Evidence-Based Care
What is Dialectical Behavioral Therapy (DBT)?
Dialectical Behavior Therapy (DBT) is an evidence-based form of psychotherapy that teaches people how to manage intense emotions, tolerate distress, improve relationships, and reduce harmful behaviors. In addiction treatment, DBT helps people cope with cravings, manage triggers, and respond to stress without turning to drugs or alcohol.
DBT was developed in the late 1970s and 1980s by psychologist Dr. Marsha M. Linehan, initially to treat people with chronic suicidal behavior and borderline personality disorder. It combines cognitive behavioral therapy (CBT) techniques with mindfulness and the principle of balancing acceptance of oneself with the need for change. DBT typically teaches four core skill areas: mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness. It was later adapted for substance use disorders and other mental health conditions.
How Does DBT Work for Addiction & Mental Health Treatment?
DBT works by teaching people to manage intense emotions and urges without engaging in harmful behaviors, including substance use. In addiction and mental health treatment, clients learn four core skill areas: mindfulness, to recognize thoughts and cravings without automatically acting on them; distress tolerance, to get through difficult moments without using drugs or alcohol; emotion regulation, to understand and manage feelings such as anger, anxiety, and shame; and interpersonal effectiveness, to set boundaries, communicate needs, and handle conflict. For example, someone who typically drinks after an argument may learn to pause, use a grounding technique, tolerate the emotional discomfort, and contact a support person instead of drinking.
Comprehensive DBT commonly includes an initial assessment, weekly individual therapy lasting about 50 to 60 minutes, and weekly group skills training lasting around 1.5 to 2.5 hours. Sessions may involve reviewing recent situations, identifying what triggered a behavior, practicing coping skills, and completing homework such as tracking emotions, cravings, or urges between appointments. Some programs also provide coaching between sessions. Treatment often lasts six months to a year, although duration varies.
DBT is generally delivered by a licensed mental health professional, such as a psychologist (PhD or PsyD), Licensed Clinical Social Worker (LCSW), Licensed Professional Counselor (LPC or LPCC), or Licensed Marriage and Family Therapist (LMFT), who has specialized training in DBT. A specific DBT license is not universally required, but a clinician should be able to explain their training, supervision, and experience using the method. Comprehensive DBT programs typically include a therapist consultation team. Skills groups may also be led by trained clinicians or other appropriately supervised staff.
DBT is best established for borderline personality disorder and recurrent self-harm or suicidal behaviors. It is also used to help people experiencing substance use disorders, depression, anxiety, post-traumatic stress disorder (PTSD), bipolar disorder, and eating disorders, although evidence varies by condition. In addiction treatment, DBT can be especially useful when substance use is linked to emotional distress, impulsivity, relationship conflict, or difficulty tolerating cravings. It is usually part of a broader treatment plan and does not replace medical care for withdrawal or other urgent health needs.
Build emotional regulation and resilience through DBT skills
Casa Recovery provides dialectical behavior therapy as a treatment modality to help patients navigate the negative emotions that obstruct progress in recovery. DBT gives you practical, teachable skills for managing intense feelings, tolerating distress, and building healthier relationships with yourself and the people around you.
What DBT Treats
Casa Recovery offers DBT
DBT is an evidence-based psychotherapy derived from cognitive behavioral therapy, originally developed to treat borderline personality disorder. Today it is a powerful, versatile approach used to support recovery across a wide range of conditions.
At Casa Recovery, DBT can be a valuable part of treatment for people facing many co-occurring and underlying challenges.
- Depression
- Bipolar disorder
- Eating disorders
- Dual diagnosis
- Substance use disorders
- PTSD
- Suicidal ideation
Who is DBT Best For?
- People with substance use disorders who experience cravings, relapse triggers, or use drugs or alcohol to cope with emotional distress.
- People with borderline personality disorder (BPD) who struggle with emotional instability, impulsivity, or relationship difficulties.
- People who engage in self-harm or experience suicidal thoughts and need skills to manage crises safely.
- People with anxiety or depression who have difficulty managing overwhelming feelings or distress.
- People with PTSD or trauma-related symptoms who need support managing emotional reactions and distress.
- People with eating disorders who struggle with urges, emotional triggers, or harmful eating behaviors.
- People with bipolar disorder who need additional skills for emotional regulation alongside appropriate psychiatric treatment.
- People who struggle with anger or relationship conflict and want to improve communication, boundaries, and problem-solving.
- People who act impulsively under stress and want to develop healthier responses instead of reacting automatically.
Examples of DBT in Addiction & Mental Health Treatment
In addiction treatment, DBT can help someone recognize the emotions and situations that trigger substance use and practice a different response. For example, a client who drinks after arguments with their partner might tell their therapist, “When we fight, I feel rejected, and I need a drink to calm down.” The therapist might respond, “Can we slow that moment down and identify what you felt before the urge to drink?” The client recognizes that anger and loneliness usually come first. Together, they practice distress tolerance skills, such as paced breathing and delaying action while the urge passes. The goal is to reduce substance use driven by emotional distress and build healthier coping strategies that lower relapse risk.
For someone experiencing borderline personality disorder and self-harm urges, DBT focuses on surviving emotional crises without engaging in dangerous behavior. A client might say, “My friend didn’t reply to my text, so I know they hate me. I want to hurt myself.” The therapist could ask, “What do we know for certain, and what are you assuming because you’re hurting?” They then practice grounding, checking the facts, and following a safety plan. The goal is to reduce self-harm, improve emotional regulation, and help the client respond to distress without acting on immediate urges.
For someone with depression and anxiety who avoids responsibilities, DBT can help break overwhelming situations into manageable steps. A client might say, “I’m so anxious about going to work that I want to call in sick and stay in bed.” The therapist might respond, “Let’s acknowledge that anxiety is real, then identify one effective action you can take even while feeling anxious.” The client practices mindfulness, evaluates their options, and plans to get dressed and leave the house before reconsidering whether to avoid work. The goal is to improve distress tolerance, reduce avoidance, and strengthen everyday functioning.
In group DBT skills training, people practice interpersonal effectiveness through realistic conversations. For example, someone in recovery may say, “My friends keep pressuring me to drink, and I don’t know how to say no without losing them.” The facilitator might ask them to rehearse a clear response: “I’m not drinking tonight. I’d still like to spend time with you, but please don’t keep asking.” Other group members offer feedback, and the facilitator helps the client maintain the boundary without becoming aggressive or apologizing excessively. The goal is to improve communication, strengthen supportive relationships, and reduce exposure to social situations that threaten recovery. These are illustrative clinical examples of DBT techniques, not verbatim transcripts from documented patient cases.
DBT & Addiction
Treating substance use disorders with DBT
Individuals with alcohol or drug dependencies often turn to substances because of emotional trauma or difficulty regulating intense emotional responses. When feelings become overwhelming, substances can feel like the only available relief.
DBT can help treat substance use disorders because it facilitates the exploration of one’s innermost thoughts and feelings and works toward finding better ways of regulating negative emotions like stress — replacing self-destructive coping with skills that support lasting recovery.
A Dialectical Approach
DBT stands out from other therapies
The dialectical approach works to resolve conflicting emotions and ideas so you can improve your relationship with yourself and your connections with others. Rather than forcing you to choose one side of a struggle, it holds two truths at once — acceptance and change.
This helps patients move away from the black-and-white thinking patterns that perpetuate negativity and toward a more balanced, flexible way of seeing themselves and their lives.
Two Main Components
How DBT is delivered
DBT is built around two complementary components that work together — personalized one-on-one support paired with structured group skill-building.
Individual therapy
Your therapist addresses your personal concerns and helps strengthen the motivation that keeps you moving forward in recovery. Sessions are tailored to what matters most in your life right now.
Skills group
Patients learn emotional management techniques together through weekly sessions lasting up to two hours, practicing new skills in a supportive, guided setting.
Learning Skills In Four Areas
The four core DBT skill areas
DBT teaches a toolkit of skills across four key areas. Together, they help you stay grounded, ride out difficult moments, manage your emotions, and connect more effectively with others.
- Mindfulness — present-moment awareness
- Distress tolerance — building resilience
- Emotional regulation — managing emotions
- Interpersonal effectiveness — relationship skills
How Much Does DBT Cost for Addiction & Mental Health in Orange County, CA?
In Orange County, CA, DBT for addiction and mental health treatment typically costs $150 to $250 per individual session and $70 to $125 per group skills session without insurance. Comprehensive DBT programs combining individual therapy and group training may cost approximately $800 to $1,800 per month.
Does Insurance Cover DBT for Addiction & Mental Health in Orange County, CA?
Yes, many insurance plans in Orange County, California, cover DBT when it is considered medically necessary for a mental health condition or substance use disorder. Coverage depends on your plan, provider network, and treatment program. You may have a copay, deductible, or prior authorization requirement. Individual DBT therapy is often billed as psychotherapy, while specialized DBT groups or comprehensive programs may have different coverage rules.
Alternatives to DBT for Addiction & Mental Health Treatment
- Cognitive Behavioral Therapy (CBT): Helps identify and change negative thought patterns and behaviors that contribute to addiction, anxiety, and depression.
- Motivational Interviewing (MI): Helps people resolve uncertainty about changing substance use or mental health behaviors and strengthen motivation for recovery.
- Acceptance and Commitment Therapy (ACT): Teaches people to accept difficult thoughts and feelings while taking actions aligned with their personal values.
- Trauma-Focused Therapy: Helps people process traumatic experiences that may contribute to substance use, PTSD, anxiety, or depression.
- EMDR Therapy: Uses structured procedures involving eye movements or other bilateral stimulation to help process distressing traumatic memories.
- Mindfulness-Based Relapse Prevention (MBRP): Combines mindfulness practices with relapse-prevention strategies to help people respond to cravings without automatically acting on them.
- 12-Step Facilitation Therapy: Encourages participation in recovery programs such as Alcoholics Anonymous or Narcotics Anonymous to build accountability and peer support.
- Contingency Management: Uses tangible rewards to reinforce treatment participation and specific recovery behaviors, particularly in substance use treatment.
- Group Therapy: Provides a structured setting to practice coping skills, share experiences, reduce isolation, and learn from others facing similar challenges.
- Family Therapy: Helps address relationship conflict, communication difficulties, and family patterns that may affect mental health or addiction recovery.
- Medication-Assisted Treatment (MAT): Combines medications with counseling and support to treat certain substance use disorders, particularly opioid and alcohol use disorders.
Balance out your life with DBT
Ready to build the skills that make lasting recovery possible? Our team at Casa Recovery is here to help you get started — reach out today to talk through your options and verify your coverage.