Some emotions arrive like a wave. Anger, panic, loneliness or shame can rise so fast that the only thing that seems to help is a drink or a drug. Afterward, the feelings come back, often stronger, along with regret.

Dialectical behavior therapy (DBT) teaches you how to ride those waves without being pulled under. At Amar Recovery, DBT for addiction is part of our outpatient treatment in San Francisco, helping adults build practical skills to manage intense emotions, tolerate distress and create healthier relationships. DBT is offered in both our partial hospitalization program (PHP) and intensive outpatient program (IOP), alongside other evidence-based and holistic therapies.

Dialectical behavior therapy is a skills-based form of therapy developed by psychologist Marsha Linehan. It developed from cognitive behavioral therapy (CBT) and was originally designed to help people who experience emotions very intensely. Today, it’s used for a wide range of concerns, including substance use.

The word “dialectical” means holding two ideas that seem opposite at the same time. In DBT, the central balance is between acceptance and change: accepting yourself and your experience as they are right now, while also working to build a life that feels better. You might hear it described as, “I’m doing the best I can, and I can learn to do better.”

This balance is especially meaningful for people in recovery who carry a lot of shame. DBT doesn’t ask you to fix everything about yourself. It helps you meet yourself with understanding while learning new ways to cope.

Many people use alcohol or drugs to escape overwhelming emotions or painful situations. DBT for addiction addresses that pattern directly by giving you alternatives that work in the moment.

DBT can help you:

• Recognize emotions early, before they become overwhelming
• Get through cravings and crises without using
• Reduce impulsive decisions driven by strong feelings
• Communicate your needs and set boundaries in relationships
• Build a daily life that feels worth staying sober for

DBT also recognizes that slips can happen. Rather than treating a lapse as total failure, DBT helps you understand what led to it, repair any harm and recommit to your goals quickly.

DBT is built around four skill areas. Each one gives you specific, practical tools you can use in daily life.

Mindfulness is the foundation of all DBT skills. It’s the practice of paying attention to the present moment, including your thoughts, feelings and body sensations, without judging them. Mindfulness helps you notice a craving or a difficult emotion as it arises, giving you space to choose how to respond instead of reacting automatically.

Distress tolerance skills help you survive a crisis without making it worse. When you can’t change a painful situation right away, these skills help you get through it safely. Examples include distracting yourself with an engaging activity, using your senses to self-soothe, changing your body temperature or breathing to calm down quickly, and practicing radical acceptance of what you can’t control.

Emotion regulation skills help you understand your emotions, reduce how vulnerable you are to them and change the ones you want to change. You’ll learn to name what you’re feeling, notice what triggers it and take care of the basics, like sleep, food and movement, that make emotions easier to manage. You’ll also build positive experiences into your life to support a more stable mood.

Interpersonal effectiveness skills help you ask for what you need, say no when you need to and maintain healthy relationships while keeping your self-respect. These skills are especially helpful in recovery, when you may be setting new boundaries, repairing trust or saying no to people and situations connected to substance use.

DBT can be helpful for anyone who wants better tools for managing emotions and relationships. It may be especially beneficial if you:

• Feel emotions very intensely or have trouble calming down
• Use alcohol or drugs to escape painful feelings
• Struggle with impulsive behavior
• Experience frequent conflict or instability in relationships
• Are living with anxiety, depression or the effects of trauma
• Have a history of self-harm or thoughts of suicide [clinical team to confirm scope of care]

DBT and CBT are closely related, and many people benefit from both. CBT focuses mainly on identifying and changing unhelpful thoughts and behaviors. DBT builds on CBT and adds a strong emphasis on acceptance, mindfulness and emotional skills.

In simple terms, CBT helps you change how you think about a situation, while DBT also helps you accept and cope with intense emotions when a situation can’t be changed right away. At Amar Recovery, your care team will use both approaches in a way that fits your needs.

DBT skills are part of both our PHP and IOP. You’ll learn and practice skills in group sessions, then apply them to your own life in individual therapy. DBT also connects naturally with our holistic program. Mindfulness skills you learn in DBT are reinforced through yoga, breathwork and qigong, helping you feel calm and present in both your mind and body.