Dialectical Behavioural Therapy (DBT)

Dialectical behavioural therapy is a type of cognitive behavioural therapy (CBT) that combines mindfulness with practical skills for changing behaviours. The Oxford Health NHS Foundation Trust describes it as a supportive therapy that depends on a good relationship between you and your therapist.

DBT was developed in the 1980s by Marsha Linehan. As Britannica notes, she found that standard CBT often left patients feeling invalidated when the focus on change came without space to acknowledge how they felt in the first place. 

The word dialectical means holding two truths at once – recognising that two opposites can be true at the same time. In dialectical behavioural therapy, those two truths are acceptance and change. You can accept where you are right now and, at the same time, work towards building a life free of addiction.

DBT works on the idea that addictive behaviour often comes from emotions that feel too intense to manage. Drinking, using drugs, gambling or other compulsive behaviours can become a way of escaping or numbing those feelings. The therapy teaches you to recognise the emotion, sit with the discomfort, and choose a different response.

The Oxford Health NHS Foundation Trust describes how some people experience emotions at a higher intensity than others, and take longer to return to baseline. If something upsetting happens before the first wave has passed, the next spike lands on top of it. DBT helps teach you skills for managing that pattern.

Whilst DBT has been shown to help reduce substance use in different presentations, the evidence base is still younger than for the effectiveness of CBT. So we use it where the clinical picture fits it in appropriately – usually alongside other approaches.

DBT teaches four core sets of skills. Each one supports a different part of recovery.

• Mindfulness: paying attention to what is happening in the present moment without judging it. This helps you notice an urge or feeling before it takes over.
• Distress tolerance: skills for getting through a crisis without making it worse. Urge surfing and the TIPP technique (temperature, intense exercise, paced breathing, paired muscle relaxation) sit here.
• Emotion regulation: understanding how emotions work and using techniques like opposite action to reduce their intensity over time.
• Interpersonal effectiveness: asking for what you need, saying no, and keeping relationships steady through recovery.

In addiction rehab, these skills give you something to reach for in the moments when an urge feels too strong to manage on your own.

Hard to manage emotions and impulsivity sit underneath addictive behaviour. DBT was built to help manage both.

A 2024 paper in the American journal Behaviour Research and Therapy looked at DBT skills training as a standalone treatment for alcohol and other substance use disorders. The researchers found that by the end of treatment, impulsivity levels were significantly lower than in untreated comparison groups. This supports what we see in practice. Dialectical behavioural therapy skills create a pause between the trigger and the behaviour, and that’s what helps give you room to practise more mindful behaviours and choices.

But, relapse is part of many people’s recovery journey, and dialectical behavioural therapy does not promise relapse won’t happen. However, the skills make a difference in the moments where one becomes more likely. Knowing what to do when an urge hits at 9pm on a Tuesday is more useful than the wish that you did not have urges in the first place.

We deliver dialectical behavioural therapy for addiction in three settings. Each is suited to different geographical locations, individual  circumstances, and the right fit depends on what is going on in your life. Our admissions team can talk you through which option makes sense for you. You can also read more about what’s involved in our residential treatment and outpatient treatment before you decide.

• Residential: you stay with us for a defined period and DBT sits within a full treatment programme. This works best when home life is making recovery harder, or when withdrawal needs medical support.
• Outpatient: you attend regular sessions while continuing with daily life. This works for people with stable support at home who are not in acute withdrawal.
• Online: DBT can be delivered remotely if travel, work or caring responsibilities make in-person attendance difficult. Online suits some people better than others, and we will be honest with you about whether it is the right fit.

DBT is rarely the whole answer for addiction treatment. It works as part of a wider programme that, depending on what you need, might include:

• Medically managed detox
• Individual and group therapy
• Family therapy
• The 12 Step approach
• Ongoing aftercare.

Sometimes, undertaking DBT for addiction is the right fit. Sometimes cognitive behavioural therapy is a better starting point, or the two work alongside each other. We assess this with you rather than slotting you into a fixed programme.

Recovery looks different at six months than it does at six years. That’s why aftercare is also essential; it’s where the ‘long work’ happens. The skills DBT teaches are skills for life and we make sure to remain involved in your recovery journey through alumni support and ongoing therapy options.

The first conversation is free and confidential. There is no pressure to commit to anything. When you call, you will speak with one of our admissions case managers, who will listen to what is going on and help you work out the next step.

If you decide to move forward with addiction treatment, the process from there is straightforward.

• A clinical assessment to understand your situation and what would help most
• A summary from your GP so we have a picture of your medical history
• A treatment plan built around you, for you, agreed by you

CBT focuses on the link between thoughts, feelings and behaviours. It helps you spot unhelpful thinking patterns and develop different responses. DBT takes that base and adds a stronger focus on emotions and acceptance. It also teaches a specific set of skills, including mindfulness and distress tolerance. CBT is usually the first therapy people meet in addiction treatment, and DBT often comes in when emotions and impulsive behaviour are involved. That’s why DBT can be referred to as ‘therapy for impulsive behaviour’. You can read more about cognitive behavioural therapy for addiction on our therapy page.

Yes. DBT works well alongside CBT, eye movement desensitisation and reprocessing (EMDR), trauma-focused therapy and the 12 Step approach. It can also sit alongside medical detox and family therapy. Most people we work with do not have DBT on its own. What we use, and in what order, is something we agree with you after assessment.

It varies. Some people notice a difference in how they manage urges within a few weeks of learning the first skills. Building the skills into how you respond automatically takes longer, often several months and sometimes more. We do not promise timelines we cannot keep, and we will give you a realistic picture at assessment.

Often, yes. Dialectical behavioural therapy  was first developed for borderline personality disorder. It has since been adapted for other conditions, including PTSD, eating disorders and bipolar disorder. Suitability is something we work out at assessment, because it depends on which conditions are present and how active they are. We are honest about where DBT helps and where another approach might fit better.