DBT Improves Emotion Regulation Skills for Addictions Recovery Success

Emotions are powerful. From emotions come passions, wild and driving, which spur us to create or to destroy.
– How Self-Regulation Builds Recovery Success

We define emotion regulation as “the ability to assess and change one’s emotional state, particularly in cases of extreme distress.” Emotion dysregulation – also termed “affect dysregulation” – can manifest as under- or over-regulation.

In our post a year ago, we cited the literature that links emotion dysregulation to substance use disorders:

“Substance use disorders are strongly linked to emotion dysregulation in the literature (Beckstead et al., 2015, Nikmanesh et al. 2014, Fox et al. 2008, Matthias et al. 2011, Axelrod et al. 2011, Dishion et al. 2011).  It has been proposed that substance use begins as an effort toward emotion regulation or self-regulation, but if use leads to addiction, it only worsens one’s ability to self-regulate.  This is known as the self-medication hypothesis of addiction, an older hypothesis which is still supported by scientific literature.

The perceived need to self-medicate begins when emotions become intolerable, and when an individual is unable to regulate those emotions. In fact, “negative affect,” or unregulated, negative moods such as anger, frustration, and depression, is the primary predictor of relapse for addicted individuals.”
– How Self-Regulation Builds Recovery Success

In the year since that post was published, Dialectical Behavior Therapy (DBT) is showing increasing favor as the treatment of choice for those struggling with addictions. DBT is a behavioral therapy developed by Marsha Linehan to help individuals with Borderline Personality Disorder (BPD) begin to simultaneously accept themselves and accept that change is needed. The skills DBT teaches patients are applicable beyond BPD, however: mindfulness, interpersonal relations, emotion regulation, and distress tolerance.

While scientists recognize more research is needed to evaluate DBT’s effectiveness outside of BPD, studies have been promising in demonstrating that DBT may improve distress tolerance, reduce depression, anxiety, and other negative affect moods, and has promise for treatment of substance use disorders. As early as 1999, Linehan found that DBT was more effective than treatment as usual in reducing drug use for women with co-occurring BPD and substance use disorders (SUDs). The mindfulness component of DBT has been extensively researched, and shows the most promise for treatment of substance use disorders.

“It is important to note, areas of the brain that have been associated with craving, negative affect, and relapse have also been shown to be affected by mindfulness training.”
– Witkiewitz et al., 2013

Mindfulness is essentially a meditation technique borrowed from Zen Buddhism. To practice mindfulness, one must simply become more aware of the present moment, without thought of past or future, and accept it without judgment. Scientists have studied Mindfulness-Based Relapse Prevention (MBRP), a repeatable mindfulness-based training program, and have found as recently as 2014 that those practicing MBRP report significantly fewer days of substance use and decreased heavy drinking, as well as significant decreases in craving, and fewer legal and medical problems.

Addictions treatment has historically been a field riddled with unsupported and even unconscionable “treatments.” With already such strong support in the literature, dialectical behavior therapy may be the very best behavioral therapy available to people in recovery.

This post was updated on 12/17/2016.