Is DBT the Standard Treatment for ADD?

Through the application of four fundamental DBT skills—mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness—dialectical behavior therapy helps patients manage the symptoms of ADHD. Find out how to do it here.


DBT Skills: What Are They?

Training in dialectical behavioral therapy (DBT) focuses on teaching four main DBT competencies: emotional regulation, mindfulness, distress tolerance, and interpersonal effectiveness. DBT is a useful treatment for a wide range of diseases characterized by an inability to regulate emotions, such as anxiety, mood, and ADHD.

It is likely that you have heard of cognitive behavioral therapy (CBT) and mindfulness meditation as research-proven methods of treating ADHD symptoms. A subset of CBT called dialectical behavior therapy (DBT) has aspects of both. To me, DBT is a fresh and enhanced version of CBT.

In order to treat borderline personality disorder (BPD), psychologist Marsha Linehan, Ph.D., created dialectical behavior therapy in Seattle, Washington, in the 1980s. The main symptom of BPD is emotional dysregulation. DBT has been shown to be a successful treatment for a number of illnesses that are characterized by an inability to manage emotions, including attention deficit disorder (ADD), mood and anxiety disorders, and substance use disorders. It is now the standard treatment for ADHD.


What Is ADHD DBT?

“Dialectical” thinking refers to viewing ideas, feelings, and circumstances in life with greater balance. It is realizing that we are not the owners of the truth and that trying to perceive what we are blind to might help us present a more nuanced and alternative picture of the world. It assists us in eschewing binary thinking and releasing ourselves from the power struggles that result from it.

Validation, or accepting painful feelings and circumstances before attempting to change them, is a fundamental component of DBT. Change seems conceivable when patients accept their unpleasant ideas and feelings. They can then collaborate with their therapists to develop a rehabilitation plan. One of my clients had trouble focusing while learning. We discussed changing her study habits and adopting a more adaptable mindset. Rather than studying for an hour straight, she studied for thirty minutes, took a ten-minute break, and then studied for an additional thirty minutes. She discovered that she could get a lot more done in two shorter amounts of time.


Four Important DBT Skill Areas

  1. Being mindful. One task at a time, in the present, with all of one’s concentration, and with acceptance is the main goal of mindfulness meditation for ADHD sufferers. For the majority of people, especially those with ADHD whose minds race, this is difficult. Although acceptance might be challenging, it can lessen emotional suffering when you are able to embrace who you are or that you have ADHD.

  2. Distress Acceptance. By using these abilities, people can learn to accept unpleasant feelings rather than striving to avoid them.

  3. Emotion Control. These abilities aid in reducing emotional intensity without acting upon it. Accurately labeling emotions is important because people sometimes confuse anger with fear or anxiety. Other skills include determining whether the emotion you are experiencing is justified by the circumstances and acting to counteract the problematic emotion by, for example, smiling in an upsetting situation.

  4. Effectiveness in Interpersonal Relations. These abilities aid in understanding one’s requirements in relationships and in creating strategies for interacting with friends and family. A client gains skills that let her interact with people in an assertive, self-respecting, and relationship-building manner.


How DBT Techniques Reduce Symptoms of ADHD

  • Inhibiting behaviors rather than impulsively reacting when experiencing an emotion (by practicing mindfulness) 

  • Refocusing attention through self-soothing and distracting skills, to prevent negative emotions from escalating 

  • Choosing value-based action to help solve a problem (perhaps through asserting oneself) or managing the emotion effectively in other ways (through acceptance) are some of the ways DBT skills help people regulate their emotions.


DBT Techniques: Distracted

You are exercising concentration when you practice mindfulness. You become more proficient at something the more you practice it. Your memory will get better as your concentration increases since you will be more focused on the one task at hand.


DBT Techniques: Impulsivity and Hyperactivity

Tolerating internal feelings (such emotions), physical sensations (like agitation and restlessness), and impulses to fidget or interrupt others are all made easier with the use of DBT techniques. People understand they can change when they can learn to accept these unpleasant situations and make better decisions.


Adhering to DBT Skills Intervention

As a skills-focused therapy, DBT necessitates a commitment to acquire and apply the skills. Individual therapy sessions are quite regimented, with a predetermined schedule to ensure therapy stays on course. Teaching skills is the responsibility of the DBT therapist; this is accomplished through practice in one-on-one sessions and through completion of homework assignments to reinforce skills outside of sessions.

A behaviorally focused therapy is DBT. The intention is to become overly proficient in these new thought processes by overlearning them. My client came to the realization that her frequent interruptions of others have strained relationships in the past. She was able to realize that her interruptions give the impression that she does not appreciate what the other person is saying by adopting a dialectical viewpoint. Her awareness of the impulse to interrupt has increased due to mindfulness. During sessions, we practice resisting the need to interrupt. She has to be aware of these urges when interacting with her mother and best friend as part of her weekly homework assignments. The good news is that she is gradually becoming a different person.


DBT Foundations

The DBT therapy plan that Marsha Linehan created can be expensive and time-consuming, typically requiring a year. The program includes individual treatment sessions with a therapist, skills coaching—a 24-hour, seven-day-a-week program where clients communicate with a DBT therapist—outpatient group skills therapy, and meetings with a DBT consultation team.

Versions of the whole program that have been customized can be helpful to individuals. “DBT-informed treatment” is offered by several therapists. For instance, in my own practice, I do not force clients to attend both individual and group sessions; instead, I teach DBT techniques in individual sessions. Instead of requiring a client to attend group sessions for a full year, I also offer a shorter (12-week) group that teaches some of the DBT skills essential to emotion regulation.


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