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Dialectical behavior therapy (DBT) at Simonds Recovery Centers is a skills-based talk therapy that helps people manage intense emotions without turning to substances. Our DBT program in Los Angeles teaches four core skills, mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness, and treats addiction alongside co-occurring conditions like depression, PTSD, and borderline personality disorder.
What dialectical behavior therapy is
Dialectical behavior therapy is a structured form of cognitive behavioral therapy that treats addiction by building emotional and behavioral skills. It was developed by psychologist Marsha Linehan in the 1980s, originally for borderline personality disorder, and has since become a leading approach for substance use and co-occurring mental health conditions. The “dialectical” part refers to its central balance: accepting yourself as you are while working to change the behaviors that harm you.
For addiction, this matters because intense emotions are a common trigger for substance use. DBT gives people concrete skills to handle those emotions differently, so a hard moment no longer has to end in relapse.
The four DBT skills
DBT is organized around four skill modules. Two are acceptance-oriented and two are change-oriented, which mirrors the acceptance-and-change balance at the center of the therapy. Together they give people practical tools for the situations that drive substance use.
Mindfulness is the foundation. It teaches you to stay present and aware of your thoughts and feelings without judgment, using skills like wise mind, the balance between emotion and reason. Distress tolerance builds the ability to get through a crisis without making it worse, through skills such as radical acceptance and TIPP for intense moments. Emotion regulation teaches you to understand and shift difficult emotions, including skills like opposite action. Interpersonal effectiveness strengthens relationships and the ability to ask for what you need or say no, through skills like DEAR MAN. The table below summarizes them.
The four DBT skills modules
| Skill module | Orientation | What it builds | Example skills |
| Mindfulness | Acceptance | Present-moment awareness without judgment | Wise mind, observe and describe |
| Distress tolerance | Acceptance | Getting through a crisis without making it worse | Radical acceptance, TIPP |
| Emotion regulation | Change | Understanding and shifting difficult emotions | Opposite action, checking the facts |
| Interpersonal effectiveness | Change | Healthier relationships and clear communication | DEAR MAN, setting boundaries |
The four skills work together: mindfulness and distress tolerance help a person accept and sit with hard moments, while emotion regulation and interpersonal effectiveness help them change what they can. In addiction recovery, these skills replace substance use as the way to cope.
How DBT treats addiction
DBT treats addiction by targeting the emotional dysregulation that often drives substance use. Many people use drugs or alcohol to escape emotions that feel unmanageable, and DBT replaces that pattern with skills that work. As a person learns to tolerate distress and regulate emotion, the automatic pull toward substances weakens.
The approach is practical and skills-focused rather than open-ended. Sessions teach specific skills, then help people apply them to the real situations, cravings, conflict, and stress, that previously led to use.
What DBT helps with
DBT is especially effective for people whose substance use is tied to intense emotions, impulsive or self-destructive behavior, or unstable relationships. It is also a core approach for co-occurring conditions, and our DBT program addresses depression, anxiety, PTSD, and borderline personality disorder alongside addiction.
Because DBT was built for emotional dysregulation, it fits people for whom other approaches have not fully addressed the feelings underneath their substance use.
DBT vs. CBT and REBT
DBT, CBT, and REBT are related cognitive-behavioral therapies, but each emphasizes something different. DBT centers on managing intense emotions and building distress-tolerance and interpersonal skills. CBT focuses on identifying and changing distorted thoughts and behaviors. REBT targets the core irrational beliefs underneath self-defeating patterns. The table below compares them.
DBT vs. CBT vs. REBT
| Dimension | DBT | CBT | REBT |
| Main focus | Managing intense emotions | Distorted thoughts and behaviors | Core irrational beliefs |
| Best known for | The four skills, distress tolerance | Cognitive restructuring, relapse prevention | Disputing irrational beliefs (ABC model) |
| Style | Skills-based, acceptance and change | Structured, skills-based | Direct, philosophy-focused |
| Often suits | Strong emotions, self-destructive behavior, unstable relationships | Most people in addiction treatment | Rigid self-defeating beliefs |
All three are evidence-based and often used together. DBT is the right emphasis when intense emotions and impulsive behavior are central; at Simonds, it is combined with CBT and other therapies as each person’s needs require.
How DBT works at Simonds
DBT at Simonds is delivered through individual therapy and group skills training, the standard structure for the approach, so people learn the skills and then practice applying them. The same approach carries across our levels of care, including our partial hospitalization program (PHP) and intensive outpatient program (IOP).
DBT is integrated with the rest of treatment rather than offered in isolation. It works alongside CBT, medical care, and medication-assisted treatment where appropriate, as part of one coordinated plan.
Insurance and getting started
DBT is part of the treatment programs we provide, and most major insurance plans cover addiction treatment that includes it. We work with carriers including Aetna, Blue Cross Blue Shield, Cigna, UnitedHealthcare, Optum, and Humana, among others, and our admissions team confirms your specific benefits before you start.
Verifying benefits takes a few minutes and carries no obligation. Submit the insurance verification form or call +1 (833) 781-8338.
Medically reviewed by
Chris Small, M.D. Addiction Psychiatrist. Dr. Small is board certified in Psychiatry, Addiction Medicine, and Family Medicine. He earned his medical degree at the University of Hawaii and completed his residency in Psychiatry and Family Medicine at UCSD.
Start treatment built on skills that last
Talk to our admissions team about DBT as part of your treatment. Call +1 (833) 781-8338 or verify your insurance now.
