The Four Stages of Dialectical Behavioral Therapy for Addiction Recovery

Dr. Marsha Linehan was an adjunct professor of psychology and psychiatry at the University of Washington, Seattle campus when she first developed dialectical behavioral therapy.  Linehan received a lifetime achievement award for literally writing the book on dialectical behavioral therapy. In the book Linehan lays out the dialectical behavioral therapy that she developed. She designed it specifically to support her patients and others like them change the they way in which they comport themselves in difficult situations. Not only does Dr Linehan work as a professor of psychology and psychiatry but she also runs a private practice and continues to research new and innovative ways to treat and offer hope to those who suffer from mental health disorders and drug or alcohol addiction.


Dialectical behavior therapy, or DBT, is in the same family as cognitive behavioral therapy. Like cognitive behavioral therapy treatment, DBT focuses in on a person’s individual behaviors through individual therapy sessions with a qualified therapist as a means of making changes to behavioral habits, but they also can use group therapy sessions for skills training exercises and lessons. Linehan originally designed DBT for treating her borderline personality disorder patients. Borderline personality disorder is one of the serious mental illnesses that can sometimes have side effects of a patient experiencing intense and chronic suicidal ideation. Because DBT helps to offer people suffering with mild to severe mental health hope, it has become one of the most utilized psychological treatments and standard in plans of care at many South Florida rehab centers especially as they treat those who suffer from  chronic suicidal ideation, borderline personality disorder, and other dual diagnosis. Dialectical behavior therapy has offered hope to people in so many ways some of the dual diagnosis that may find this type of therapy useful are:

  • Those with dual diagnosis substance abuse
  • Depression
  • Generalized Anxiety Disorder
  • Post Traumatic Stress Disorder, or PTSD
  • Eating Disorders
  • And Others


The Four Stages of Dialectical Behavior Therapy

  • 1st Stage of DBT: In the first stages of therapy a patient spends time addressing the chaos that is within them, the chaos that brought them to the therapy they are about to begin. It is likely that at this stage their behavior is chaotic and so is their emotional state. It is likely that when it all comes down to hit the patient feels out of control.  
  • 2nd Stage of DBT: The 2nd stage of dialectical behavioral therapy sees the person who is struggling from an addiction to drugs or alcohol still struggling with the addiction and the chaos but they are starting to feel more capable of controlling their reactions to situations that trigger them. This doesn’t mean that they are free from feeling the trigger, they still experience the struggle, but they are able to choose a more constructive reaction with the help of DBT. In this second stage of the therapy the idea is to bring the patient out of any silent pain they may have, trauma or neglect they are still dealing with, shoved down pain or emotion.
  • 3rd Stage of DBT:  Now that the person who first approached dialectical behavioral therapy, someone addicted to drugs and alcohol, who has made it through a residential detox treatment plan, is no longer suffocating under the same weight of chaos and fear that they were. The first two steps have offered them new ways of behaving. They have started to live free of that dangerous frenetic chaos of the heart and the mind of  and have instead started to change those destructive habits. They are building new habits and new rituals – new grooves in their brain to help them have a standard practice of having control over their habits and behaviors. This sort of control is what will allow them to safely pick up those stuffed away emotions, or to begin to truly understand the weight of childhood trauma, neglect, or whatever kind of pain they are holding close.
  • 4th Stage of DBT: Many people choose to engage with the fourth stage of dialectical behavioral therapy because for them a spiritual component to healing feels not only helpful, or valuable but absolutely necessary. The idea of a higher power is absolutely a motivating factor for many people. There are also many who decide that the fourth stage of DBT is not for them and they are not seeking out that spiritual connection within DBT. Dr. Marsha Linehan designed the fourth stage of DBT to play that role of spiritual connect, to help patients set a goal of spiritual fulfillment within the plan of their healing


It doesn’t matter if you are suffering from an addiction to alcohol, meth, or oxycodone, treatment at almost any drug rehab facility in Florida will offer some time of behavioral therapy. Dialectic behavioral therapy is just one of many different types of therapies, all designed to help a patient become more self aware of their emotions and reactions and to alter their behavior and self perception. 

Contact us today for help ending your addiction.

Cognitive Behavioral Therapy For Higher Success in South Florida Rehab Centers

Cognitive behavioral therapy is a type of behavioral therapy that is designed around the goal of helping to instill within patients the types of skills that they require in order to be able to face their most difficult moments with as much grace as possible and to be able to behave in the precise way that they want to in the moment. This requires basic but often unlearned skills like being able to recognizing mood shifts in the moment, and emotional responses linked to different triggers. It takes an in depth and fundamental understanding of one’s self for a person who is suffering with a chemical dependency, and a deep of understanding of one’s own addiction, not to mention the intoxicant, whether illicit drug, prescription drug, or alcohol, at the center of the addiction itself to reach true sobriety and health.


This sort of deep dive into the matter teaches a person who is suffering with an addiction how they came to their struggle with addiction, how they came to this place and time, and just what addiction really means. The way that the person’s specific drug or alcohol changes their state of mind changes the way the person’s unique addiction functions, along with how their individual addiction feeds off of each of the other elements in the life of the addict can be startling to explore at first. It can all be very overwhelming for someone when they are new at the process but it reaps benefits that are not even imaginable when you start the therapy.


It can be pretty intense to learn so much. Cognitive behavioral therapy can take a patient to a real understanding of not only their personal emotional state but also of the chemical makeup and psychological underpinnings of addiction itself. Whether illicit drug, prescription drug, or alcohol, chances are if the patient is in detox, the patient’s body has been battered and bullied by the havoc that the substance has been wreaking.. It can be truly intimidating to stand face to face with one’s own fear and deep of self hatred and trauma, but doing allows the recovering patient to acquire the skills they need to change the way they are vulnerable to cravings and triggers, and how they are affected by them. One of the most important aspects of cognitive behavioral therapy is that it assists recovering addicts in being able to dig down and find compassion within themselves for themselves. This is important because it helps the addict resist the addiction shame and guilt spiral. This provides for not only a higher quality of life, but also it generally works to increase the chances of sustained sobriety in the recovery of any person who is suffering with an addiction to either an illicit drug, prescription drug, or alcohol. This is especially valuable to a rehab patient who has been diagnosed with a dual diagnosis, or co-occurring disorder. A dual diagnosis occurs when a patient who is suffering from an addiction to a drug, illicit or prescription, or to alcohol, also struggles with a comorbidity of one of any number of mental health disorders such as schizophrenia, personality disorder, generalized anxiety disorder or depression. A patient with a co-occurring disorder or dual diagnosis such as the disorders listed above will have a more intricate recovery process ahead of them. In order to reach active recovery and heal from these struggles, a person must treat the two illnesses, the mental illness as well as the drug or alcohol addiction, at the same time. Cognitive behavioral therapy is one of the few types of recovery treatments used that is able to target both of the dual diagnoses at their core simultaneously.


CBT is created based on a three founding principles.

  • Concerning behavioral problems usually rear their head because of incorrect, inappropriate, or inaccurate learning, comprehension, practice, or understanding of the rest of the world.
  • Practice makes perfect, sometimes. Sure, a person can practice an action over and over again in just the right way and go from just so-so to close to perfect in a matter of time, but practice can also make for a lifetime of incorrect or problematic actions and habits. If a patient practices 1+1= 5 long enough, they will solidify the idea in their minds and it will become a habit, or a settled knowledge in their minds. If a patient believes that they are useless and proceed to tell themselves so too many times, or perhaps they hear it from someone else in their lives, they will likely develop the habit of believing that they themselves are indeed useless.  
  • It is possible to stop doing this. It is possible to heal. You can relearn ways of thinking. You can rewrite the paths in your brain with correct practice, and learn new ways of coping in the world around you with skills that help you stay healthy and sober. Survival skills or coping methods which may have initially been all you could do to survive can become problematic behaviors that need to be altered in the long run.  

Finding Help Through 1st Step’s Behavioral Therapy in South Florida

Drug detox and rehab centers in Florida will almost all offer some form of behavioral therapy throughout their treatment programs. The best plans will consider the patients each as individuals when setting them up with an addiction recovery treatment plan. At 1st Step we will look at each person individually to take into consideration unique struggles and individual addiction as we set up therapy and treatment for each patient. This allows each patient to work on any dual diagnosis they are struggling with, and also to as address trauma they may need to process at this time. 1st Step employs a staff of licensed medical clinicians as well as licensed therapists who work with each patient on an individual level. Call us today to learn more.