Dialectical Behavior Therapy and Emotional Regulation

For many, substance use is about the feeling it gives them— relief from overwhelm, escape from unbearable thoughts, or simply turning down the noise level on a nervous system that never lets you rest. For those who identify with these experiences, Dialectical Behavior Therapy (DBT) may provide a critical tool for developing long-term sobriety.

DBT was developed specifically to help people who experience emotions very intensely — those who feel deeply, respond quickly, and struggle to develop healthy ways to regulate themselves. At Forward Motion Health, DBT is a core part of our men’s treatment program, offering clients a structured, evidence-based framework for building the emotional skills that make lasting recovery possible.

 

What Is Dialectical Behavior Therapy?

DBT is a structured form of psychotherapy developed in the late 1980s by psychologist Marsha Linehan at the University of Washington.[1] It was originally developed to help treat borderline personality disorder (BPD), which includes symptoms such as intense emotional dysregulation, unstable interpersonal relationships, and self-harm behaviors. Since then, however, DBT has proven effective for treating a wide range of mental health and substance abuse disorders

The word “dialectical” refers to the core philosophy behind DBT —  balancing acceptance and change. Clients learn to accept their current state while also recognizing the need to change to improve their lives. This acceptance and change balance separates DBT from other purely change-focused models of therapy like cognitive behavioral therapy (CBT).

DBT is a comprehensive treatment approach that uses individual therapy sessions with group skills training. It is structured, goal-oriented, and focused on building four core skill sets that address the emotional and behavioral challenges most commonly associated with addiction and co-occurring mental health conditions.

Each client receiving DBT at Forward Motion Health is provided with DBT by trained clinicians who apply its tenets alongside other evidence-based therapies.

How (and Why) DBT Works for Addiction

DBT works well for addiction because it addresses the emotional dysregulation that is often the primary motivator for using drugs or alcohol.[2] 

In many instances, the substance used becomes a fast-acting, though destructive, way to temporarily alleviate difficult emotions. DBT gives individuals a tangible alternative: the ability to practice several concrete emotion regulation techniques that allow them to cope with stressors and overwhelming emotions, and to make conscious, rather than reactive, decisions to help navigate difficult situations, rather than turning to substances.

Unlike some types of therapy that attempt to suppress an individual’s emotional response, DBT teaches individuals to cope with their emotional responses, reducing the likelihood that they will need to rely on substance use to escape their discomfort.

 

The Four Core DBT Skill Sets

DBT is organized into four interrelated areas of skill development. Each area represents a distinct aspect of emotional and behavioral health:

• Mindfulness is the foundation of DBT and the skill that underlies all the others. Mindfulness is defined as the process of being able to observe your thoughts, emotions, and sensations as they occur — without responding to them, judging them, or attempting to suppress them. For individuals in recovery from addiction, mindfulness can be very helpful in creating a critical pause between the trigger and reaction, allowing people to make a conscious decision instead of a reactive one.
• Distress tolerance abilities are designed to help during a crisis, at times of peak emotional intensity, and during the greatest urge to use. Although it is not possible to completely eliminate distress, distress tolerance strategies help clients through them without making the situation worse. Techniques include distraction, self-soothing, radical acceptance, and methods for improving the moment without resorting to harmful behaviors.
• Emotional regulation skills address the broader patterns of emotional experience — helping clients understand their emotions, reduce vulnerability to intense emotional reactions, and increase positive emotional experiences over time. For people whose substance use has been driven by emotional pain, this is often the most transformative skill set in the DBT framework.
• Interpersonal effectiveness skills help clients navigate their relationships and learn how to ask for what they need, maintain healthy boundaries, and manage conflict without damaging the relationship. As substance abuse often destroys relationships, repairing the damage requires learning to communicate and interpersonal effectiveness skills that are often absent in people recovering from substance abuse.

Efficacy of DBT for Substance Use Disorders

DBT has one of the largest bodies of evidence supporting its effectiveness for treating both mental health conditions and addiction. Studies demonstrating this efficacy include:

• Research by Marsha Linehan and colleagues demonstrated that DBT significantly reduces substance use, self-destructive behavior, and psychiatric hospitalization compared to standard treatment approaches for clients with borderline personality disorder and co-occurring addiction.[3]
• Studies adapting DBT specifically for substance use disorders have demonstrated reductions in rates of drug and alcohol use, improved treatment retention, and enhanced emotional functioning among participants.[4]
• DBT is uniquely beneficial for individuals with co-occurring mental health conditions such as post-traumatic stress disorder (PTSD), borderline personality disorder, and bipolar disorder that complicate addiction treatment, because it directly addresses the emotional distress that contributes to substance use.[5]
• Numerous studies demonstrate that DBT can be delivered effectively in either individual or group format, as well as in a wide range of treatment settings, including inpatient and outpatient.[6]
• Follow-up studies examining long-term maintenance of DBT treatment gains indicate that clients who participate in DBT report maintaining improvements in emotional regulation and reduced substance use far beyond the conclusion of formal treatment.[7]

What to Expect from DBT

DBT is a unique type of therapy that differs from other forms of psychotherapy. Experiences may vary based on facility and counselor, but here is typically what you can expect:

• DBT combines individual therapy and skills training. With a full DBT program, people receive both individual therapy to discuss personal issues, goals, and difficulties, and attend skills training groups where all four DBT skill areas are taught and practiced in a structured way.
• Skills are explicitly taught. DBT views skills like distress tolerance and emotion regulation as trainable behaviors which can be learned, practiced, and improved, just like any skill.
• Diary cards and homework are part of the process. Many times DBT involves completing structured diary cards between individual sessions to track emotions, urges, and skill use. This is a key factor in developing true competence versus intellectual understanding.
• The therapeutic relationship is direct and validating. A DBT therapist balances honesty, feedback, and challenge with genuine validation, accepting that the client’s response makes sense given their past, while still working towards change. The combination of being warm and direct is a hallmark of effective DBT.
• Progress is gradual and nonlinear. Learning to develop new emotional skills takes time, and relapses are expected during the process. DBT prepares clients for this by viewing relapses as useful data and a chance to improve skills rather than as failure. 
• The work goes beyond the therapy room. The ultimate goal of DBT is not to feel better in session but to create a life outside of treatment that is truly fulfilling. Skill development in real-world settings is where the actual change happens.

DBT at Forward Motion Health

At Forward Motion Health, DBT is integrated into our treatment program as a core clinical offering, not an add-on. Clinicians at Forward Motion Health have formal training and know how to apply DBT principles to complex presentations commonly found in addiction treatment: trauma, co-occurring mental health diagnoses, emotional dysregulation, and the ambivalence so many individuals have regarding making changes.

We recognize that for many, the biggest challenge in recovery is not just stopping substance use — it’s tolerating what emerges when the substance is no longer available. DBT provides these people a systematic way to accomplish this work. When combined with individual therapy, group therapy, and medication-assisted treatment if necessary, DBT becomes a significant aspect of an overall approach to treatment.