term
recovery success and well-being.
Improving Emotion Regulation Skills
While mindfulness fosters awareness, DBT directly teaches core strategies
for modulating emotions: opposite action, changing vulnerability factors,
urges surfing, ACCEPTS framework. When applied alongside counselor
guidance and group processing, these tools become empowering skills
clients own for long-term management of affective triggers maintaining
addictions:
Opposite Action
Deliberately acting opposite cravings/emotions by engaging in healthful
distracting activities like exercise or calling supports interrupts addiction's
automatic pilot processes. Over time, new response patterns replace harmful
ones (Lindenboim et al., 2007).
Changing Vulnerability Factors
Clients identify avoidant patterns exacerbating emotional vulnerabilities like
lack of sleep, isolation from supports, self-criticism, all-or-nothing thinking,
then take wise preemptive actions before distressing triggers arise (Dimeff &
Linehan, 2008).
Urge Surfing
Mindfully "riding the emotional wave" of cravings/triggers without reacting
teaches clients to detach from transient feelings and wait patiently for
intensity to naturally lessen on its own without acting out dysfunctional urges
(Lindenboim et al., 2007).
ACCEPTS Framework
This acronym guides clients moving through difficult emotions by Activating
wise mind, identifying Current thoughts/emotions kindly, evaluating
Pros/cons objectively, nurturing compassion for self with softer self-talk,
noting Thoughts are fleeting mental events, experiencing physical
Sensations fully with mindfulness, and committing to Self-care by tolerating
distress adaptively (Dimeff & Linehan, 2008).
Overall, enhancing clients' emotional intelligence and expanding skills
repertoires for balancing reason and feelings provides an arsenal against
addiction-related vulnerabilities. Over time, habitual thoughts like "I just
need to use to feel better" lose power as viable alternative responses are
practiced.
Developing Interpersonal Effectiveness
Another component crucial for sustained recovery is reducing dependency on
unhealthy relationships maintaining addictions while cultivating fulfilling
connections supporting well-balanced living. The DBT Interpersonal
Effectiveness module teaches constructive strategies including:
DEARMAN
This acronym guides assertively asking for what one wants respectfully while
maintaining self-respect and the relationship. Clients apply it to set
boundaries with enabling contacts (Lindenboim et al., 2007).
GIVE
Giving information clearly and validly, expressing wishes/feelings
respectfully, validating others and negotiating disputes constructively helps
clients navigate interpersonal challenges constructively.
FAST
Avoiding risky situations threatening safety/goals, thinking things through
considering priorities/limits, negotiating for win-win compromises, asserting
calmly and truthfully preserves solid recovery support systems over time
through balanced living principles (Dimeff & Linehan, 2008).
Validation/Empathy
Showing compassion for others without enabling harm and resolving
misunderstandings through validating different perspectives strengthens
fulfilling relationships integral for long-term recovery maintenance and
overall well-being.
Overall, equipping clients to meet interpersonal needs constructively without
codependency or enabling dysfunctional patterns provides critical relational
tools serving as protective factors buttressing recovery success over a
lifetime. DBT strategies foster socially supportive ecosystems nourishing
wellness.
Coping with Distress and Cravings
Perhaps the greatest test for newly recovering individuals is tolerating
unpleasant emotions and resisting craving-driven urges without losing
control. Core DBT strategies address this challenge:
Coping Ahead Plans
Proactively strategizing how to handle high-risk situations/emotions
beforehand using all learned skills increases clients’ sense of self-efficacy
and preparedness for challenges (Dimeff & Linehan, 2008).
Distracting with Opposite Emotions/Activities
Engaging in enjoyable hobbies, calling supports, self-soothing behaviors like
snapping a rubber band rides out cravings by shifting focus from addiction to
more productive outlets (Lindenboim et al., 2007).
Reality Acceptance
Letting go of desire to control unchangeable aspects of situations/feelings
allows clients to disengage from urges and make wise behavior choices
under stress (Dimeff & Linehan, 2008).
Self-Soothe with Five Senses
Soothing oneself through grounding sensory awareness exercises like deep
breathing, cool showers, music, tactile fidgets tolerates distress adaptively.
Wise Mind
Making decisions from balanced perspective considers priorities/values over
impulses, maintaining clarity under duress crucial for withstanding lapses
(Lindenboim et al., 2007).
Overall, distress tolerance skills strengthen clients to independently ride
emotional waves without relapsing by choosing constructive outlets
respecting recovery priorities. Over time, cravings lose power through
habituating new self-care patterns.
Conclusion
Addiction arises from complex interactions between biological, psychological
and social factors. Emotion dysregulation and maladaptive coping play
critical roles in both developing and maintaining substance dependence. For
these core reasons, therapeutic approaches like DBT directly targeting
emotional awareness, interpersonal effectiveness and distress tolerance hold
immense promise for empowering clients for long-term recovery success.
Through its dialectical philosophy balancing acceptance and change, DBT's
evidence-based techniques cultivate mindfulness, adaptive emotion
regulation and coping strategies serving as portable protective skills clients
can apply independently throughout their lifetime recovery journeys.
Whether facing relationship stressors, cravings and lapses or general life
challenges, these transdiagnostic DBT strategies bolster psychological
resilience against substance misuse. Overall, integrating such skills directly
addressing underlying vulnerabilities can greatly expand addiction
counselors’ toolbox for equipping clients with lifelong wellness tools.
Addiction is a disease involving compulsively seeking rewards and relief
through the use of substances or engaging in unhealthy behaviors despite
repercussions. A core reason many individuals develop addictions is due to
difficulties regulating feelings and coping with distress that arises from life's
challenges. Research shows a significant relationship between emotion
dysregulation and substance use disorders (SUDs), with high rates of co-
occurring mood and anxiety disorders as well (Witkiewitz & Bowen, 2010).
For this reason, therapeutic approaches that teach emotional regulation and
distress tolerance skills have particular relevance for addiction counseling.
One such evidence-based model is Dialectical Behavior Therapy (DBT).
Originally developed by Marsha Linehan in the 1980s to treat borderline
personality disorder, DBT has since been adapted and studied for treating
SUDs with great success (Dimeff & Linehan, 2008). Its core aim is balancing
acceptance of oneself and reality with a commitment to positive change
through teaching mindfulness, interpersonal effectiveness, emotional
regulation, and distress tolerance skills. This paper explores how DBT
strategies addressing emotion dysregulation and maladaptive coping can
benefit addiction counselors and their clients working toward long-term
recovery maintenance through building psychological resilience and
balanced living.
Overview of DBT Model and Strategies
DBT is a cognitive-behavioral treatment approach rooted in Zen Buddhism,
dialectics, and biosocial theory. Its overarching philosophy balances
acceptance and change in a dialectical manner, recognizing both the need to
validate inner experiences while committing to behavioral improvements
through skills practice. Therapists follow a "validation and encouragement"
stance, accepting clients where they are without judgment while also
motivating adaptive changes (Lindenboim et al., 2007). Individual therapy
sessions interweave this dialectical approach with teaching core DBT skills
modules.
The first skills module targets core mindfulness practices to cultivate wise,
balanced awareness of present internal and external experiences. Tasks like
breathing, body awareness, and daily logging exercises train non-judgmental
focus and observation that counteract tendencies toward emotional
reactivity, avoidance, and lack of self-care.
The second module trains interpersonal effectiveness through strategies like
DEARMAN, GIVE, and FAST that respectively help clients assert needs
respectfully, clearly communicate boundaries, and navigate challenging
social situations effectively and respectfully. Related communication
trainings address building empathy, validation, and compromise in
relationships (Swales, 2009).
The third module targets distress tolerance by identifying primary and
secondary emotions, tolerating painful experiences through wise "riding the
wave" and coping ahead techniques, distracting with safe activities,
improving with self-soothing behaviors, and accepting reality rather than
fighting unchangeable factors.
Finally, the emotion regulation module provides tools for mindfulness of
emotions, reducing vulnerability factors, changing emotional states through
opposing behaviors, and taking wise actions guided by healthy emotions
rather than impulsivity (Swales, 2009).
All strategies are manualized to ensure treatment fidelity and teach skills in a
hierarchical, paced manner through individual therapy, weekly group skills
training, phone coaching for intersession practice, and therapist consultation
meetings (Lindenboim et al., 2007). Therapists further encourage daily diary
card tracking to reinforce new behaviors and problem-solve obstacles
(Dimeff & Linehan, 2008).
Benefits for Addiction Counseling
DBT's mechanisms for addressing emotion dysregulation and distress
tolerance through mindfulness, interpersonal effectiveness and adaptive
coping strategies directly translate to benefiting addiction recovery in
several ways:
Cultivating Emotional Awareness
Mindfulness practices increase clients' ability to notice internal triggers for
substance urges and situational factors contributing to maladaptive coping
without becoming overwhelmed or acting impulsively. This awareness
provides distance and choice.
Managing Strong Emotions
DBT techniques like riding emotional waves, opposite action, and thinking of
wise mind give clients tools to experience even difficult feelings without
defaulting to addictive behaviors by tolerating distress or changing
emotional states in healthy ways.
Improving Relationship Dynamics
Interpersonal effectiveness skills help navigate social challenges and set
boundaries constructively without slipping into codependency, enabling
clients to build fulfilling support systems key for long-term sobriety.
Coping with Cravings and Relapse Triggers
Distress tolerance strategies such as self-soothing, distracting with
alternative activities, acceptance, and coping ahead plans equip clients to
manage cravings, urges or setbacks without losing control or abandoning
recovery entirely.
Reducing Shame and Self-Criticism
The validating, non-judgmental philosophy of DBT, combined with building
self-esteem through skills mastery, counters typical addict self-loathing,
isolation and hopelessness, fueling courage for change.
Addressing Co-Occurring Disorders
Clients dually diagnosed with addictions and mood/anxiety issues directly
benefit from DBT interventions targeting underlying emotion dysregulation
maintaining all related problems.
In summary, DBT offers versatile transdiagnostic techniques addressing root
factors at the emotions-addictions interface through mindfulness, effective
communication, and adaptive coping strategies. These empower clients to
establish long-term wellness and balance in recovery.
Cultivating Mindfulness for Emotional Awareness
A primary way DBT builds emotional regulation is through cultivating
mindfulness—non-judging, present-moment awareness of internal and
external experiences. This metacognitive skill counters addiction-related
tendencies toward emotional avoidance, reactivity and lack of self-care. DBT
mindfulness practices include:
Observational Exercises
Clients notice thoughts/feelings passively without reaction through Body
Scan meditation, Pleasant Events daily logs, or Emotion Diary homework
logging triggers. This detachment interrupts addiction's automatic pilot and
compulsion cycles (Lindenboim et al., 2007).
Focus & Breath Awareness
Focusing mind on breathing or other external sensory anchors like music
pulls attention to anchoring physical sensations rather than
racing/ruminating thoughts sustaining craving-using cycles. Short- and long-
term breath practices help sustain wise mindfulness.
Distress Tolerance Strategies
Self-soothing behaviors like holding an ice cube, blowing bubbles, smelling
pleasant scents, or saying encouraging self-talk provide concrete
mindfulness tools for tolerating distressing triggers or lapses without
abandoning broader recovery efforts (Dimeff & Linehan, 2008).
Wise Mind State
This balanced perspective integrating reason and intuition gives clients
capacity to make clear choices guided by sobriety priorities rather than
emotions alone. Mindfulness maintains wise mind clarity during decision-
making.
The detached, non-reactive stance cultivated through mindfulness allows
clients to recognize addiction-related thoughts or urges arising without
immediately becoming overwhelmed or impulsively acting out self-
destructive patterns (Lindenboim et al., 2007). Instead, mindfulness creates
psychological space to choose constructive coping options. Over time, this
metacognition enhances emotion regulation abilities crucial for long-term
recovery success and well-being.
Improving Emotion Regulation Skills
While mindfulness fosters awareness, DBT directly teaches core strategies
for modulating emotions: opposite action, changing vulnerability factors,
urges surfing, ACCEPTS framework. When applied alongside counselor
guidance and group processing, these tools become empowering skills
clients own for long-term management of affective triggers maintaining
addictions:
Opposite Action
Deliberately acting opposite cravings/emotions by engaging in healthful
distracting activities like exercise or calling supports interrupts addiction's
automatic pilot processes. Over time, new response patterns replace harmful
ones (Lindenboim et al., 2007).
Changing Vulnerability Factors
Clients identify avoidant patterns exacerbating emotional vulnerabilities like
lack of sleep, isolation from supports, self-criticism, all-or-nothing thinking,
then take wise preemptive actions before distressing triggers arise (Dimeff &
Linehan, 2008).
Urge Surfing
Mindfully "riding the emotional wave" of cravings/triggers without reacting
teaches clients to detach from transient feelings and wait patiently for
intensity to naturally lessen on its own without acting out dysfunctional urges
(Lindenboim et al., 2007).
ACCEPTS Framework
This acronym guides clients moving through difficult emotions by Activating
wise mind, identifying Current thoughts/emotions kindly, evaluating
Pros/cons objectively, nurturing compassion for self with softer self-talk,
noting Thoughts are fleeting mental events, experiencing physical
Sensations fully with mindfulness, and committing to Self-care by tolerating
distress adaptively (Dimeff & Linehan, 2008).
Overall, enhancing clients' emotional intelligence and expanding skills
repertoires for balancing reason and feelings provides an arsenal against
addiction-related vulnerabilities. Over time, habitual thoughts like "I just
need to use to feel better" lose power as viable alternative responses are
practiced.
Developing Interpersonal Effectiveness
Another component crucial for sustained recovery is reducing dependency on
unhealthy relationships maintaining addictions while cultivating fulfilling
connections supporting well-balanced living. The DBT Interpersonal
Effectiveness module teaches constructive strategies including:
DEARMAN
This acronym guides assertively asking for what one wants respectfully while
maintaining self-respect and the relationship. Clients apply it to set
boundaries with enabling contacts (Lindenboim et al., 2007).
GIVE
Giving information clearly and validly, expressing wishes/feelings
respectfully, validating others and negotiating disputes constructively helps
clients navigate interpersonal challenges constructively.
FAST
Avoiding risky situations threatening safety/goals, thinking things through
considering priorities/limits, negotiating for win-win compromises, asserting
calmly and truthfully preserves solid recovery support systems over time
through balanced living principles (Dimeff & Linehan, 2008).
Validation/Empathy
Showing compassion for others without enabling harm and resolving
misunderstandings through validating different perspectives strengthens
fulfilling relationships integral for long-term recovery maintenance and
overall well-being.
Overall, equipping clients to meet interpersonal needs constructively without
codependency or enabling dysfunctional patterns provides critical relational
tools serving as protective factors buttressing recovery success over a
lifetime. DBT strategies foster socially supportive ecosystems nourishing
wellness.
Coping with Distress and Cravings
Perhaps the greatest test for newly recovering individuals is tolerating
unpleasant emotions and resisting craving-driven urges without losing
control. Core DBT strategies address this challenge:
Coping Ahead Plans
Proactively strategizing how to handle high-risk situations/emotions
beforehand using all learned skills increases clients’ sense of self-efficacy
and preparedness for challenges (Dimeff & Linehan, 2008).
Distracting with Opposite Emotions/Activities
Engaging in enjoyable hobbies, calling supports, self-soothing behaviors like
snapping a rubber band rides out cravings by shifting focus from addiction to
more productive outlets (Lindenboim et al., 2007).
Reality Acceptance
Letting go of desire to control unchangeable aspects of situations/feelings
allows clients to disengage from urges and make wise behavior choices
under stress (Dimeff & Linehan, 2008).
Self-Soothe with Five Senses
Soothing oneself through grounding sensory awareness exercises like deep
breathing, cool showers, music, tactile fidgets tolerates distress adaptively.
Wise Mind
Making decisions from balanced perspective considers priorities/values over
impulses, maintaining clarity under duress crucial for withstanding lapses
(Lindenboim et al., 2007).
Overall, distress tolerance skills strengthen clients to independently ride
emotional waves without relapsing by choosing constructive outlets
respecting recovery priorities. Over time, cravings lose power through
habituating new self-care patterns.
Conclusion
Addiction arises from complex interactions between biological, psychological
and social factors. Emotion dysregulation and maladaptive coping play
critical roles in both developing and maintaining substance dependence. For
these core reasons, therapeutic approaches like DBT directly targeting
emotional awareness, interpersonal effectiveness and distress tolerance hold
immense promise for empowering clients for long-term recovery success.
Through its dialectical philosophy balancing acceptance and change, DBT's
evidence-based techniques cultivate mindfulness, adaptive emotion
regulation and coping strategies serving as portable protective skills clients
can apply independently throughout their lifetime recovery journeys.
Whether facing relationship stressors, cravings and lapses or general life
challenges, these transdiagnostic DBT strategies bolster psychological
resilience against substance misuse. Overall, integrating such skills directly
addressing underlying vulnerabilities can greatly expand addiction
counselors’ toolbox for equipping clients with lifelong wellness tools.
Addiction is a disease involving compulsively seeking rewards and relief
through the use of substances or engaging in unhealthy behaviors despite
repercussions. A core reason many individuals develop addictions is due to
difficulties regulating feelings and coping with distress that arises from life's
challenges. Research shows a significant relationship between emotion
dysregulation and substance use disorders (SUDs), with high rates of co-
occurring mood and anxiety disorders as well (Witkiewitz & Bowen, 2010).
For this reason, therapeutic approaches that teach emotional regulation and
distress tolerance skills have particular relevance for addiction counseling.
One such evidence-based model is Dialectical Behavior Therapy (DBT).
Originally developed by Marsha Linehan in the 1980s to treat borderline
personality disorder, DBT has since been adapted and studied for treating
SUDs with great success (Dimeff & Linehan, 2008). Its core aim is balancing
acceptance of oneself and reality with a commitment to positive change
through teaching mindfulness, interpersonal effectiveness, emotional
regulation, and distress tolerance skills. This paper explores how DBT
strategies addressing emotion dysregulation and maladaptive coping can
benefit addiction counselors and their clients working toward long-term
recovery maintenance through building psychological resilience and
balanced living.
Overview of DBT Model and Strategies
DBT is a cognitive-behavioral treatment approach rooted in Zen Buddhism,
dialectics, and biosocial theory. Its overarching philosophy balances
acceptance and change in a dialectical manner, recognizing both the need to
validate inner experiences while committing to behavioral improvements
through skills practice. Therapists follow a "validation and encouragement"
stance, accepting clients where they are without judgment while also
motivating adaptive changes (Lindenboim et al., 2007). Individual therapy
sessions interweave this dialectical approach with teaching core DBT skills
modules.
The first skills module targets core mindfulness practices to cultivate wise,
balanced awareness of present internal and external experiences. Tasks like
breathing, body awareness, and daily logging exercises train non-judgmental
focus and observation that counteract tendencies toward emotional
reactivity, avoidance, and lack of self-care.
The second module trains interpersonal effectiveness through strategies like
DEARMAN, GIVE, and FAST that respectively help clients assert needs
respectfully, clearly communicate boundaries, and navigate challenging
social situations effectively and respectfully. Related communication
trainings address building empathy, validation, and compromise in
relationships (Swales, 2009).
The third module targets distress tolerance by identifying primary and
secondary emotions, tolerating painful experiences through wise "riding the
wave" and coping ahead techniques, distracting with safe activities,
improving with self-soothing behaviors, and accepting reality rather than
fighting unchangeable factors.
Finally, the emotion regulation module provides tools for mindfulness of
emotions, reducing vulnerability factors, changing emotional states through
opposing behaviors, and taking wise actions guided by healthy emotions
rather than impulsivity (Swales, 2009).
All strategies are manualized to ensure treatment fidelity and teach skills in a
hierarchical, paced manner through individual therapy, weekly group skills
training, phone coaching for intersession practice, and therapist consultation
meetings (Lindenboim et al., 2007). Therapists further encourage daily diary
card tracking to reinforce new behaviors and problem-solve obstacles
(Dimeff & Linehan, 2008).
Benefits for Addiction Counseling
DBT's mechanisms for addressing emotion dysregulation and distress
tolerance through mindfulness, interpersonal effectiveness and adaptive
coping strategies directly translate to benefiting addiction recovery in
several ways:
Cultivating Emotional Awareness
Mindfulness practices increase clients' ability to notice internal triggers for
substance urges and situational factors contributing to maladaptive coping
without becoming overwhelmed or acting impulsively. This awareness
provides distance and choice.
Managing Strong Emotions
DBT techniques like riding emotional waves, opposite action, and thinking of
wise mind give clients tools to experience even difficult feelings without
defaulting to addictive behaviors by tolerating distress or changing
emotional states in healthy ways.
Improving Relationship Dynamics
Interpersonal effectiveness skills help navigate social challenges and set
boundaries constructively without slipping into codependency, enabling
clients to build fulfilling support systems key for long-term sobriety.
Coping with Cravings and Relapse Triggers
Distress tolerance strategies such as self-soothing, distracting with
alternative activities, acceptance, and coping ahead plans equip clients to
manage cravings, urges or setbacks without losing control or abandoning
recovery entirely.
Reducing Shame and Self-Criticism
The validating, non-judgmental philosophy of DBT, combined with building
self-esteem through skills mastery, counters typical addict self-loathing,
isolation and hopelessness, fueling courage for change.
Addressing Co-Occurring Disorders
Clients dually diagnosed with addictions and mood/anxiety issues directly
benefit from DBT interventions targeting underlying emotion dysregulation
maintaining all related problems.
In summary, DBT offers versatile transdiagnostic techniques addressing root
factors at the emotions-addictions interface through mindfulness, effective
communication, and adaptive coping strategies. These empower clients to
establish long-term wellness and balance in recovery.
Cultivating Mindfulness for Emotional Awareness
A primary way DBT builds emotional regulation is through cultivating
mindfulness—non-judging, present-moment awareness of internal and
external experiences. This metacognitive skill counters addiction-related
tendencies toward emotional avoidance, reactivity and lack of self-care. DBT
mindfulness practices include:
Observational Exercises
Clients notice thoughts/feelings passively without reaction through Body
Scan meditation, Pleasant Events daily logs, or Emotion Diary homework
logging triggers. This detachment interrupts addiction's automatic pilot and
compulsion cycles (Lindenboim et al., 2007).
Focus & Breath Awareness
Focusing mind on breathing or other external sensory anchors like music
pulls attention to anchoring physical sensations rather than
racing/ruminating thoughts sustaining craving-using cycles. Short- and long-
term breath practices help sustain wise mindfulness.
Distress Tolerance Strategies
Self-soothing behaviors like holding an ice cube, blowing bubbles, smelling
pleasant scents, or saying encouraging self-talk provide concrete
mindfulness tools for tolerating distressing triggers or lapses without
abandoning broader recovery efforts (Dimeff & Linehan, 2008).
Wise Mind State
This balanced perspective integrating reason and intuition gives clients
capacity to make clear choices guided by sobriety priorities rather than
emotions alone. Mindfulness maintains wise mind clarity during decision-
making.
The detached, non-reactive stance cultivated through mindfulness allows
clients to recognize addiction-related thoughts or urges arising without
immediately becoming overwhelmed or impulsively acting out self-
destructive patterns (Lindenboim et al., 2007). Instead, mindfulness creates
psychological space to choose constructive coping options. Over time, this
metacognition enhances emotion regulation abilities crucial for long-term
recovery success and well-being.
Improving Emotion Regulation Skills
While mindfulness fosters awareness, DBT directly teaches core strategies
for modulating emotions: opposite action, changing vulnerability factors,
urges surfing, ACCEPTS framework. When applied alongside counselor
guidance and group processing, these tools become empowering skills
clients own for long-term management of affective triggers maintaining
addictions:
Opposite Action
Deliberately acting opposite cravings/emotions by engaging in healthful
distracting activities like exercise or calling supports interrupts addiction's
automatic pilot processes. Over time, new response patterns replace harmful
ones (Lindenboim et al., 2007).
Changing Vulnerability Factors
Clients identify avoidant patterns exacerbating emotional vulnerabilities like
lack of sleep, isolation from supports, self-criticism, all-or-nothing thinking,
then take wise preemptive actions before distressing triggers arise (Dimeff &
Linehan, 2008).
Urge Surfing
Mindfully "riding the emotional wave" of cravings/triggers without reacting
teaches clients to detach from transient feelings and wait patiently for
intensity to naturally lessen on its own without acting out dysfunctional urges
(Lindenboim et al., 2007).
ACCEPTS Framework
This acronym guides clients moving through difficult emotions by Activating
wise mind, identifying Current thoughts/emotions kindly, evaluating
Pros/cons objectively, nurturing compassion for self with softer self-talk,
noting Thoughts are fleeting mental events, experiencing physical
Sensations fully with mindfulness, and committing to Self-care by tolerating
distress adaptively (Dimeff & Linehan, 2008).
Overall, enhancing clients' emotional intelligence and expanding skills
repertoires for balancing reason and feelings provides an arsenal against
addiction-related vulnerabilities. Over time, habitual thoughts like "I just
need to use to feel better" lose power as viable alternative responses are
practiced.
Developing Interpersonal Effectiveness
Another component crucial for sustained recovery is reducing dependency on
unhealthy relationships maintaining addictions while cultivating fulfilling
connections supporting well-balanced living. The DBT Interpersonal
Effectiveness module teaches constructive strategies including:
DEARMAN
This acronym guides assertively asking for what one wants respectfully while
maintaining self-respect and the relationship. Clients apply it to set
boundaries with enabling contacts (Lindenboim et al., 2007).
GIVE
Giving information clearly and validly, expressing wishes/feelings
respectfully, validating others and negotiating disputes constructively helps
clients navigate interpersonal challenges constructively.
FAST
Avoiding risky situations threatening safety/goals, thinking things through
considering priorities/limits, negotiating for win-win compromises, asserting
calmly and truthfully preserves solid recovery support systems over time
through balanced living principles (Dimeff & Linehan, 2008).
Validation/Empathy
Showing compassion for others without enabling harm and resolving
misunderstandings through validating different perspectives strengthens
fulfilling relationships integral for long-term recovery maintenance and
overall well-being.
Overall, equipping clients to meet interpersonal needs constructively without
codependency or enabling dysfunctional patterns provides critical relational
tools serving as protective factors buttressing recovery success over a
lifetime. DBT strategies foster socially supportive ecosystems nourishing
wellness.
Coping with Distress and Cravings
Perhaps the greatest test for newly recovering individuals is tolerating
unpleasant emotions and resisting craving-driven urges without losing
control. Core DBT strategies address this challenge:
Coping Ahead Plans
Proactively strategizing how to handle high-risk situations/emotions
beforehand using all learned skills increases clients’ sense of self-efficacy
and preparedness for challenges (Dimeff & Linehan, 2008).
Distracting with Opposite Emotions/Activities
Engaging in enjoyable hobbies, calling supports, self-soothing behaviors like
snapping a rubber band rides out cravings by shifting focus from addiction to
more productive outlets (Lindenboim et al., 2007).
Reality Acceptance
Letting go of desire to control unchangeable aspects of situations/feelings
allows clients to disengage from urges and make wise behavior choices
under stress (Dimeff & Linehan, 2008).
Self-Soothe with Five Senses
Soothing oneself through grounding sensory awareness exercises like deep
breathing, cool showers, music, tactile fidgets tolerates distress adaptively.
Wise Mind
Making decisions from balanced perspective considers priorities/values over
impulses, maintaining clarity under duress crucial for withstanding lapses
(Lindenboim et al., 2007).
Overall, distress tolerance skills strengthen clients to independently ride
emotional waves without relapsing by choosing constructive outlets
respecting recovery priorities. Over time, cravings lose power through
habituating new self-care patterns.
Conclusion
Addiction arises from complex interactions between biological, psychological
and social factors. Emotion dysregulation and maladaptive coping play
critical roles in both developing and maintaining substance dependence. For
these core reasons, therapeutic approaches like DBT directly targeting
emotional awareness, interpersonal effectiveness and distress tolerance hold
immense promise for empowering clients for long-term recovery success.
Through its dialectical philosophy balancing acceptance and change, DBT's
evidence-based techniques cultivate mindfulness, adaptive emotion
regulation and coping strategies serving as portable protective skills clients
can apply independently throughout their lifetime recovery journeys.
Whether facing relationship stressors, cravings and lapses or general life
challenges, these transdiagnostic DBT strategies bolster psychological
resilience against substance misuse. Overall, integrating such skills directly
addressing underlying vulnerabilities can greatly expand addiction
counselors’ toolbox for equipping clients with lifelong wellness tools.
Addiction is a disease involving compulsively seeking rewards and relief
through the use of substances or engaging in unhealthy behaviors despite
repercussions. A core reason many individuals develop addictions is due to
difficulties regulating feelings and coping with distress that arises from life's
challenges. Research shows a significant relationship between emotion
dysregulation and substance use disorders (SUDs), with high rates of co-
occurring mood and anxiety disorders as well (Witkiewitz & Bowen, 2010).
For this reason, therapeutic approaches that teach emotional regulation and
distress tolerance skills have particular relevance for addiction counseling.
One such evidence-based model is Dialectical Behavior Therapy (DBT).
Originally developed by Marsha Linehan in the 1980s to treat borderline
personality disorder, DBT has since been adapted and studied for treating
SUDs with great success (Dimeff & Linehan, 2008). Its core aim is balancing
acceptance of oneself and reality with a commitment to positive change
through teaching mindfulness, interpersonal effectiveness, emotional
regulation, and distress tolerance skills. This paper explores how DBT
strategies addressing emotion dysregulation and maladaptive coping can
benefit addiction counselors and their clients working toward long-term
recovery maintenance through building psychological resilience and
balanced living.
Overview of DBT Model and Strategies
DBT is a cognitive-behavioral treatment approach rooted in Zen Buddhism,
dialectics, and biosocial theory. Its overarching philosophy balances
acceptance and change in a dialectical manner, recognizing both the need to
validate inner experiences while committing to behavioral improvements
through skills practice. Therapists follow a "validation and encouragement"
stance, accepting clients where they are without judgment while also
motivating adaptive changes (Lindenboim et al., 2007). Individual therapy
sessions interweave this dialectical approach with teaching core DBT skills
modules.
The first skills module targets core mindfulness practices to cultivate wise,
balanced awareness of present internal and external experiences. Tasks like
breathing, body awareness, and daily logging exercises train non-judgmental
focus and observation that counteract tendencies toward emotional
reactivity, avoidance, and lack of self-care.
The second module trains interpersonal effectiveness through strategies like
DEARMAN, GIVE, and FAST that respectively help clients assert needs
respectfully, clearly communicate boundaries, and navigate challenging
social situations effectively and respectfully. Related communication
trainings address building empathy, validation, and compromise in
relationships (Swales, 2009).
The third module targets distress tolerance by identifying primary and
secondary emotions, tolerating painful experiences through wise "riding the
wave" and coping ahead techniques, distracting with safe activities,
improving with self-soothing behaviors, and accepting reality rather than
fighting unchangeable factors.
Finally, the emotion regulation module provides tools for mindfulness of
emotions, reducing vulnerability factors, changing emotional states through
opposing behaviors, and taking wise actions guided by healthy emotions
rather than impulsivity (Swales, 2009).
All strategies are manualized to ensure treatment fidelity and teach skills in a
hierarchical, paced manner through individual therapy, weekly group skills
training, phone coaching for intersession practice, and therapist consultation
meetings (Lindenboim et al., 2007). Therapists further encourage daily diary
card tracking to reinforce new behaviors and problem-solve obstacles
(Dimeff & Linehan, 2008).
Benefits for Addiction Counseling
DBT's mechanisms for addressing emotion dysregulation and distress
tolerance through mindfulness, interpersonal effectiveness and adaptive
coping strategies directly translate to benefiting addiction recovery in
several ways:
Cultivating Emotional Awareness
Mindfulness practices increase clients' ability to notice internal triggers for
substance urges and situational factors contributing to maladaptive coping
without becoming overwhelmed or acting impulsively. This awareness
provides distance and choice.
Managing Strong Emotions
DBT techniques like riding emotional waves, opposite action, and thinking of
wise mind give clients tools to experience even difficult feelings without
defaulting to addictive behaviors by tolerating distress or changing
emotional states in healthy ways.
Improving Relationship Dynamics
Interpersonal effectiveness skills help navigate social challenges and set
boundaries constructively without slipping into codependency, enabling
clients to build fulfilling support systems key for long-term sobriety.
Coping with Cravings and Relapse Triggers
Distress tolerance strategies such as self-soothing, distracting with
alternative activities, acceptance, and coping ahead plans equip clients to
manage cravings, urges or setbacks without losing control or abandoning
recovery entirely.
Reducing Shame and Self-Criticism
The validating, non-judgmental philosophy of DBT, combined with building
self-esteem through skills mastery, counters typical addict self-loathing,
isolation and hopelessness, fueling courage for change.
Addressing Co-Occurring Disorders
Clients dually diagnosed with addictions and mood/anxiety issues directly
benefit from DBT interventions targeting underlying emotion dysregulation
maintaining all related problems.
In summary, DBT offers versatile transdiagnostic techniques addressing root
factors at the emotions-addictions interface through mindfulness, effective
communication, and adaptive coping strategies. These empower clients to
establish long-term wellness and balance in recovery.
Cultivating Mindfulness for Emotional Awareness
A primary way DBT builds emotional regulation is through cultivating
mindfulness—non-judging, present-moment awareness of internal and
external experiences. This metacognitive skill counters addiction-related
tendencies toward emotional avoidance, reactivity and lack of self-care. DBT
mindfulness practices include:
Observational Exercises
Clients notice thoughts/feelings passively without reaction through Body
Scan meditation, Pleasant Events daily logs, or Emotion Diary homework
logging triggers. This detachment interrupts addiction's automatic pilot and
compulsion cycles (Lindenboim et al., 2007).
Focus & Breath Awareness
Focusing mind on breathing or other external sensory anchors like music
pulls attention to anchoring physical sensations rather than
racing/ruminating thoughts sustaining craving-using cycles. Short- and long-
term breath practices help sustain wise mindfulness.
Distress Tolerance Strategies
Self-soothing behaviors like holding an ice cube, blowing bubbles, smelling
pleasant scents, or saying encouraging self-talk provide concrete
mindfulness tools for tolerating distressing triggers or lapses without
abandoning broader recovery efforts (Dimeff & Linehan, 2008).
Wise Mind State
This balanced perspective integrating reason and intuition gives clients
capacity to make clear choices guided by sobriety priorities rather than
emotions alone. Mindfulness maintains wise mind clarity during decision-
making.
The detached, non-reactive stance cultivated through mindfulness allows
clients to recognize addiction-related thoughts or urges arising without
immediately becoming overwhelmed or impulsively acting out self-
destructive patterns (Lindenboim et al., 2007). Instead, mindfulness creates
psychological space to choose constructive coping options. Over time, this
metacognition enhances emotion regulation abilities crucial for long-term
recovery success and well-being.
Improving Emotion Regulation Skills
While mindfulness fosters awareness, DBT directly teaches core strategies
for modulating emotions: opposite action, changing vulnerability factors,
urges surfing, ACCEPTS framework. When applied alongside counselor
guidance and group processing, these tools become empowering skills
clients own for long-term management of affective triggers maintaining
addictions:
Opposite Action
Deliberately acting opposite cravings/emotions by engaging in healthful
distracting activities like exercise or calling supports interrupts addiction's
automatic pilot processes. Over time, new response patterns replace harmful
ones (Lindenboim et al., 2007).
Changing Vulnerability Factors
Clients identify avoidant patterns exacerbating emotional vulnerabilities like
lack of sleep, isolation from supports, self-criticism, all-or-nothing thinking,
then take wise preemptive actions before distressing triggers arise (Dimeff &
Linehan, 2008).
Urge Surfing
Mindfully "riding the emotional wave" of cravings/triggers without reacting
teaches clients to detach from transient feelings and wait patiently for
intensity to naturally lessen on its own without acting out dysfunctional urges
(Lindenboim et al., 2007).
ACCEPTS Framework
This acronym guides clients moving through difficult emotions by Activating
wise mind, identifying Current thoughts/emotions kindly, evaluating
Pros/cons objectively, nurturing compassion for self with softer self-talk,
noting Thoughts are fleeting mental events, experiencing physical
Sensations fully with mindfulness, and committing to Self-care by tolerating
distress adaptively (Dimeff & Linehan, 2008).
Overall, enhancing clients' emotional intelligence and expanding skills
repertoires for balancing reason and feelings provides an arsenal against
addiction-related vulnerabilities. Over time, habitual thoughts like "I just
need to use to feel better" lose power as viable alternative responses are
practiced.
Developing Interpersonal Effectiveness
Another component crucial for sustained recovery is reducing dependency on
unhealthy relationships maintaining addictions while cultivating fulfilling
connections supporting well-balanced living. The DBT Interpersonal
Effectiveness module teaches constructive strategies including:
DEARMAN
This acronym guides assertively asking for what one wants respectfully while
maintaining self-respect and the relationship. Clients apply it to set
boundaries with enabling contacts (Lindenboim et al., 2007).
GIVE
Giving information clearly and validly, expressing wishes/feelings
respectfully, validating others and negotiating disputes constructively helps
clients navigate interpersonal challenges constructively.
FAST
Avoiding risky situations threatening safety/goals, thinking things through
considering priorities/limits, negotiating for win-win compromises, asserting
calmly and truthfully preserves solid recovery support systems over time
through balanced living principles (Dimeff & Linehan, 2008).
Validation/Empathy
Showing compassion for others without enabling harm and resolving
misunderstandings through validating different perspectives strengthens
fulfilling relationships integral for long-term recovery maintenance and
overall well-being.
Overall, equipping clients to meet interpersonal needs constructively without
codependency or enabling dysfunctional patterns provides critical relational
tools serving as protective factors buttressing recovery success over a
lifetime. DBT strategies foster socially supportive ecosystems nourishing
wellness.
Coping with Distress and Cravings
Perhaps the greatest test for newly recovering individuals is tolerating
unpleasant emotions and resisting craving-driven urges without losing
control. Core DBT strategies address this challenge:
Coping Ahead Plans
Proactively strategizing how to handle high-risk situations/emotions
beforehand using all learned skills increases clients’ sense of self-efficacy
and preparedness for challenges (Dimeff & Linehan, 2008).
Distracting with Opposite Emotions/Activities
Engaging in enjoyable hobbies, calling supports, self-soothing behaviors like
snapping a rubber band rides out cravings by shifting focus from addiction to
more productive outlets (Lindenboim et al., 2007).
Reality Acceptance
Letting go of desire to control unchangeable aspects of situations/feelings
allows clients to disengage from urges and make wise behavior choices
under stress (Dimeff & Linehan, 2008).
Self-Soothe with Five Senses
Soothing oneself through grounding sensory awareness exercises like deep
breathing, cool showers, music, tactile fidgets tolerates distress adaptively.
Wise Mind
Making decisions from balanced perspective considers priorities/values over
impulses, maintaining clarity under duress crucial for withstanding lapses
(Lindenboim et al., 2007).
Overall, distress tolerance skills strengthen clients to independently ride
emotional waves without relapsing by choosing constructive outlets
respecting recovery priorities. Over time, cravings lose power through
habituating new self-care patterns.
Conclusion
Addiction arises from complex interactions between biological, psychological
and social factors. Emotion dysregulation and maladaptive coping play
critical roles in both developing and maintaining substance dependence. For
these core reasons, therapeutic approaches like DBT directly targeting
emotional awareness, interpersonal effectiveness and distress tolerance hold
immense promise for empowering clients for long-term recovery success.
Through its dialectical philosophy balancing acceptance and change, DBT's
evidence-based techniques cultivate mindfulness, adaptive emotion
regulation and coping strategies serving as portable protective skills clients
can apply independently throughout their lifetime recovery journeys.
Whether facing relationship stressors, cravings and lapses or general life
challenges, these transdiagnostic DBT strategies bolster psychological
resilience against substance misuse. Overall, integrating such skills directly
addressing underlying vulnerabilities can greatly expand addiction
counselors’ toolbox for equipping clients with lifelong wellness tools.
Addiction is a disease involving compulsively seeking rewards and relief
through the use of substances or engaging in unhealthy behaviors despite
repercussions. A core reason many individuals develop addictions is due to
difficulties regulating feelings and coping with distress that arises from life's
challenges. Research shows a significant relationship between emotion
dysregulation and substance use disorders (SUDs), with high rates of co-
occurring mood and anxiety disorders as well (Witkiewitz & Bowen, 2010).
For this reason, therapeutic approaches that teach emotional regulation and
distress tolerance skills have particular relevance for addiction counseling.
One such evidence-based model is Dialectical Behavior Therapy (DBT).
Originally developed by Marsha Linehan in the 1980s to treat borderline
personality disorder, DBT has since been adapted and studied for treating
SUDs with great success (Dimeff & Linehan, 2008). Its core aim is balancing
acceptance of oneself and reality with a commitment to positive change
through teaching mindfulness, interpersonal effectiveness, emotional
regulation, and distress tolerance skills. This paper explores how DBT
strategies addressing emotion dysregulation and maladaptive coping can
benefit addiction counselors and their clients working toward long-term
recovery maintenance through building psychological resilience and
balanced living.
Overview of DBT Model and Strategies
DBT is a cognitive-behavioral treatment approach rooted in Zen Buddhism,
dialectics, and biosocial theory. Its overarching philosophy balances
acceptance and change in a dialectical manner, recognizing both the need to
validate inner experiences while committing to behavioral improvements
through skills practice. Therapists follow a "validation and encouragement"
stance, accepting clients where they are without judgment while also
motivating adaptive changes (Lindenboim et al., 2007). Individual therapy
sessions interweave this dialectical approach with teaching core DBT skills
modules.
The first skills module targets core mindfulness practices to cultivate wise,
balanced awareness of present internal and external experiences. Tasks like
breathing, body awareness, and daily logging exercises train non-judgmental
focus and observation that counteract tendencies toward emotional
reactivity, avoidance, and lack of self-care.
The second module trains interpersonal effectiveness through strategies like
DEARMAN, GIVE, and FAST that respectively help clients assert needs
respectfully, clearly communicate boundaries, and navigate challenging
social situations effectively and respectfully. Related communication
trainings address building empathy, validation, and compromise in
relationships (Swales, 2009).
The third module targets distress tolerance by identifying primary and
secondary emotions, tolerating painful experiences through wise "riding the
wave" and coping ahead techniques, distracting with safe activities,
improving with self-soothing behaviors, and accepting reality rather than
fighting unchangeable factors.
Finally, the emotion regulation module provides tools for mindfulness of
emotions, reducing vulnerability factors, changing emotional states through
opposing behaviors, and taking wise actions guided by healthy emotions
rather than impulsivity (Swales, 2009).
All strategies are manualized to ensure treatment fidelity and teach skills in a
hierarchical, paced manner through individual therapy, weekly group skills
training, phone coaching for intersession practice, and therapist consultation
meetings (Lindenboim et al., 2007). Therapists further encourage daily diary
card tracking to reinforce new behaviors and problem-solve obstacles
(Dimeff & Linehan, 2008).
Benefits for Addiction Counseling
DBT's mechanisms for addressing emotion dysregulation and distress
tolerance through mindfulness, interpersonal effectiveness and adaptive
coping strategies directly translate to benefiting addiction recovery in
several ways:
Cultivating Emotional Awareness
Mindfulness practices increase clients' ability to notice internal triggers for
substance urges and situational factors contributing to maladaptive coping
without becoming overwhelmed or acting impulsively. This awareness
provides distance and choice.
Managing Strong Emotions
DBT techniques like riding emotional waves, opposite action, and thinking of
wise mind give clients tools to experience even difficult feelings without
defaulting to addictive behaviors by tolerating distress or changing
emotional states in healthy ways.
Improving Relationship Dynamics
Interpersonal effectiveness skills help navigate social challenges and set
boundaries constructively without slipping into codependency, enabling
clients to build fulfilling support systems key for long-term sobriety.
Coping with Cravings and Relapse Triggers
Distress tolerance strategies such as self-soothing, distracting with
alternative activities, acceptance, and coping ahead plans equip clients to
manage cravings, urges or setbacks without losing control or abandoning
recovery entirely.
Reducing Shame and Self-Criticism
The validating, non-judgmental philosophy of DBT, combined with building
self-esteem through skills mastery, counters typical addict self-loathing,
isolation and hopelessness, fueling courage for change.
Addressing Co-Occurring Disorders
Clients dually diagnosed with addictions and mood/anxiety issues directly
benefit from DBT interventions targeting underlying emotion dysregulation
maintaining all related problems.
In summary, DBT offers versatile transdiagnostic techniques addressing root
factors at the emotions-addictions interface through mindfulness, effective
communication, and adaptive coping strategies. These empower clients to
establish long-term wellness and balance in recovery.
Cultivating Mindfulness for Emotional Awareness
A primary way DBT builds emotional regulation is through cultivating
mindfulness—non-judging, present-moment awareness of internal and
external experiences. This metacognitive skill counters addiction-related
tendencies toward emotional avoidance, reactivity and lack of self-care. DBT
mindfulness practices include:
Observational Exercises
Clients notice thoughts/feelings passively without reaction through Body
Scan meditation, Pleasant Events daily logs, or Emotion Diary homework
logging triggers. This detachment interrupts addiction's automatic pilot and
compulsion cycles (Lindenboim et al., 2007).
Focus & Breath Awareness
Focusing mind on breathing or other external sensory anchors like music
pulls attention to anchoring physical sensations rather than
racing/ruminating thoughts sustaining craving-using cycles. Short- and long-
term breath practices help sustain wise mindfulness.
Distress Tolerance Strategies
Self-soothing behaviors like holding an ice cube, blowing bubbles, smelling
pleasant scents, or saying encouraging self-talk provide concrete
mindfulness tools for tolerating distressing triggers or lapses without
abandoning broader recovery efforts (Dimeff & Linehan, 2008).
Wise Mind State
This balanced perspective integrating reason and intuition gives clients
capacity to make clear choices guided by sobriety priorities rather than
emotions alone. Mindfulness maintains wise mind clarity during decision-
making.
The detached, non-reactive stance cultivated through mindfulness allows
clients to recognize addiction-related thoughts or urges arising without
immediately becoming overwhelmed or impulsively acting out self-
destructive patterns (Lindenboim et al., 2007). Instead, mindfulness creates
psychological space to choose constructive coping options. Over time, this
metacognition enhances emotion regulation abilities crucial for long-term
recovery success and well-being.
Improving Emotion Regulation Skills
While mindfulness fosters awareness, DBT directly teaches core strategies
for modulating emotions: opposite action, changing vulnerability factors,
urges surfing, ACCEPTS framework. When applied alongside counselor
guidance and group processing, these tools become empowering skills
clients own for long-term management of affective triggers maintaining
addictions:
Opposite Action
Deliberately acting opposite cravings/emotions by engaging in healthful
distracting activities like exercise or calling supports interrupts addiction's
automatic pilot processes. Over time, new response patterns replace harmful
ones (Lindenboim et al., 2007).
Changing Vulnerability Factors
Clients identify avoidant patterns exacerbating emotional vulnerabilities like
lack of sleep, isolation from supports, self-criticism, all-or-nothing thinking,
then take wise preemptive actions before distressing triggers arise (Dimeff &
Linehan, 2008).
Urge Surfing
Mindfully "riding the emotional wave" of cravings/triggers without reacting
teaches clients to detach from transient feelings and wait patiently for
intensity to naturally lessen on its own without acting out dysfunctional urges
(Lindenboim et al., 2007).
ACCEPTS Framework
This acronym guides clients moving through difficult emotions by Activating
wise mind, identifying Current thoughts/emotions kindly, evaluating
Pros/cons objectively, nurturing compassion for self with softer self-talk,
noting Thoughts are fleeting mental events, experiencing physical
Sensations fully with mindfulness, and committing to Self-care by tolerating
distress adaptively (Dimeff & Linehan, 2008).
Overall, enhancing clients' emotional intelligence and expanding skills
repertoires for balancing reason and feelings provides an arsenal against
addiction-related vulnerabilities. Over time, habitual thoughts like "I just
need to use to feel better" lose power as viable alternative responses are
practiced.
Developing Interpersonal Effectiveness
Another component crucial for sustained recovery is reducing dependency on
unhealthy relationships maintaining addictions while cultivating fulfilling
connections supporting well-balanced living. The DBT Interpersonal
Effectiveness module teaches constructive strategies including:
DEARMAN
This acronym guides assertively asking for what one wants respectfully while
maintaining self-respect and the relationship. Clients apply it to set
boundaries with enabling contacts (Lindenboim et al., 2007).
GIVE
Giving information clearly and validly, expressing wishes/feelings
respectfully, validating others and negotiating disputes constructively helps
clients navigate interpersonal challenges constructively.
FAST
Avoiding risky situations threatening safety/goals, thinking things through
considering priorities/limits, negotiating for win-win compromises, asserting
calmly and truthfully preserves solid recovery support systems over time
through balanced living principles (Dimeff & Linehan, 2008).
Validation/Empathy
Showing compassion for others without enabling harm and resolving
misunderstandings through validating different perspectives strengthens
fulfilling relationships integral for long-term recovery maintenance and
overall well-being.
Overall, equipping clients to meet interpersonal needs constructively without
codependency or enabling dysfunctional patterns provides critical relational
tools serving as protective factors buttressing recovery success over a
lifetime. DBT strategies foster socially supportive ecosystems nourishing
wellness.
Coping with Distress and Cravings
Perhaps the greatest test for newly recovering individuals is tolerating
unpleasant emotions and resisting craving-driven urges without losing
control. Core DBT strategies address this challenge:
Coping Ahead Plans
Proactively strategizing how to handle high-risk situations/emotions
beforehand using all learned skills increases clients’ sense of self-efficacy
and preparedness for challenges (Dimeff & Linehan, 2008).
Distracting with Opposite Emotions/Activities
Engaging in enjoyable hobbies, calling supports, self-soothing behaviors like
snapping a rubber band rides out cravings by shifting focus from addiction to
more productive outlets (Lindenboim et al., 2007).
Reality Acceptance
Letting go of desire to control unchangeable aspects of situations/feelings
allows clients to disengage from urges and make wise behavior choices
under stress (Dimeff & Linehan, 2008).
Self-Soothe with Five Senses
Soothing oneself through grounding sensory awareness exercises like deep
breathing, cool showers, music, tactile fidgets tolerates distress adaptively.
Wise Mind
Making decisions from balanced perspective considers priorities/values over
impulses, maintaining clarity under duress crucial for withstanding lapses
(Lindenboim et al., 2007).
Overall, distress tolerance skills strengthen clients to independently ride
emotional waves without relapsing by choosing constructive outlets
respecting recovery priorities. Over time, cravings lose power through
habituating new self-care patterns.
Conclusion
Addiction arises from complex interactions between biological, psychological
and social factors. Emotion dysregulation and maladaptive coping play
critical roles in both developing and maintaining substance dependence. For
these core reasons, therapeutic approaches like DBT directly targeting
emotional awareness, interpersonal effectiveness and distress tolerance hold
immense promise for empowering clients for long-term recovery success.
Through its dialectical philosophy balancing acceptance and change, DBT's
evidence-based techniques cultivate mindfulness, adaptive emotion
regulation and coping strategies serving as portable protective skills clients
can apply independently throughout their lifetime recovery journeys.
Whether facing relationship stressors, cravings and lapses or general life
challenges, these transdiagnostic DBT strategies bolster psychological
resilience against substance misuse. Overall, integrating such skills directly
addressing underlying vulnerabilities can greatly expand addiction
counselors’ toolbox for equipping clients with lifelong wellness tools.
Addiction is a disease involving compulsively seeking rewards and relief
through the use of substances or engaging in unhealthy behaviors despite
repercussions. A core reason many individuals develop addictions is due to
difficulties regulating feelings and coping with distress that arises from life's
challenges. Research shows a significant relationship between emotion
dysregulation and substance use disorders (SUDs), with high rates of co-
occurring mood and anxiety disorders as well (Witkiewitz & Bowen, 2010).
For this reason, therapeutic approaches that teach emotional regulation and
distress tolerance skills have particular relevance for addiction counseling.
One such evidence-based model is Dialectical Behavior Therapy (DBT).
Originally developed by Marsha Linehan in the 1980s to treat borderline
personality disorder, DBT has since been adapted and studied for treating
SUDs with great success (Dimeff & Linehan, 2008). Its core aim is balancing
acceptance of oneself and reality with a commitment to positive change
through teaching mindfulness, interpersonal effectiveness, emotional
regulation, and distress tolerance skills. This paper explores how DBT
strategies addressing emotion dysregulation and maladaptive coping can
benefit addiction counselors and their clients working toward long-term
recovery maintenance through building psychological resilience and
balanced living.
Overview of DBT Model and Strategies
DBT is a cognitive-behavioral treatment approach rooted in Zen Buddhism,
dialectics, and biosocial theory. Its overarching philosophy balances
acceptance and change in a dialectical manner, recognizing both the need to
validate inner experiences while committing to behavioral improvements
through skills practice. Therapists follow a "validation and encouragement"
stance, accepting clients where they are without judgment while also
motivating adaptive changes (Lindenboim et al., 2007). Individual therapy
sessions interweave this dialectical approach with teaching core DBT skills
modules.
The first skills module targets core mindfulness practices to cultivate wise,
balanced awareness of present internal and external experiences. Tasks like
breathing, body awareness, and daily logging exercises train non-judgmental
focus and observation that counteract tendencies toward emotional
reactivity, avoidance, and lack of self-care.
The second module trains interpersonal effectiveness through strategies like
DEARMAN, GIVE, and FAST that respectively help clients assert needs
respectfully, clearly communicate boundaries, and navigate challenging
social situations effectively and respectfully. Related communication
trainings address building empathy, validation, and compromise in
relationships (Swales, 2009).
The third module targets distress tolerance by identifying primary and
secondary emotions, tolerating painful experiences through wise "riding the
wave" and coping ahead techniques, distracting with safe activities,
improving with self-soothing behaviors, and accepting reality rather than
fighting unchangeable factors.
Finally, the emotion regulation module provides tools for mindfulness of
emotions, reducing vulnerability factors, changing emotional states through
opposing behaviors, and taking wise actions guided by healthy emotions
rather than impulsivity (Swales, 2009).
All strategies are manualized to ensure treatment fidelity and teach skills in a
hierarchical, paced manner through individual therapy, weekly group skills
training, phone coaching for intersession practice, and therapist consultation
meetings (Lindenboim et al., 2007). Therapists further encourage daily diary
card tracking to reinforce new behaviors and problem-solve obstacles
(Dimeff & Linehan, 2008).
Benefits for Addiction Counseling
DBT's mechanisms for addressing emotion dysregulation and distress
tolerance through mindfulness, interpersonal effectiveness and adaptive
coping strategies directly translate to benefiting addiction recovery in
several ways:
Cultivating Emotional Awareness
Mindfulness practices increase clients' ability to notice internal triggers for
substance urges and situational factors contributing to maladaptive coping
without becoming overwhelmed or acting impulsively. This awareness
provides distance and choice.
Managing Strong Emotions
DBT techniques like riding emotional waves, opposite action, and thinking of
wise mind give clients tools to experience even difficult feelings without
defaulting to addictive behaviors by tolerating distress or changing
emotional states in healthy ways.
Improving Relationship Dynamics
Interpersonal effectiveness skills help navigate social challenges and set
boundaries constructively without slipping into codependency, enabling
clients to build fulfilling support systems key for long-term sobriety.
Coping with Cravings and Relapse Triggers
Distress tolerance strategies such as self-soothing, distracting with
alternative activities, acceptance, and coping ahead plans equip clients to
manage cravings, urges or setbacks without losing control or abandoning
recovery entirely.
Reducing Shame and Self-Criticism
The validating, non-judgmental philosophy of DBT, combined with building
self-esteem through skills mastery, counters typical addict self-loathing,
isolation and hopelessness, fueling courage for change.
Addressing Co-Occurring Disorders
Clients dually diagnosed with addictions and mood/anxiety issues directly
benefit from DBT interventions targeting underlying emotion dysregulation
maintaining all related problems.
In summary, DBT offers versatile transdiagnostic techniques addressing root
factors at the emotions-addictions interface through mindfulness, effective
communication, and adaptive coping strategies. These empower clients to
establish long-term wellness and balance in recovery.
Cultivating Mindfulness for Emotional Awareness
A primary way DBT builds emotional regulation is through cultivating
mindfulness—non-judging, present-moment awareness of internal and
external experiences. This metacognitive skill counters addiction-related
tendencies toward emotional avoidance, reactivity and lack of self-care. DBT
mindfulness practices include:
Observational Exercises
Clients notice thoughts/feelings passively without reaction through Body
Scan meditation, Pleasant Events daily logs, or Emotion Diary homework
logging triggers. This detachment interrupts addiction's automatic pilot and
compulsion cycles (Lindenboim et al., 2007).
Focus & Breath Awareness
Focusing mind on breathing or other external sensory anchors like music
pulls attention to anchoring physical sensations rather than
racing/ruminating thoughts sustaining craving-using cycles. Short- and long-
term breath practices help sustain wise mindfulness.
Distress Tolerance Strategies
Self-soothing behaviors like holding an ice cube, blowing bubbles, smelling
pleasant scents, or saying encouraging self-talk provide concrete
mindfulness tools for tolerating distressing triggers or lapses without
abandoning broader recovery efforts (Dimeff & Linehan, 2008).
Wise Mind State
This balanced perspective integrating reason and intuition gives clients
capacity to make clear choices guided by sobriety priorities rather than
emotions alone. Mindfulness maintains wise mind clarity during decision-
making.
The detached, non-reactive stance cultivated through mindfulness allows
clients to recognize addiction-related thoughts or urges arising without
immediately becoming overwhelmed or impulsively acting out self-
destructive patterns (Lindenboim et al., 2007). Instead, mindfulness creates
psychological space to choose constructive coping options. Over time, this
metacognition enhances emotion regulation abilities crucial for long-term
recovery success and well-being.
Improving Emotion Regulation Skills
While mindfulness fosters awareness, DBT directly teaches core strategies
for modulating emotions: opposite action, changing vulnerability factors,
urges surfing, ACCEPTS framework. When applied alongside counselor
guidance and group processing, these tools become empowering skills
clients own for long-term management of affective triggers maintaining
addictions:
Opposite Action
Deliberately acting opposite cravings/emotions by engaging in healthful
distracting activities like exercise or calling supports interrupts addiction's
automatic pilot processes. Over time, new response patterns replace harmful
ones (Lindenboim et al., 2007).
Changing Vulnerability Factors
Clients identify avoidant patterns exacerbating emotional vulnerabilities like
lack of sleep, isolation from supports, self-criticism, all-or-nothing thinking,
then take wise preemptive actions before distressing triggers arise (Dimeff &
Linehan, 2008).
Urge Surfing
Mindfully "riding the emotional wave" of cravings/triggers without reacting
teaches clients to detach from transient feelings and wait patiently for
intensity to naturally lessen on its own without acting out dysfunctional urges
(Lindenboim et al., 2007).
ACCEPTS Framework
This acronym guides clients moving through difficult emotions by Activating
wise mind, identifying Current thoughts/emotions kindly, evaluating
Pros/cons objectively, nurturing compassion for self with softer self-talk,
noting Thoughts are fleeting mental events, experiencing physical
Sensations fully with mindfulness, and committing to Self-care by tolerating
distress adaptively (Dimeff & Linehan, 2008).
Overall, enhancing clients' emotional intelligence and expanding skills
repertoires for balancing reason and feelings provides an arsenal against
addiction-related vulnerabilities. Over time, habitual thoughts like "I just
need to use to feel better" lose power as viable alternative responses are
practiced.
Developing Interpersonal Effectiveness
Another component crucial for sustained recovery is reducing dependency on
unhealthy relationships maintaining addictions while cultivating fulfilling
connections supporting well-balanced living. The DBT Interpersonal
Effectiveness module teaches constructive strategies including:
DEARMAN
This acronym guides assertively asking for what one wants respectfully while
maintaining self-respect and the relationship. Clients apply it to set
boundaries with enabling contacts (Lindenboim et al., 2007).
GIVE
Giving information clearly and validly, expressing wishes/feelings
respectfully, validating others and negotiating disputes constructively helps
clients navigate interpersonal challenges constructively.
FAST
Avoiding risky situations threatening safety/goals, thinking things through
considering priorities/limits, negotiating for win-win compromises, asserting
calmly and truthfully preserves solid recovery support systems over time
through balanced living principles (Dimeff & Linehan, 2008).
Validation/Empathy
Showing compassion for others without enabling harm and resolving
misunderstandings through validating different perspectives strengthens
fulfilling relationships integral for long-term recovery maintenance and
overall well-being.
Overall, equipping clients to meet interpersonal needs constructively without
codependency or enabling dysfunctional patterns provides critical relational
tools serving as protective factors buttressing recovery success over a
lifetime. DBT strategies foster socially supportive ecosystems nourishing
wellness.
Coping with Distress and Cravings
Perhaps the greatest test for newly recovering individuals is tolerating
unpleasant emotions and resisting craving-driven urges without losing
control. Core DBT strategies address this challenge:
Coping Ahead Plans
Proactively strategizing how to handle high-risk situations/emotions
beforehand using all learned skills increases clients’ sense of self-efficacy
and preparedness for challenges (Dimeff & Linehan, 2008).
Distracting with Opposite Emotions/Activities
Engaging in enjoyable hobbies, calling supports, self-soothing behaviors like
snapping a rubber band rides out cravings by shifting focus from addiction to
more productive outlets (Lindenboim et al., 2007).
Reality Acceptance
Letting go of desire to control unchangeable aspects of situations/feelings
allows clients to disengage from urges and make wise behavior choices
under stress (Dimeff & Linehan, 2008).
Self-Soothe with Five Senses
Soothing oneself through grounding sensory awareness exercises like deep
breathing, cool showers, music, tactile fidgets tolerates distress adaptively.
Wise Mind
Making decisions from balanced perspective considers priorities/values over
impulses, maintaining clarity under duress crucial for withstanding lapses
(Lindenboim et al., 2007).
Overall, distress tolerance skills strengthen clients to independently ride
emotional waves without relapsing by choosing constructive outlets
respecting recovery priorities. Over time, cravings lose power through
habituating new self-care patterns.
Conclusion
Addiction arises from complex interactions between biological, psychological
and social factors. Emotion dysregulation and maladaptive coping play
critical roles in both developing and maintaining substance dependence. For
these core reasons, therapeutic approaches like DBT directly targeting
emotional awareness, interpersonal effectiveness and distress tolerance hold
immense promise for empowering clients for long-term recovery success.
Through its dialectical philosophy balancing acceptance and change, DBT's
evidence-based techniques cultivate mindfulness, adaptive emotion
regulation and coping strategies serving as portable protective skills clients
can apply independently throughout their lifetime recovery journeys.
Whether facing relationship stressors, cravings and lapses or general life
challenges, these transdiagnostic DBT strategies bolster psychological
resilience against substance misuse. Overall, integrating such skills directly
addressing underlying vulnerabilities can greatly expand addiction
counselors’ toolbox for equipping clients with lifelong wellness tools.
Addiction is a disease involving compulsively seeking rewards and relief
through the use of substances or engaging in unhealthy behaviors despite
repercussions. A core reason many individuals develop addictions is due to
difficulties regulating feelings and coping with distress that arises from life's
challenges. Research shows a significant relationship between emotion
dysregulation and substance use disorders (SUDs), with high rates of co-
occurring mood and anxiety disorders as well (Witkiewitz & Bowen, 2010).
For this reason, therapeutic approaches that teach emotional regulation and
distress tolerance skills have particular relevance for addiction counseling.
One such evidence-based model is Dialectical Behavior Therapy (DBT).
Originally developed by Marsha Linehan in the 1980s to treat borderline
personality disorder, DBT has since been adapted and studied for treating
SUDs with great success (Dimeff & Linehan, 2008). Its core aim is balancing
acceptance of oneself and reality with a commitment to positive change
through teaching mindfulness, interpersonal effectiveness, emotional
regulation, and distress tolerance skills. This paper explores how DBT
strategies addressing emotion dysregulation and maladaptive coping can
benefit addiction counselors and their clients working toward long-term
recovery maintenance through building psychological resilience and
balanced living.
Overview of DBT Model and Strategies
DBT is a cognitive-behavioral treatment approach rooted in Zen Buddhism,
dialectics, and biosocial theory. Its overarching philosophy balances
acceptance and change in a dialectical manner, recognizing both the need to
validate inner experiences while committing to behavioral improvements
through skills practice. Therapists follow a "validation and encouragement"
stance, accepting clients where they are without judgment while also
motivating adaptive changes (Lindenboim et al., 2007). Individual therapy
sessions interweave this dialectical approach with teaching core DBT skills
modules.
The first skills module targets core mindfulness practices to cultivate wise,
balanced awareness of present internal and external experiences. Tasks like
breathing, body awareness, and daily logging exercises train non-judgmental
focus and observation that counteract tendencies toward emotional
reactivity, avoidance, and lack of self-care.
The second module trains interpersonal effectiveness through strategies like
DEARMAN, GIVE, and FAST that respectively help clients assert needs
respectfully, clearly communicate boundaries, and navigate challenging
social situations effectively and respectfully. Related communication
trainings address building empathy, validation, and compromise in
relationships (Swales, 2009).
The third module targets distress tolerance by identifying primary and
secondary emotions, tolerating painful experiences through wise "riding the
wave" and coping ahead techniques, distracting with safe activities,
improving with self-soothing behaviors, and accepting reality rather than
fighting unchangeable factors.
Finally, the emotion regulation module provides tools for mindfulness of
emotions, reducing vulnerability factors, changing emotional states through
opposing behaviors, and taking wise actions guided by healthy emotions
rather than impulsivity (Swales, 2009).
All strategies are manualized to ensure treatment fidelity and teach skills in a
hierarchical, paced manner through individual therapy, weekly group skills
training, phone coaching for intersession practice, and therapist consultation
meetings (Lindenboim et al., 2007). Therapists further encourage daily diary
card tracking to reinforce new behaviors and problem-solve obstacles
(Dimeff & Linehan, 2008).
Benefits for Addiction Counseling
DBT's mechanisms for addressing emotion dysregulation and distress
tolerance through mindfulness, interpersonal effectiveness and adaptive
coping strategies directly translate to benefiting addiction recovery in
several ways:
Cultivating Emotional Awareness
Mindfulness practices increase clients' ability to notice internal triggers for
substance urges and situational factors contributing to maladaptive coping
without becoming overwhelmed or acting impulsively. This awareness
provides distance and choice.
Managing Strong Emotions
DBT techniques like riding emotional waves, opposite action, and thinking of
wise mind give clients tools to experience even difficult feelings without
defaulting to addictive behaviors by tolerating distress or changing
emotional states in healthy ways.
Improving Relationship Dynamics
Interpersonal effectiveness skills help navigate social challenges and set
boundaries constructively without slipping into codependency, enabling
clients to build fulfilling support systems key for long-term sobriety.
Coping with Cravings and Relapse Triggers
Distress tolerance strategies such as self-soothing, distracting with
alternative activities, acceptance, and coping ahead plans equip clients to
manage cravings, urges or setbacks without losing control or abandoning
recovery entirely.
Reducing Shame and Self-Criticism
The validating, non-judgmental philosophy of DBT, combined with building
self-esteem through skills mastery, counters typical addict self-loathing,
isolation and hopelessness, fueling courage for change.
Addressing Co-Occurring Disorders
Clients dually diagnosed with addictions and mood/anxiety issues directly
benefit from DBT interventions targeting underlying emotion dysregulation
maintaining all related problems.
In summary, DBT offers versatile transdiagnostic techniques addressing root
factors at the emotions-addictions interface through mindfulness, effective
communication, and adaptive coping strategies. These empower clients to
establish long-term wellness and balance in recovery.
Cultivating Mindfulness for Emotional Awareness
A primary way DBT builds emotional regulation is through cultivating
mindfulness—non-judging, present-moment awareness of internal and
external experiences. This metacognitive skill counters addiction-related
tendencies toward emotional avoidance, reactivity and lack of self-care. DBT
mindfulness practices include:
Observational Exercises
Clients notice thoughts/feelings passively without reaction through Body
Scan meditation, Pleasant Events daily logs, or Emotion Diary homework
logging triggers. This detachment interrupts addiction's automatic pilot and
compulsion cycles (Lindenboim et al., 2007).
Focus & Breath Awareness
Focusing mind on breathing or other external sensory anchors like music
pulls attention to anchoring physical sensations rather than
racing/ruminating thoughts sustaining craving-using cycles. Short- and long-
term breath practices help sustain wise mindfulness.
Distress Tolerance Strategies
Self-soothing behaviors like holding an ice cube, blowing bubbles, smelling
pleasant scents, or saying encouraging self-talk provide concrete
mindfulness tools for tolerating distressing triggers or lapses without
abandoning broader recovery efforts (Dimeff & Linehan, 2008).
Wise Mind State
This balanced perspective integrating reason and intuition gives clients
capacity to make clear choices guided by sobriety priorities rather than
emotions alone. Mindfulness maintains wise mind clarity during decision-
making.
The detached, non-reactive stance cultivated through mindfulness allows
clients to recognize addiction-related thoughts or urges arising without
immediately becoming overwhelmed or impulsively acting out self-
destructive patterns (Lindenboim et al., 2007). Instead, mindfulness creates
psychological space to choose constructive coping options. Over time, this
metacognition enhances emotion regulation abilities crucial for long-term
recovery success and well-being.
Improving Emotion Regulation Skills
While mindfulness fosters awareness, DBT directly teaches core strategies
for modulating emotions: opposite action, changing vulnerability factors,
urges surfing, ACCEPTS framework. When applied alongside counselor
guidance and group processing, these tools become empowering skills
clients own for long-term management of affective triggers maintaining
addictions:
Opposite Action
Deliberately acting opposite cravings/emotions by engaging in healthful
distracting activities like exercise or calling supports interrupts addiction's
automatic pilot processes. Over time, new response patterns replace harmful
ones (Lindenboim et al., 2007).
Changing Vulnerability Factors
Clients identify avoidant patterns exacerbating emotional vulnerabilities like
lack of sleep, isolation from supports, self-criticism, all-or-nothing thinking,
then take wise preemptive actions before distressing triggers arise (Dimeff &
Linehan, 2008).
Urge Surfing
Mindfully "riding the emotional wave" of cravings/triggers without reacting
teaches clients to detach from transient feelings and wait patiently for
intensity to naturally lessen on its own without acting out dysfunctional urges
(Lindenboim et al., 2007).
ACCEPTS Framework
This acronym guides clients moving through difficult emotions by Activating
wise mind, identifying Current thoughts/emotions kindly, evaluating
Pros/cons objectively, nurturing compassion for self with softer self-talk,
noting Thoughts are fleeting mental events, experiencing physical
Sensations fully with mindfulness, and committing to Self-care by tolerating
distress adaptively (Dimeff & Linehan, 2008).
Overall, enhancing clients' emotional intelligence and expanding skills
repertoires for balancing reason and feelings provides an arsenal against
addiction-related vulnerabilities. Over time, habitual thoughts like "I just
need to use to feel better" lose power as viable alternative responses are
practiced.
Developing Interpersonal Effectiveness
Another component crucial for sustained recovery is reducing dependency on
unhealthy relationships maintaining addictions while cultivating fulfilling
connections supporting well-balanced living. The DBT Interpersonal
Effectiveness module teaches constructive strategies including:
DEARMAN
This acronym guides assertively asking for what one wants respectfully while
maintaining self-respect and the relationship. Clients apply it to set
boundaries with enabling contacts (Lindenboim et al., 2007).
GIVE
Giving information clearly and validly, expressing wishes/feelings
respectfully, validating others and negotiating disputes constructively helps
clients navigate interpersonal challenges constructively.
FAST
Avoiding risky situations threatening safety/goals, thinking things through
considering priorities/limits, negotiating for win-win compromises, asserting
calmly and truthfully preserves solid recovery support systems over time
through balanced living principles (Dimeff & Linehan, 2008).
Validation/Empathy
Showing compassion for others without enabling harm and resolving
misunderstandings through validating different perspectives strengthens
fulfilling relationships integral for long-term recovery maintenance and
overall well-being.
Overall, equipping clients to meet interpersonal needs constructively without
codependency or enabling dysfunctional patterns provides critical relational
tools serving as protective factors buttressing recovery success over a
lifetime. DBT strategies foster socially supportive ecosystems nourishing
wellness.
Coping with Distress and Cravings
Perhaps the greatest test for newly recovering individuals is tolerating
unpleasant emotions and resisting craving-driven urges without losing
control. Core DBT strategies address this challenge:
Coping Ahead Plans
Proactively strategizing how to handle high-risk situations/emotions
beforehand using all learned skills increases clients’ sense of self-efficacy
and preparedness for challenges (Dimeff & Linehan, 2008).
Distracting with Opposite Emotions/Activities
Engaging in enjoyable hobbies, calling supports, self-soothing behaviors like
snapping a rubber band rides out cravings by shifting focus from addiction to
more productive outlets (Lindenboim et al., 2007).
Reality Acceptance
Letting go of desire to control unchangeable aspects of situations/feelings
allows clients to disengage from urges and make wise behavior choices
under stress (Dimeff & Linehan, 2008).
Self-Soothe with Five Senses
Soothing oneself through grounding sensory awareness exercises like deep
breathing, cool showers, music, tactile fidgets tolerates distress adaptively.
Wise Mind
Making decisions from balanced perspective considers priorities/values over
impulses, maintaining clarity under duress crucial for withstanding lapses
(Lindenboim et al., 2007).
Overall, distress tolerance skills strengthen clients to independently ride
emotional waves without relapsing by choosing constructive outlets
respecting recovery priorities. Over time, cravings lose power through
habituating new self-care patterns.
Conclusion
Addiction arises from complex interactions between biological, psychological
and social factors. Emotion dysregulation and maladaptive coping play
critical roles in both developing and maintaining substance dependence. For
these core reasons, therapeutic approaches like DBT directly targeting
emotional awareness, interpersonal effectiveness and distress tolerance hold
immense promise for empowering clients for long-term recovery success.
Through its dialectical philosophy balancing acceptance and change, DBT's
evidence-based techniques cultivate mindfulness, adaptive emotion
regulation and coping strategies serving as portable protective skills clients
can apply independently throughout their lifetime recovery journeys.
Whether facing relationship stressors, cravings and lapses or general life
challenges, these transdiagnostic DBT strategies bolster psychological
resilience against substance misuse. Overall, integrating such skills directly
addressing underlying vulnerabilities can greatly expand addiction
counselors’ toolbox for equipping clients with lifelong wellness tools.
Addiction is a disease involving compulsively seeking rewards and relief
through the use of substances or engaging in unhealthy behaviors despite
repercussions. A core reason many individuals develop addictions is due to
difficulties regulating feelings and coping with distress that arises from life's
challenges. Research shows a significant relationship between emotion
dysregulation and substance use disorders (SUDs), with high rates of co-
occurring mood and anxiety disorders as well (Witkiewitz & Bowen, 2010).
For this reason, therapeutic approaches that teach emotional regulation and
distress tolerance skills have particular relevance for addiction counseling.
One such evidence-based model is Dialectical Behavior Therapy (DBT).
Originally developed by Marsha Linehan in the 1980s to treat borderline
personality disorder, DBT has since been adapted and studied for treating
SUDs with great success (Dimeff & Linehan, 2008). Its core aim is balancing
acceptance of oneself and reality with a commitment to positive change
through teaching mindfulness, interpersonal effectiveness, emotional
regulation, and distress tolerance skills. This paper explores how DBT
strategies addressing emotion dysregulation and maladaptive coping can
benefit addiction counselors and their clients working toward long-term
recovery maintenance through building psychological resilience and
balanced living.
Overview of DBT Model and Strategies
DBT is a cognitive-behavioral treatment approach rooted in Zen Buddhism,
dialectics, and biosocial theory. Its overarching philosophy balances
acceptance and change in a dialectical manner, recognizing both the need to
validate inner experiences while committing to behavioral improvements
through skills practice. Therapists follow a "validation and encouragement"
stance, accepting clients where they are without judgment while also
motivating adaptive changes (Lindenboim et al., 2007). Individual therapy
sessions interweave this dialectical approach with teaching core DBT skills
modules.
The first skills module targets core mindfulness practices to cultivate wise,
balanced awareness of present internal and external experiences. Tasks like
breathing, body awareness, and daily logging exercises train non-judgmental
focus and observation that counteract tendencies toward emotional
reactivity, avoidance, and lack of self-care.
The second module trains interpersonal effectiveness through strategies like
DEARMAN, GIVE, and FAST that respectively help clients assert needs
respectfully, clearly communicate boundaries, and navigate challenging
social situations effectively and respectfully. Related communication
trainings address building empathy, validation, and compromise in
relationships (Swales, 2009).
The third module targets distress tolerance by identifying primary and
secondary emotions, tolerating painful experiences through wise "riding the
wave" and coping ahead techniques, distracting with safe activities,
improving with self-soothing behaviors, and accepting reality rather than
fighting unchangeable factors.
Finally, the emotion regulation module provides tools for mindfulness of
emotions, reducing vulnerability factors, changing emotional states through
opposing behaviors, and taking wise actions guided by healthy emotions
rather than impulsivity (Swales, 2009).
All strategies are manualized to ensure treatment fidelity and teach skills in a
hierarchical, paced manner through individual therapy, weekly group skills
training, phone coaching for intersession practice, and therapist consultation
meetings (Lindenboim et al., 2007). Therapists further encourage daily diary
card tracking to reinforce new behaviors and problem-solve obstacles
(Dimeff & Linehan, 2008).
Benefits for Addiction Counseling
DBT's mechanisms for addressing emotion dysregulation and distress
tolerance through mindfulness, interpersonal effectiveness and adaptive
coping strategies directly translate to benefiting addiction recovery in
several ways:
Cultivating Emotional Awareness
Mindfulness practices increase clients' ability to notice internal triggers for
substance urges and situational factors contributing to maladaptive coping
without becoming overwhelmed or acting impulsively. This awareness
provides distance and choice.
Managing Strong Emotions
DBT techniques like riding emotional waves, opposite action, and thinking of
wise mind give clients tools to experience even difficult feelings without
defaulting to addictive behaviors by tolerating distress or changing
emotional states in healthy ways.
Improving Relationship Dynamics
Interpersonal effectiveness skills help navigate social challenges and set
boundaries constructively without slipping into codependency, enabling
clients to build fulfilling support systems key for long-term sobriety.
Coping with Cravings and Relapse Triggers
Distress tolerance strategies such as self-soothing, distracting with
alternative activities, acceptance, and coping ahead plans equip clients to
manage cravings, urges or setbacks without losing control or abandoning
recovery entirely.
Reducing Shame and Self-Criticism
The validating, non-judgmental philosophy of DBT, combined with building
self-esteem through skills mastery, counters typical addict self-loathing,
isolation and hopelessness, fueling courage for change.
Addressing Co-Occurring Disorders
Clients dually diagnosed with addictions and mood/anxiety issues directly
benefit from DBT interventions targeting underlying emotion dysregulation
maintaining all related problems.
In summary, DBT offers versatile transdiagnostic techniques addressing root
factors at the emotions-addictions interface through mindfulness, effective
communication, and adaptive coping strategies. These empower clients to
establish long-term wellness and balance in recovery.
Cultivating Mindfulness for Emotional Awareness
A primary way DBT builds emotional regulation is through cultivating
mindfulness—non-judging, present-moment awareness of internal and
external experiences. This metacognitive skill counters addiction-related
tendencies toward emotional avoidance, reactivity and lack of self-care. DBT
mindfulness practices include:
Observational Exercises
Clients notice thoughts/feelings passively without reaction through Body
Scan meditation, Pleasant Events daily logs, or Emotion Diary homework
logging triggers. This detachment interrupts addiction's automatic pilot and
compulsion cycles (Lindenboim et al., 2007).
Focus & Breath Awareness
Focusing mind on breathing or other external sensory anchors like music
pulls attention to anchoring physical sensations rather than
racing/ruminating thoughts sustaining craving-using cycles. Short- and long-
term breath practices help sustain wise mindfulness.
Distress Tolerance Strategies
Self-soothing behaviors like holding an ice cube, blowing bubbles, smelling
pleasant scents, or saying encouraging self-talk provide concrete
mindfulness tools for tolerating distressing triggers or lapses without
abandoning broader recovery efforts (Dimeff & Linehan, 2008).
Wise Mind State
This balanced perspective integrating reason and intuition gives clients
capacity to make clear choices guided by sobriety priorities rather than
emotions alone. Mindfulness maintains wise mind clarity during decision-
making.
The detached, non-reactive stance cultivated through mindfulness allows
clients to recognize addiction-related thoughts or urges arising without
immediately becoming overwhelmed or impulsively acting out self-
destructive patterns (Lindenboim et al., 2007). Instead, mindfulness creates
psychological space to choose constructive coping options. Over time, this
metacognition enhances emotion regulation abilities crucial for long-term
recovery success and well-being.
Improving Emotion Regulation Skills
While mindfulness fosters awareness, DBT directly teaches core strategies
for modulating emotions: opposite action, changing vulnerability factors,
urges surfing, ACCEPTS framework. When applied alongside counselor
guidance and group processing, these tools become empowering skills
clients own for long-term management of affective triggers maintaining
addictions:
Opposite Action
Deliberately acting opposite cravings/emotions by engaging in healthful
distracting activities like exercise or calling supports interrupts addiction's
automatic pilot processes. Over time, new response patterns replace harmful
ones (Lindenboim et al., 2007).
Changing Vulnerability Factors
Clients identify avoidant patterns exacerbating emotional vulnerabilities like
lack of sleep, isolation from supports, self-criticism, all-or-nothing thinking,
then take wise preemptive actions before distressing triggers arise (Dimeff &
Linehan, 2008).
Urge Surfing
Mindfully "riding the emotional wave" of cravings/triggers without reacting
teaches clients to detach from transient feelings and wait patiently for
intensity to naturally lessen on its own without acting out dysfunctional urges
(Lindenboim et al., 2007).
ACCEPTS Framework
This acronym guides clients moving through difficult emotions by Activating
wise mind, identifying Current thoughts/emotions kindly, evaluating
Pros/cons objectively, nurturing compassion for self with softer self-talk,
noting Thoughts are fleeting mental events, experiencing physical
Sensations fully with mindfulness, and committing to Self-care by tolerating
distress adaptively (Dimeff & Linehan, 2008).
Overall, enhancing clients' emotional intelligence and expanding skills
repertoires for balancing reason and feelings provides an arsenal against
addiction-related vulnerabilities. Over time, habitual thoughts like "I just
need to use to feel better" lose power as viable alternative responses are
practiced.
Developing Interpersonal Effectiveness
Another component crucial for sustained recovery is reducing dependency on
unhealthy relationships maintaining addictions while cultivating fulfilling
connections supporting well-balanced living. The DBT Interpersonal
Effectiveness module teaches constructive strategies including:
DEARMAN
This acronym guides assertively asking for what one wants respectfully while
maintaining self-respect and the relationship. Clients apply it to set
boundaries with enabling contacts (Lindenboim et al., 2007).
GIVE
Giving information clearly and validly, expressing wishes/feelings
respectfully, validating others and negotiating disputes constructively helps
clients navigate interpersonal challenges constructively.
FAST
Avoiding risky situations threatening safety/goals, thinking things through
considering priorities/limits, negotiating for win-win compromises, asserting
calmly and truthfully preserves solid recovery support systems over time
through balanced living principles (Dimeff & Linehan, 2008).
Validation/Empathy
Showing compassion for others without enabling harm and resolving
misunderstandings through validating different perspectives strengthens
fulfilling relationships integral for long-term recovery maintenance and
overall well-being.
Overall, equipping clients to meet interpersonal needs constructively without
codependency or enabling dysfunctional patterns provides critical relational
tools serving as protective factors buttressing recovery success over a
lifetime. DBT strategies foster socially supportive ecosystems nourishing
wellness.
Coping with Distress and Cravings
Perhaps the greatest test for newly recovering individuals is tolerating
unpleasant emotions and resisting craving-driven urges without losing
control. Core DBT strategies address this challenge:
Coping Ahead Plans
Proactively strategizing how to handle high-risk situations/emotions
beforehand using all learned skills increases clients’ sense of self-efficacy
and preparedness for challenges (Dimeff & Linehan, 2008).
Distracting with Opposite Emotions/Activities
Engaging in enjoyable hobbies, calling supports, self-soothing behaviors like
snapping a rubber band rides out cravings by shifting focus from addiction to
more productive outlets (Lindenboim et al., 2007).
Reality Acceptance
Letting go of desire to control unchangeable aspects of situations/feelings
allows clients to disengage from urges and make wise behavior choices
under stress (Dimeff & Linehan, 2008).
Self-Soothe with Five Senses
Soothing oneself through grounding sensory awareness exercises like deep
breathing, cool showers, music, tactile fidgets tolerates distress adaptively.
Wise Mind
Making decisions from balanced perspective considers priorities/values over
impulses, maintaining clarity under duress crucial for withstanding lapses
(Lindenboim et al., 2007).
Overall, distress tolerance skills strengthen clients to independently ride
emotional waves without relapsing by choosing constructive outlets
respecting recovery priorities. Over time, cravings lose power through
habituating new self-care patterns.
Conclusion
Addiction arises from complex interactions between biological, psychological
and social factors. Emotion dysregulation and maladaptive coping play
critical roles in both developing and maintaining substance dependence. For
these core reasons, therapeutic approaches like DBT directly targeting
emotional awareness, interpersonal effectiveness and distress tolerance hold
immense promise for empowering clients for long-term recovery success.
Through its dialectical philosophy balancing acceptance and change, DBT's
evidence-based techniques cultivate mindfulness, adaptive emotion
regulation and coping strategies serving as portable protective skills clients
can apply independently throughout their lifetime recovery journeys.
Whether facing relationship stressors, cravings and lapses or general life
challenges, these transdiagnostic DBT strategies bolster psychological
resilience against substance misuse. Overall, integrating such skills directly
addressing underlying vulnerabilities can greatly expand addiction
counselors’ toolbox for equipping clients with lifelong wellness tools.
Addiction is a disease involving compulsively seeking rewards and relief
through the use of substances or engaging in unhealthy behaviors despite
repercussions. A core reason many individuals develop addictions is due to
difficulties regulating feelings and coping with distress that arises from life's
challenges. Research shows a significant relationship between emotion
dysregulation and substance use disorders (SUDs), with high rates of co-
occurring mood and anxiety disorders as well (Witkiewitz & Bowen, 2010).
For this reason, therapeutic approaches that teach emotional regulation and
distress tolerance skills have particular relevance for addiction counseling.
One such evidence-based model is Dialectical Behavior Therapy (DBT).
Originally developed by Marsha Linehan in the 1980s to treat borderline
personality disorder, DBT has since been adapted and studied for treating
SUDs with great success (Dimeff & Linehan, 2008). Its core aim is balancing
acceptance of oneself and reality with a commitment to positive change
through teaching mindfulness, interpersonal effectiveness, emotional
regulation, and distress tolerance skills. This paper explores how DBT
strategies addressing emotion dysregulation and maladaptive coping can
benefit addiction counselors and their clients working toward long-term
recovery maintenance through building psychological resilience and
balanced living.
Overview of DBT Model and Strategies
DBT is a cognitive-behavioral treatment approach rooted in Zen Buddhism,
dialectics, and biosocial theory. Its overarching philosophy balances
acceptance and change in a dialectical manner, recognizing both the need to
validate inner experiences while committing to behavioral improvements
through skills practice. Therapists follow a "validation and encouragement"
stance, accepting clients where they are without judgment while also
motivating adaptive changes (Lindenboim et al., 2007). Individual therapy
sessions interweave this dialectical approach with teaching core DBT skills
modules.
The first skills module targets core mindfulness practices to cultivate wise,
balanced awareness of present internal and external experiences. Tasks like
breathing, body awareness, and daily logging exercises train non-judgmental
focus and observation that counteract tendencies toward emotional
reactivity, avoidance, and lack of self-care.
The second module trains interpersonal effectiveness through strategies like
DEARMAN, GIVE, and FAST that respectively help clients assert needs
respectfully, clearly communicate boundaries, and navigate challenging
social situations effectively and respectfully. Related communication
trainings address building empathy, validation, and compromise in
relationships (Swales, 2009).
The third module targets distress tolerance by identifying primary and
secondary emotions, tolerating painful experiences through wise "riding the
wave" and coping ahead techniques, distracting with safe activities,
improving with self-soothing behaviors, and accepting reality rather than
fighting unchangeable factors.
Finally, the emotion regulation module provides tools for mindfulness of
emotions, reducing vulnerability factors, changing emotional states through
opposing behaviors, and taking wise actions guided by healthy emotions
rather than impulsivity (Swales, 2009).
All strategies are manualized to ensure treatment fidelity and teach skills in a
hierarchical, paced manner through individual therapy, weekly group skills
training, phone coaching for intersession practice, and therapist consultation
meetings (Lindenboim et al., 2007). Therapists further encourage daily diary
card tracking to reinforce new behaviors and problem-solve obstacles
(Dimeff & Linehan, 2008).
Benefits for Addiction Counseling
DBT's mechanisms for addressing emotion dysregulation and distress
tolerance through mindfulness, interpersonal effectiveness and adaptive
coping strategies directly translate to benefiting addiction recovery in
several ways:
Cultivating Emotional Awareness
Mindfulness practices increase clients' ability to notice internal triggers for
substance urges and situational factors contributing to maladaptive coping
without becoming overwhelmed or acting impulsively. This awareness
provides distance and choice.
Managing Strong Emotions
DBT techniques like riding emotional waves, opposite action, and thinking of
wise mind give clients tools to experience even difficult feelings without
defaulting to addictive behaviors by tolerating distress or changing
emotional states in healthy ways.
Improving Relationship Dynamics
Interpersonal effectiveness skills help navigate social challenges and set
boundaries constructively without slipping into codependency, enabling
clients to build fulfilling support systems key for long-term sobriety.
Coping with Cravings and Relapse Triggers
Distress tolerance strategies such as self-soothing, distracting with
alternative activities, acceptance, and coping ahead plans equip clients to
manage cravings, urges or setbacks without losing control or abandoning
recovery entirely.
Reducing Shame and Self-Criticism
The validating, non-judgmental philosophy of DBT, combined with building
self-esteem through skills mastery, counters typical addict self-loathing,
isolation and hopelessness, fueling courage for change.
Addressing Co-Occurring Disorders
Clients dually diagnosed with addictions and mood/anxiety issues directly
benefit from DBT interventions targeting underlying emotion dysregulation
maintaining all related problems.
In summary, DBT offers versatile transdiagnostic techniques addressing root
factors at the emotions-addictions interface through mindfulness, effective
communication, and adaptive coping strategies. These empower clients to
establish long-term wellness and balance in recovery.
Cultivating Mindfulness for Emotional Awareness
A primary way DBT builds emotional regulation is through cultivating
mindfulness—non-judging, present-moment awareness of internal and
external experiences. This metacognitive skill counters addiction-related
tendencies toward emotional avoidance, reactivity and lack of self-care. DBT
mindfulness practices include:
Observational Exercises
Clients notice thoughts/feelings passively without reaction through Body
Scan meditation, Pleasant Events daily logs, or Emotion Diary homework
logging triggers. This detachment interrupts addiction's automatic pilot and
compulsion cycles (Lindenboim et al., 2007).
Focus & Breath Awareness
Focusing mind on breathing or other external sensory anchors like music
pulls attention to anchoring physical sensations rather than
racing/ruminating thoughts sustaining craving-using cycles. Short- and long-
term breath practices help sustain wise mindfulness.
Distress Tolerance Strategies
Self-soothing behaviors like holding an ice cube, blowing bubbles, smelling
pleasant scents, or saying encouraging self-talk provide concrete
mindfulness tools for tolerating distressing triggers or lapses without
abandoning broader recovery efforts (Dimeff & Linehan, 2008).
Wise Mind State
This balanced perspective integrating reason and intuition gives clients
capacity to make clear choices guided by sobriety priorities rather than
emotions alone. Mindfulness maintains wise mind clarity during decision-
making.
The detached, non-reactive stance cultivated through mindfulness allows
clients to recognize addiction-related thoughts or urges arising without
immediately becoming overwhelmed or impulsively acting out self-
destructive patterns (Lindenboim et al., 2007). Instead, mindfulness creates
psychological space to choose constructive coping options. Over time, this
metacognition enhances emotion regulation abilities crucial for long-term
recovery success and well-being.
Improving Emotion Regulation Skills
While mindfulness fosters awareness, DBT directly teaches core strategies
for modulating emotions: opposite action, changing vulnerability factors,
urges surfing, ACCEPTS framework. When applied alongside counselor
guidance and group processing, these tools become empowering skills
clients own for long-term management of affective triggers maintaining
addictions:
Opposite Action
Deliberately acting opposite cravings/emotions by engaging in healthful
distracting activities like exercise or calling supports interrupts addiction's
automatic pilot processes. Over time, new response patterns replace harmful
ones (Lindenboim et al., 2007).
Changing Vulnerability Factors
Clients identify avoidant patterns exacerbating emotional vulnerabilities like
lack of sleep, isolation from supports, self-criticism, all-or-nothing thinking,
then take wise preemptive actions before distressing triggers arise (Dimeff &
Linehan, 2008).
Urge Surfing
Mindfully "riding the emotional wave" of cravings/triggers without reacting
teaches clients to detach from transient feelings and wait patiently for
intensity to naturally lessen on its own without acting out dysfunctional urges
(Lindenboim et al., 2007).
ACCEPTS Framework
This acronym guides clients moving through difficult emotions by Activating
wise mind, identifying Current thoughts/emotions kindly, evaluating
Pros/cons objectively, nurturing compassion for self with softer self-talk,
noting Thoughts are fleeting mental events, experiencing physical
Sensations fully with mindfulness, and committing to Self-care by tolerating
distress adaptively (Dimeff & Linehan, 2008).
Overall, enhancing clients' emotional intelligence and expanding skills
repertoires for balancing reason and feelings provides an arsenal against
addiction-related vulnerabilities. Over time, habitual thoughts like "I just
need to use to feel better" lose power as viable alternative responses are
practiced.
Developing Interpersonal Effectiveness
Another component crucial for sustained recovery is reducing dependency on
unhealthy relationships maintaining addictions while cultivating fulfilling
connections supporting well-balanced living. The DBT Interpersonal
Effectiveness module teaches constructive strategies including:
DEARMAN
This acronym guides assertively asking for what one wants respectfully while
maintaining self-respect and the relationship. Clients apply it to set
boundaries with enabling contacts (Lindenboim et al., 2007).
GIVE
Giving information clearly and validly, expressing wishes/feelings
respectfully, validating others and negotiating disputes constructively helps
clients navigate interpersonal challenges constructively.
FAST
Avoiding risky situations threatening safety/goals, thinking things through
considering priorities/limits, negotiating for win-win compromises, asserting
calmly and truthfully preserves solid recovery support systems over time
through balanced living principles (Dimeff & Linehan, 2008).
Validation/Empathy
Showing compassion for others without enabling harm and resolving
misunderstandings through validating different perspectives strengthens
fulfilling relationships integral for long-term recovery maintenance and
overall well-being.
Overall, equipping clients to meet interpersonal needs constructively without
codependency or enabling dysfunctional patterns provides critical relational
tools serving as protective factors buttressing recovery success over a
lifetime. DBT strategies foster socially supportive ecosystems nourishing
wellness.
Coping with Distress and Cravings
Perhaps the greatest test for newly recovering individuals is tolerating
unpleasant emotions and resisting craving-driven urges without losing
control. Core DBT strategies address this challenge:
Coping Ahead Plans
Proactively strategizing how to handle high-risk situations/emotions
beforehand using all learned skills increases clients’ sense of self-efficacy
and preparedness for challenges (Dimeff & Linehan, 2008).
Distracting with Opposite Emotions/Activities
Engaging in enjoyable hobbies, calling supports, self-soothing behaviors like
snapping a rubber band rides out cravings by shifting focus from addiction to
more productive outlets (Lindenboim et al., 2007).
Reality Acceptance
Letting go of desire to control unchangeable aspects of situations/feelings
allows clients to disengage from urges and make wise behavior choices
under stress (Dimeff & Linehan, 2008).
Self-Soothe with Five Senses
Soothing oneself through grounding sensory awareness exercises like deep
breathing, cool showers, music, tactile fidgets tolerates distress adaptively.
Wise Mind
Making decisions from balanced perspective considers priorities/values over
impulses, maintaining clarity under duress crucial for withstanding lapses
(Lindenboim et al., 2007).
Overall, distress tolerance skills strengthen clients to independently ride
emotional waves without relapsing by choosing constructive outlets
respecting recovery priorities. Over time, cravings lose power through
habituating new self-care patterns.
Conclusion
Addiction arises from complex interactions between biological, psychological
and social factors. Emotion dysregulation and maladaptive coping play
critical roles in both developing and maintaining substance dependence. For
these core reasons, therapeutic approaches like DBT directly targeting
emotional awareness, interpersonal effectiveness and distress tolerance hold
immense promise for empowering clients for long-term recovery success.
Through its dialectical philosophy balancing acceptance and change, DBT's
evidence-based techniques cultivate mindfulness, adaptive emotion
regulation and coping strategies serving as portable protective skills clients
can apply independently throughout their lifetime recovery journeys.
Whether facing relationship stressors, cravings and lapses or general life
challenges, these transdiagnostic DBT strategies bolster psychological
resilience against substance misuse. Overall, integrating such skills directly
addressing underlying vulnerabilities can greatly expand addiction
counselors’ toolbox for equipping clients with lifelong wellness tools.
Addiction is a disease involving compulsively seeking rewards and relief
through the use of substances or engaging in unhealthy behaviors despite
repercussions. A core reason many individuals develop addictions is due to
difficulties regulating feelings and coping with distress that arises from life's
challenges. Research shows a significant relationship between emotion
dysregulation and substance use disorders (SUDs), with high rates of co-
occurring mood and anxiety disorders as well (Witkiewitz & Bowen, 2010).
For this reason, therapeutic approaches that teach emotional regulation and
distress tolerance skills have particular relevance for addiction counseling.
One such evidence-based model is Dialectical Behavior Therapy (DBT).
Originally developed by Marsha Linehan in the 1980s to treat borderline
personality disorder, DBT has since been adapted and studied for treating
SUDs with great success (Dimeff & Linehan, 2008). Its core aim is balancing
acceptance of oneself and reality with a commitment to positive change
through teaching mindfulness, interpersonal effectiveness, emotional
regulation, and distress tolerance skills. This paper explores how DBT
strategies addressing emotion dysregulation and maladaptive coping can
benefit addiction counselors and their clients working toward long-term
recovery maintenance through building psychological resilience and
balanced living.
Overview of DBT Model and Strategies
DBT is a cognitive-behavioral treatment approach rooted in Zen Buddhism,
dialectics, and biosocial theory. Its overarching philosophy balances
acceptance and change in a dialectical manner, recognizing both the need to
validate inner experiences while committing to behavioral improvements
through skills practice. Therapists follow a "validation and encouragement"
stance, accepting clients where they are without judgment while also
motivating adaptive changes (Lindenboim et al., 2007). Individual therapy
sessions interweave this dialectical approach with teaching core DBT skills
modules.
The first skills module targets core mindfulness practices to cultivate wise,
balanced awareness of present internal and external experiences. Tasks like
breathing, body awareness, and daily logging exercises train non-judgmental
focus and observation that counteract tendencies toward emotional
reactivity, avoidance, and lack of self-care.
The second module trains interpersonal effectiveness through strategies like
DEARMAN, GIVE, and FAST that respectively help clients assert needs
respectfully, clearly communicate boundaries, and navigate challenging
social situations effectively and respectfully. Related communication
trainings address building empathy, validation, and compromise in
relationships (Swales, 2009).
The third module targets distress tolerance by identifying primary and
secondary emotions, tolerating painful experiences through wise "riding the
wave" and coping ahead techniques, distracting with safe activities,
improving with self-soothing behaviors, and accepting reality rather than
fighting unchangeable factors.
Finally, the emotion regulation module provides tools for mindfulness of
emotions, reducing vulnerability factors, changing emotional states through
opposing behaviors, and taking wise actions guided by healthy emotions
rather than impulsivity (Swales, 2009).
All strategies are manualized to ensure treatment fidelity and teach skills in a
hierarchical, paced manner through individual therapy, weekly group skills
training, phone coaching for intersession practice, and therapist consultation
meetings (Lindenboim et al., 2007). Therapists further encourage daily diary
card tracking to reinforce new behaviors and problem-solve obstacles
(Dimeff & Linehan, 2008).
Benefits for Addiction Counseling
DBT's mechanisms for addressing emotion dysregulation and distress
tolerance through mindfulness, interpersonal effectiveness and adaptive
coping strategies directly translate to benefiting addiction recovery in
several ways:
Cultivating Emotional Awareness
Mindfulness practices increase clients' ability to notice internal triggers for
substance urges and situational factors contributing to maladaptive coping
without becoming overwhelmed or acting impulsively. This awareness
provides distance and choice.
Managing Strong Emotions
DBT techniques like riding emotional waves, opposite action, and thinking of
wise mind give clients tools to experience even difficult feelings without
defaulting to addictive behaviors by tolerating distress or changing
emotional states in healthy ways.
Improving Relationship Dynamics
Interpersonal effectiveness skills help navigate social challenges and set
boundaries constructively without slipping into codependency, enabling
clients to build fulfilling support systems key for long-term sobriety.
Coping with Cravings and Relapse Triggers
Distress tolerance strategies such as self-soothing, distracting with
alternative activities, acceptance, and coping ahead plans equip clients to
manage cravings, urges or setbacks without losing control or abandoning
recovery entirely.
Reducing Shame and Self-Criticism
The validating, non-judgmental philosophy of DBT, combined with building
self-esteem through skills mastery, counters typical addict self-loathing,
isolation and hopelessness, fueling courage for change.
Addressing Co-Occurring Disorders
Clients dually diagnosed with addictions and mood/anxiety issues directly
benefit from DBT interventions targeting underlying emotion dysregulation
maintaining all related problems.
In summary, DBT offers versatile transdiagnostic techniques addressing root
factors at the emotions-addictions interface through mindfulness, effective
communication, and adaptive coping strategies. These empower clients to
establish long-term wellness and balance in recovery.
Cultivating Mindfulness for Emotional Awareness
A primary way DBT builds emotional regulation is through cultivating
mindfulness—non-judging, present-moment awareness of internal and
external experiences. This metacognitive skill counters addiction-related
tendencies toward emotional avoidance, reactivity and lack of self-care. DBT
mindfulness practices include:
Observational Exercises
Clients notice thoughts/feelings passively without reaction through Body
Scan meditation, Pleasant Events daily logs, or Emotion Diary homework
logging triggers. This detachment interrupts addiction's automatic pilot and
compulsion cycles (Lindenboim et al., 2007).
Focus & Breath Awareness
Focusing mind on breathing or other external sensory anchors like music
pulls attention to anchoring physical sensations rather than
racing/ruminating thoughts sustaining craving-using cycles. Short- and long-
term breath practices help sustain wise mindfulness.
Distress Tolerance Strategies
Self-soothing behaviors like holding an ice cube, blowing bubbles, smelling
pleasant scents, or saying encouraging self-talk provide concrete
mindfulness tools for tolerating distressing triggers or lapses without
abandoning broader recovery efforts (Dimeff & Linehan, 2008).
Wise Mind State
This balanced perspective integrating reason and intuition gives clients
capacity to make clear choices guided by sobriety priorities rather than
emotions alone. Mindfulness maintains wise mind clarity during decision-
making.
The detached, non-reactive stance cultivated through mindfulness allows
clients to recognize addiction-related thoughts or urges arising without
immediately becoming overwhelmed or impulsively acting out self-
destructive patterns (Lindenboim et al., 2007). Instead, mindfulness creates
psychological space to choose constructive coping options. Over time, this
metacognition enhances emotion regulation abilities crucial for long-term
recovery success and well-being.
Improving Emotion Regulation Skills
While mindfulness fosters awareness, DBT directly teaches core strategies
for modulating emotions: opposite action, changing vulnerability factors,
urges surfing, ACCEPTS framework. When applied alongside counselor
guidance and group processing, these tools become empowering skills
clients own for long-term management of affective triggers maintaining
addictions:
Opposite Action
Deliberately acting opposite cravings/emotions by engaging in healthful
distracting activities like exercise or calling supports interrupts addiction's
automatic pilot processes. Over time, new response patterns replace harmful
ones (Lindenboim et al., 2007).
Changing Vulnerability Factors
Clients identify avoidant patterns exacerbating emotional vulnerabilities like
lack of sleep, isolation from supports, self-criticism, all-or-nothing thinking,
then take wise preemptive actions before distressing triggers arise (Dimeff &
Linehan, 2008).
Urge Surfing
Mindfully "riding the emotional wave" of cravings/triggers without reacting
teaches clients to detach from transient feelings and wait patiently for
intensity to naturally lessen on its own without acting out dysfunctional urges
(Lindenboim et al., 2007).
ACCEPTS Framework
This acronym guides clients moving through difficult emotions by Activating
wise mind, identifying Current thoughts/emotions kindly, evaluating
Pros/cons objectively, nurturing compassion for self with softer self-talk,
noting Thoughts are fleeting mental events, experiencing physical
Sensations fully with mindfulness, and committing to Self-care by tolerating
distress adaptively (Dimeff & Linehan, 2008).
Overall, enhancing clients' emotional intelligence and expanding skills
repertoires for balancing reason and feelings provides an arsenal against
addiction-related vulnerabilities. Over time, habitual thoughts like "I just
need to use to feel better" lose power as viable alternative responses are
practiced.
Developing Interpersonal Effectiveness
Another component crucial for sustained recovery is reducing dependency on
unhealthy relationships maintaining addictions while cultivating fulfilling
connections supporting well-balanced living. The DBT Interpersonal
Effectiveness module teaches constructive strategies including:
DEARMAN
This acronym guides assertively asking for what one wants respectfully while
maintaining self-respect and the relationship. Clients apply it to set
boundaries with enabling contacts (Lindenboim et al., 2007).
GIVE
Giving information clearly and validly, expressing wishes/feelings
respectfully, validating others and negotiating disputes constructively helps
clients navigate interpersonal challenges constructively.
FAST
Avoiding risky situations threatening safety/goals, thinking things through
considering priorities/limits, negotiating for win-win compromises, asserting
calmly and truthfully preserves solid recovery support systems over time
through balanced living principles (Dimeff & Linehan, 2008).
Validation/Empathy
Showing compassion for others without enabling harm and resolving
misunderstandings through validating different perspectives strengthens
fulfilling relationships integral for long-term recovery maintenance and
overall well-being.
Overall, equipping clients to meet interpersonal needs constructively without
codependency or enabling dysfunctional patterns provides critical relational
tools serving as protective factors buttressing recovery success over a
lifetime. DBT strategies foster socially supportive ecosystems nourishing
wellness.
Coping with Distress and Cravings
Perhaps the greatest test for newly recovering individuals is tolerating
unpleasant emotions and resisting craving-driven urges without losing
control. Core DBT strategies address this challenge:
Coping Ahead Plans
Proactively strategizing how to handle high-risk situations/emotions
beforehand using all learned skills increases clients’ sense of self-efficacy
and preparedness for challenges (Dimeff & Linehan, 2008).
Distracting with Opposite Emotions/Activities
Engaging in enjoyable hobbies, calling supports, self-soothing behaviors like
snapping a rubber band rides out cravings by shifting focus from addiction to
more productive outlets (Lindenboim et al., 2007).
Reality Acceptance
Letting go of desire to control unchangeable aspects of situations/feelings
allows clients to disengage from urges and make wise behavior choices
under stress (Dimeff & Linehan, 2008).
Self-Soothe with Five Senses
Soothing oneself through grounding sensory awareness exercises like deep
breathing, cool showers, music, tactile fidgets tolerates distress adaptively.
Wise Mind
Making decisions from balanced perspective considers priorities/values over
impulses, maintaining clarity under duress crucial for withstanding lapses
(Lindenboim et al., 2007).
Overall, distress tolerance skills strengthen clients to independently ride
emotional waves without relapsing by choosing constructive outlets
respecting recovery priorities. Over time, cravings lose power through
habituating new self-care patterns.
Conclusion
Addiction arises from complex interactions between biological, psychological
and social factors. Emotion dysregulation and maladaptive coping play
critical roles in both developing and maintaining substance dependence. For
these core reasons, therapeutic approaches like DBT directly targeting
emotional awareness, interpersonal effectiveness and distress tolerance hold
immense promise for empowering clients for long-term recovery success.
Through its dialectical philosophy balancing acceptance and change, DBT's
evidence-based techniques cultivate mindfulness, adaptive emotion
regulation and coping strategies serving as portable protective skills clients
can apply independently throughout their lifetime recovery journeys.
Whether facing relationship stressors, cravings and lapses or general life
challenges, these transdiagnostic DBT strategies bolster psychological
resilience against substance misuse. Overall, integrating such skills directly
addressing underlying vulnerabilities can greatly expand addiction
counselors’ toolbox for equipping clients with lifelong wellness tools.
Addiction is a disease involving compulsively seeking rewards and relief
through the use of substances or engaging in unhealthy behaviors despite
repercussions. A core reason many individuals develop addictions is due to
difficulties regulating feelings and coping with distress that arises from life's
challenges. Research shows a significant relationship between emotion
dysregulation and substance use disorders (SUDs), with high rates of co-
occurring mood and anxiety disorders as well (Witkiewitz & Bowen, 2010).
For this reason, therapeutic approaches that teach emotional regulation and
distress tolerance skills have particular relevance for addiction counseling.
One such evidence-based model is Dialectical Behavior Therapy (DBT).
Originally developed by Marsha Linehan in the 1980s to treat borderline
personality disorder, DBT has since been adapted and studied for treating
SUDs with great success (Dimeff & Linehan, 2008). Its core aim is balancing
acceptance of oneself and reality with a commitment to positive change
through teaching mindfulness, interpersonal effectiveness, emotional
regulation, and distress tolerance skills. This paper explores how DBT
strategies addressing emotion dysregulation and maladaptive coping can
benefit addiction counselors and their clients working toward long-term
recovery maintenance through building psychological resilience and
balanced living.
Overview of DBT Model and Strategies
DBT is a cognitive-behavioral treatment approach rooted in Zen Buddhism,
dialectics, and biosocial theory. Its overarching philosophy balances
acceptance and change in a dialectical manner, recognizing both the need to
validate inner experiences while committing to behavioral improvements
through skills practice. Therapists follow a "validation and encouragement"
stance, accepting clients where they are without judgment while also
motivating adaptive changes (Lindenboim et al., 2007). Individual therapy
sessions interweave this dialectical approach with teaching core DBT skills
modules.
The first skills module targets core mindfulness practices to cultivate wise,
balanced awareness of present internal and external experiences. Tasks like
breathing, body awareness, and daily logging exercises train non-judgmental
focus and observation that counteract tendencies toward emotional
reactivity, avoidance, and lack of self-care.
The second module trains interpersonal effectiveness through strategies like
DEARMAN, GIVE, and FAST that respectively help clients assert needs
respectfully, clearly communicate boundaries, and navigate challenging
social situations effectively and respectfully. Related communication
trainings address building empathy, validation, and compromise in
relationships (Swales, 2009).
The third module targets distress tolerance by identifying primary and
secondary emotions, tolerating painful experiences through wise "riding the
wave" and coping ahead techniques, distracting with safe activities,
improving with self-soothing behaviors, and accepting reality rather than
fighting unchangeable factors.
Finally, the emotion regulation module provides tools for mindfulness of
emotions, reducing vulnerability factors, changing emotional states through
opposing behaviors, and taking wise actions guided by healthy emotions
rather than impulsivity (Swales, 2009).
All strategies are manualized to ensure treatment fidelity and teach skills in a
hierarchical, paced manner through individual therapy, weekly group skills
training, phone coaching for intersession practice, and therapist consultation
meetings (Lindenboim et al., 2007). Therapists further encourage daily diary
card tracking to reinforce new behaviors and problem-solve obstacles
(Dimeff & Linehan, 2008).
Benefits for Addiction Counseling
DBT's mechanisms for addressing emotion dysregulation and distress
tolerance through mindfulness, interpersonal effectiveness and adaptive
coping strategies directly translate to benefiting addiction recovery in
several ways:
Cultivating Emotional Awareness
Mindfulness practices increase clients' ability to notice internal triggers for
substance urges and situational factors contributing to maladaptive coping
without becoming overwhelmed or acting impulsively. This awareness
provides distance and choice.
Managing Strong Emotions
DBT techniques like riding emotional waves, opposite action, and thinking of
wise mind give clients tools to experience even difficult feelings without
defaulting to addictive behaviors by tolerating distress or changing
emotional states in healthy ways.
Improving Relationship Dynamics
Interpersonal effectiveness skills help navigate social challenges and set
boundaries constructively without slipping into codependency, enabling
clients to build fulfilling support systems key for long-term sobriety.
Coping with Cravings and Relapse Triggers
Distress tolerance strategies such as self-soothing, distracting with
alternative activities, acceptance, and coping ahead plans equip clients to
manage cravings, urges or setbacks without losing control or abandoning
recovery entirely.
Reducing Shame and Self-Criticism
The validating, non-judgmental philosophy of DBT, combined with building
self-esteem through skills mastery, counters typical addict self-loathing,
isolation and hopelessness, fueling courage for change.
Addressing Co-Occurring Disorders
Clients dually diagnosed with addictions and mood/anxiety issues directly
benefit from DBT interventions targeting underlying emotion dysregulation
maintaining all related problems.
In summary, DBT offers versatile transdiagnostic techniques addressing root
factors at the emotions-addictions interface through mindfulness, effective
communication, and adaptive coping strategies. These empower clients to
establish long-term wellness and balance in recovery.
Cultivating Mindfulness for Emotional Awareness
A primary way DBT builds emotional regulation is through cultivating
mindfulness—non-judging, present-moment awareness of internal and
external experiences. This metacognitive skill counters addiction-related
tendencies toward emotional avoidance, reactivity and lack of self-care. DBT
mindfulness practices include:
Observational Exercises
Clients notice thoughts/feelings passively without reaction through Body
Scan meditation, Pleasant Events daily logs, or Emotion Diary homework
logging triggers. This detachment interrupts addiction's automatic pilot and
compulsion cycles (Lindenboim et al., 2007).
Focus & Breath Awareness
Focusing mind on breathing or other external sensory anchors like music
pulls attention to anchoring physical sensations rather than
racing/ruminating thoughts sustaining craving-using cycles. Short- and long-
term breath practices help sustain wise mindfulness.
Distress Tolerance Strategies
Self-soothing behaviors like holding an ice cube, blowing bubbles, smelling
pleasant scents, or saying encouraging self-talk provide concrete
mindfulness tools for tolerating distressing triggers or lapses without
abandoning broader recovery efforts (Dimeff & Linehan, 2008).
Wise Mind State
This balanced perspective integrating reason and intuition gives clients
capacity to make clear choices guided by sobriety priorities rather than
emotions alone. Mindfulness maintains wise mind clarity during decision-
making.
The detached, non-reactive stance cultivated through mindfulness allows
clients to recognize addiction-related thoughts or urges arising without
immediately becoming overwhelmed or impulsively acting out self-
destructive patterns (Lindenboim et al., 2007). Instead, mindfulness creates
psychological space to choose constructive coping options. Over time, this
metacognition enhances emotion regulation abilities crucial for long-term
recovery success and well-being.
Improving Emotion Regulation Skills
While mindfulness fosters awareness, DBT directly teaches core strategies
for modulating emotions: opposite action, changing vulnerability factors,
urges surfing, ACCEPTS framework. When applied alongside counselor
guidance and group processing, these tools become empowering skills
clients own for long-term management of affective triggers maintaining
addictions:
Opposite Action
Deliberately acting opposite cravings/emotions by engaging in healthful
distracting activities like exercise or calling supports interrupts addiction's
automatic pilot processes. Over time, new response patterns replace harmful
ones (Lindenboim et al., 2007).
Changing Vulnerability Factors
Clients identify avoidant patterns exacerbating emotional vulnerabilities like
lack of sleep, isolation from supports, self-criticism, all-or-nothing thinking,
then take wise preemptive actions before distressing triggers arise (Dimeff &
Linehan, 2008).
Urge Surfing
Mindfully "riding the emotional wave" of cravings/triggers without reacting
teaches clients to detach from transient feelings and wait patiently for
intensity to naturally lessen on its own without acting out dysfunctional urges
(Lindenboim et al., 2007).
ACCEPTS Framework
This acronym guides clients moving through difficult emotions by Activating
wise mind, identifying Current thoughts/emotions kindly, evaluating
Pros/cons objectively, nurturing compassion for self with softer self-talk,
noting Thoughts are fleeting mental events, experiencing physical
Sensations fully with mindfulness, and committing to Self-care by tolerating
distress adaptively (Dimeff & Linehan, 2008).
Overall, enhancing clients' emotional intelligence and expanding skills
repertoires for balancing reason and feelings provides an arsenal against
addiction-related vulnerabilities. Over time, habitual thoughts like "I just
need to use to feel better" lose power as viable alternative responses are
practiced.
Developing Interpersonal Effectiveness
Another component crucial for sustained recovery is reducing dependency on
unhealthy relationships maintaining addictions while cultivating fulfilling
connections supporting well-balanced living. The DBT Interpersonal
Effectiveness module teaches constructive strategies including:
DEARMAN
This acronym guides assertively asking for what one wants respectfully while
maintaining self-respect and the relationship. Clients apply it to set
boundaries with enabling contacts (Lindenboim et al., 2007).
GIVE
Giving information clearly and validly, expressing wishes/feelings
respectfully, validating others and negotiating disputes constructively helps
clients navigate interpersonal challenges constructively.
FAST
Avoiding risky situations threatening safety/goals, thinking things through
considering priorities/limits, negotiating for win-win compromises, asserting
calmly and truthfully preserves solid recovery support systems over time
through balanced living principles (Dimeff & Linehan, 2008).
Validation/Empathy
Showing compassion for others without enabling harm and resolving
misunderstandings through validating different perspectives strengthens
fulfilling relationships integral for long-term recovery maintenance and
overall well-being.
Overall, equipping clients to meet interpersonal needs constructively without
codependency or enabling dysfunctional patterns provides critical relational
tools serving as protective factors buttressing recovery success over a
lifetime. DBT strategies foster socially supportive ecosystems nourishing
wellness.
Coping with Distress and Cravings
Perhaps the greatest test for newly recovering individuals is tolerating
unpleasant emotions and resisting craving-driven urges without losing
control. Core DBT strategies address this challenge:
Coping Ahead Plans
Proactively strategizing how to handle high-risk situations/emotions
beforehand using all learned skills increases clients’ sense of self-efficacy
and preparedness for challenges (Dimeff & Linehan, 2008).
Distracting with Opposite Emotions/Activities
Engaging in enjoyable hobbies, calling supports, self-soothing behaviors like
snapping a rubber band rides out cravings by shifting focus from addiction to
more productive outlets (Lindenboim et al., 2007).
Reality Acceptance
Letting go of desire to control unchangeable aspects of situations/feelings
allows clients to disengage from urges and make wise behavior choices
under stress (Dimeff & Linehan, 2008).
Self-Soothe with Five Senses
Soothing oneself through grounding sensory awareness exercises like deep
breathing, cool showers, music, tactile fidgets tolerates distress adaptively.
Wise Mind
Making decisions from balanced perspective considers priorities/values over
impulses, maintaining clarity under duress crucial for withstanding lapses
(Lindenboim et al., 2007).
Overall, distress tolerance skills strengthen clients to independently ride
emotional waves without relapsing by choosing constructive outlets
respecting recovery priorities. Over time, cravings lose power through
habituating new self-care patterns.
Conclusion
Addiction arises from complex interactions between biological, psychological
and social factors. Emotion dysregulation and maladaptive coping play
critical roles in both developing and maintaining substance dependence. For
these core reasons, therapeutic approaches like DBT directly targeting
emotional awareness, interpersonal effectiveness and distress tolerance hold
immense promise for empowering clients for long-term recovery success.
Through its dialectical philosophy balancing acceptance and change, DBT's
evidence-based techniques cultivate mindfulness, adaptive emotion
regulation and coping strategies serving as portable protective skills clients
can apply independently throughout their lifetime recovery journeys.
Whether facing relationship stressors, cravings and lapses or general life
challenges, these transdiagnostic DBT strategies bolster psychological
resilience against substance misuse. Overall, integrating such skills directly
addressing underlying vulnerabilities can greatly expand addiction
counselors’ toolbox for equipping clients with lifelong wellness tools.
Addiction is a disease involving compulsively seeking rewards and relief
through the use of substances or engaging in unhealthy behaviors despite
repercussions. A core reason many individuals develop addictions is due to
difficulties regulating feelings and coping with distress that arises from life's
challenges. Research shows a significant relationship between emotion
dysregulation and substance use disorders (SUDs), with high rates of co-
occurring mood and anxiety disorders as well (Witkiewitz & Bowen, 2010).
For this reason, therapeutic approaches that teach emotional regulation and
distress tolerance skills have particular relevance for addiction counseling.
One such evidence-based model is Dialectical Behavior Therapy (DBT).
Originally developed by Marsha Linehan in the 1980s to treat borderline
personality disorder, DBT has since been adapted and studied for treating
SUDs with great success (Dimeff & Linehan, 2008). Its core aim is balancing
acceptance of oneself and reality with a commitment to positive change
through teaching mindfulness, interpersonal effectiveness, emotional
regulation, and distress tolerance skills. This paper explores how DBT
strategies addressing emotion dysregulation and maladaptive coping can
benefit addiction counselors and their clients working toward long-term
recovery maintenance through building psychological resilience and
balanced living.
Overview of DBT Model and Strategies
DBT is a cognitive-behavioral treatment approach rooted in Zen Buddhism,
dialectics, and biosocial theory. Its overarching philosophy balances
acceptance and change in a dialectical manner, recognizing both the need to
validate inner experiences while committing to behavioral improvements
through skills practice. Therapists follow a "validation and encouragement"
stance, accepting clients where they are without judgment while also
motivating adaptive changes (Lindenboim et al., 2007). Individual therapy
sessions interweave this dialectical approach with teaching core DBT skills
modules.
The first skills module targets core mindfulness practices to cultivate wise,
balanced awareness of present internal and external experiences. Tasks like
breathing, body awareness, and daily logging exercises train non-judgmental
focus and observation that counteract tendencies toward emotional
reactivity, avoidance, and lack of self-care.
The second module trains interpersonal effectiveness through strategies like
DEARMAN, GIVE, and FAST that respectively help clients assert needs
respectfully, clearly communicate boundaries, and navigate challenging
social situations effectively and respectfully. Related communication
trainings address building empathy, validation, and compromise in
relationships (Swales, 2009).
The third module targets distress tolerance by identifying primary and
secondary emotions, tolerating painful experiences through wise "riding the
wave" and coping ahead techniques, distracting with safe activities,
improving with self-soothing behaviors, and accepting reality rather than
fighting unchangeable factors.
Finally, the emotion regulation module provides tools for mindfulness of
emotions, reducing vulnerability factors, changing emotional states through
opposing behaviors, and taking wise actions guided by healthy emotions
rather than impulsivity (Swales, 2009).
All strategies are manualized to ensure treatment fidelity and teach skills in a
hierarchical, paced manner through individual therapy, weekly group skills
training, phone coaching for intersession practice, and therapist consultation
meetings (Lindenboim et al., 2007). Therapists further encourage daily diary
card tracking to reinforce new behaviors and problem-solve obstacles
(Dimeff & Linehan, 2008).
Benefits for Addiction Counseling
DBT's mechanisms for addressing emotion dysregulation and distress
tolerance through mindfulness, interpersonal effectiveness and adaptive
coping strategies directly translate to benefiting addiction recovery in
several ways:
Cultivating Emotional Awareness
Mindfulness practices increase clients' ability to notice internal triggers for
substance urges and situational factors contributing to maladaptive coping
without becoming overwhelmed or acting impulsively. This awareness
provides distance and choice.
Managing Strong Emotions
DBT techniques like riding emotional waves, opposite action, and thinking of
wise mind give clients tools to experience even difficult feelings without
defaulting to addictive behaviors by tolerating distress or changing
emotional states in healthy ways.
Improving Relationship Dynamics
Interpersonal effectiveness skills help navigate social challenges and set
boundaries constructively without slipping into codependency, enabling
clients to build fulfilling support systems key for long-term sobriety.
Coping with Cravings and Relapse Triggers
Distress tolerance strategies such as self-soothing, distracting with
alternative activities, acceptance, and coping ahead plans equip clients to
manage cravings, urges or setbacks without losing control or abandoning
recovery entirely.
Reducing Shame and Self-Criticism
The validating, non-judgmental philosophy of DBT, combined with building
self-esteem through skills mastery, counters typical addict self-loathing,
isolation and hopelessness, fueling courage for change.
Addressing Co-Occurring Disorders
Clients dually diagnosed with addictions and mood/anxiety issues directly
benefit from DBT interventions targeting underlying emotion dysregulation
maintaining all related problems.
In summary, DBT offers versatile transdiagnostic techniques addressing root
factors at the emotions-addictions interface through mindfulness, effective
communication, and adaptive coping strategies. These empower clients to
establish long-term wellness and balance in recovery.
Cultivating Mindfulness for Emotional Awareness
A primary way DBT builds emotional regulation is through cultivating
mindfulness—non-judging, present-moment awareness of internal and
external experiences. This metacognitive skill counters addiction-related
tendencies toward emotional avoidance, reactivity and lack of self-care. DBT
mindfulness practices include:
Observational Exercises
Clients notice thoughts/feelings passively without reaction through Body
Scan meditation, Pleasant Events daily logs, or Emotion Diary homework
logging triggers. This detachment interrupts addiction's automatic pilot and
compulsion cycles (Lindenboim et al., 2007).
Focus & Breath Awareness
Focusing mind on breathing or other external sensory anchors like music
pulls attention to anchoring physical sensations rather than
racing/ruminating thoughts sustaining craving-using cycles. Short- and long-
term breath practices help sustain wise mindfulness.
Distress Tolerance Strategies
Self-soothing behaviors like holding an ice cube, blowing bubbles, smelling
pleasant scents, or saying encouraging self-talk provide concrete
mindfulness tools for tolerating distressing triggers or lapses without
abandoning broader recovery efforts (Dimeff & Linehan, 2008).
Wise Mind State
This balanced perspective integrating reason and intuition gives clients
capacity to make clear choices guided by sobriety priorities rather than
emotions alone. Mindfulness maintains wise mind clarity during decision-
making.
The detached, non-reactive stance cultivated through mindfulness allows
clients to recognize addiction-related thoughts or urges arising without
immediately becoming overwhelmed or impulsively acting out self-
destructive patterns (Lindenboim et al., 2007). Instead, mindfulness creates
psychological space to choose constructive coping options. Over time, this
metacognition enhances emotion regulation abilities crucial for long-term
recovery success and well-being.
Improving Emotion Regulation Skills
While mindfulness fosters awareness, DBT directly teaches core strategies
for modulating emotions: opposite action, changing vulnerability factors,
urges surfing, ACCEPTS framework. When applied alongside counselor
guidance and group processing, these tools become empowering skills
clients own for long-term management of affective triggers maintaining
addictions:
Opposite Action
Deliberately acting opposite cravings/emotions by engaging in healthful
distracting activities like exercise or calling supports interrupts addiction's
automatic pilot processes. Over time, new response patterns replace harmful
ones (Lindenboim et al., 2007).
Changing Vulnerability Factors
Clients identify avoidant patterns exacerbating emotional vulnerabilities like
lack of sleep, isolation from supports, self-criticism, all-or-nothing thinking,
then take wise preemptive actions before distressing triggers arise (Dimeff &
Linehan, 2008).
Urge Surfing
Mindfully "riding the emotional wave" of cravings/triggers without reacting
teaches clients to detach from transient feelings and wait patiently for
intensity to naturally lessen on its own without acting out dysfunctional urges
(Lindenboim et al., 2007).
ACCEPTS Framework
This acronym guides clients moving through difficult emotions by Activating
wise mind, identifying Current thoughts/emotions kindly, evaluating
Pros/cons objectively, nurturing compassion for self with softer self-talk,
noting Thoughts are fleeting mental events, experiencing physical
Sensations fully with mindfulness, and committing to Self-care by tolerating
distress adaptively (Dimeff & Linehan, 2008).
Overall, enhancing clients' emotional intelligence and expanding skills
repertoires for balancing reason and feelings provides an arsenal against
addiction-related vulnerabilities. Over time, habitual thoughts like "I just
need to use to feel better" lose power as viable alternative responses are
practiced.
Developing Interpersonal Effectiveness
Another component crucial for sustained recovery is reducing dependency on
unhealthy relationships maintaining addictions while cultivating fulfilling
connections supporting well-balanced living. The DBT Interpersonal
Effectiveness module teaches constructive strategies including:
DEARMAN
This acronym guides assertively asking for what one wants respectfully while
maintaining self-respect and the relationship. Clients apply it to set
boundaries with enabling contacts (Lindenboim et al., 2007).
GIVE
Giving information clearly and validly, expressing wishes/feelings
respectfully, validating others and negotiating disputes constructively helps
clients navigate interpersonal challenges constructively.
FAST
Avoiding risky situations threatening safety/goals, thinking things through
considering priorities/limits, negotiating for win-win compromises, asserting
calmly and truthfully preserves solid recovery support systems over time
through balanced living principles (Dimeff & Linehan, 2008).
Validation/Empathy
Showing compassion for others without enabling harm and resolving
misunderstandings through validating different perspectives strengthens
fulfilling relationships integral for long-term recovery maintenance and
overall well-being.
Overall, equipping clients to meet interpersonal needs constructively without
codependency or enabling dysfunctional patterns provides critical relational
tools serving as protective factors buttressing recovery success over a
lifetime. DBT strategies foster socially supportive ecosystems nourishing
wellness.
Coping with Distress and Cravings
Perhaps the greatest test for newly recovering individuals is tolerating
unpleasant emotions and resisting craving-driven urges without losing
control. Core DBT strategies address this challenge:
Coping Ahead Plans
Proactively strategizing how to handle high-risk situations/emotions
beforehand using all learned skills increases clients’ sense of self-efficacy
and preparedness for challenges (Dimeff & Linehan, 2008).
Distracting with Opposite Emotions/Activities
Engaging in enjoyable hobbies, calling supports, self-soothing behaviors like
snapping a rubber band rides out cravings by shifting focus from addiction to
more productive outlets (Lindenboim et al., 2007).
Reality Acceptance
Letting go of desire to control unchangeable aspects of situations/feelings
allows clients to disengage from urges and make wise behavior choices
under stress (Dimeff & Linehan, 2008).
Self-Soothe with Five Senses
Soothing oneself through grounding sensory awareness exercises like deep
breathing, cool showers, music, tactile fidgets tolerates distress adaptively.
Wise Mind
Making decisions from balanced perspective considers priorities/values over
impulses, maintaining clarity under duress crucial for withstanding lapses
(Lindenboim et al., 2007).
Overall, distress tolerance skills strengthen clients to independently ride
emotional waves without relapsing by choosing constructive outlets
respecting recovery priorities. Over time, cravings lose power through
habituating new self-care patterns.
Conclusion
Addiction arises from complex interactions between biological, psychological
and social factors. Emotion dysregulation and maladaptive coping play
critical roles in both developing and maintaining substance dependence. For
these core reasons, therapeutic approaches like DBT directly targeting
emotional awareness, interpersonal effectiveness and distress tolerance hold
immense promise for empowering clients for long-term recovery success.
Through its dialectical philosophy balancing acceptance and change, DBT's
evidence-based techniques cultivate mindfulness, adaptive emotion
regulation and coping strategies serving as portable protective skills clients
can apply independently throughout their lifetime recovery journeys.
Whether facing relationship stressors, cravings and lapses or general life
challenges, these transdiagnostic DBT strategies bolster psychological
resilience against substance misuse. Overall, integrating such skills directly
addressing underlying vulnerabilities can greatly expand addiction
counselors’ toolbox for equipping clients with lifelong wellness tools.
