DBT Mindfulness Strategies for Substance Abuse


Private Practice

Key Points

  1. Mindfulness is a core component of DBT and helps clients with substance abuse issues focus on the present moment, reducing distractions and increasing overall well-being.
  2. Mindfulness increases awareness of automatic negative thoughts and self-criticism, allowing clients to challenge and replace them with more realistic and positive thoughts.
  3. Exercises like box breathing and self-soothing help clients manage overwhelming emotions, develop self-compassion, and respond rather than react to triggering situations.
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Mindfulness is a foundational aspect of DBT and played a crucial role in Michael’s therapeutic journey. Dr. Petracek provided instruction in meditation techniques and encouraged him to cultivate a heightened awareness of the present moment. By attuning himself to his thoughts and emotions as they arose, Michael acquired the capacity to respond in a more skillful way, enhancing his overall well-being.

Attention to the Present Moment

One mindfulness tool involves guiding the client to sit comfortably and engage in an exercise called box breathing. They inhale slowly to the count of three, hold their breath for three seconds, exhale to the count of three, and hold their breath for three seconds again. Three can also be a four-count. They repeat this cycle while focusing on the present moment by mentally repeating the word “here” or another mantra.

By practicing this technique, clients can direct attention away from past regrets and future anxieties, allowing them to center themselves in the present. This mindfulness practice has particular significance for clients contending with alcohol and substance abuse, as they often exhibit erratic thought patterns and struggle to maintain focus.

Automatic Negative Thoughts

Mindfulness also facilitated Michael’s recognition of the automatic negative thoughts and self-critical tendencies that contributed to his negative emotional states. For instance, he frequently berated himself, saying things like, “I’m so stupid. I can’t believe I did this.” For such instances, Dr. Petracek used a cognitive tool called the thought record. This prompted Michael to document a negative thought, rate his corresponding emotional distress on a scale of 1 to 10, then interject with a more realistic and positive alternative.

Using thought records to monitor and challenge negative thinking patterns reduces self-criticism and judgmental attitudes within clients and increases self-compassion. By transforming such thoughts into realistic appraisals by, for example, acknowledging that his actions were influenced by a lack of information, Michael experienced a decrease in emotional distress. He shifted from an eight on the scale of depression to a more manageable three.

Self-Soothing Exercises

Various self-soothing exercises, such as indulging in a bath or listening to calming music, proved invaluable to Michael when he felt overwhelmed. Sometimes he fell into cycles of escalating anxiety, concerned about potential job termination or the failure to receive a return call. Dr. Petracek encouraged him to pause and explore self-soothing techniques. A simple action like rubbing his own hand and arm could promptly alleviate physiological responses.

The Raisin Exercise

Michael was prompted to close his eyes and slowly chew a raisin, engaging in this with all of his senses. He reflected on what he saw when he placed the raisin in his mouth, and how it felt, tasted, and smelled. By employing this DBT mindfulness skill, especially in connection with food, clients can slow down their thought processes.

This exercise is particularly beneficial for those struggling with eating disorders, as compulsive food consumption shares parallels with substance addiction. Mindfulness, in this context, fosters senses of tranquility and control.

Response vs Reaction

Typically, individuals with alcohol or drug addictions find themselves bouncing from one situation to another, reacting impulsively rather than mindfully. Teaching clients the art of response vs reaction is another critical aspect of Dr. Petracek’s therapeutic work.

For example, during a conversation with his father, Michael encountered a triggering remark, which propelled him to verbally attack his father. To address this pattern, Dr. Petracek guided Michael to reassess the situation, encouraging him to respond instead of react. He initially struggled to comprehend the distinction. Dr. Petracek emphasized that responding involves expressing oneself without resorting to attacks.

Drawing from the teachings of Dr. Marsha Linehan, the pioneering figure behind DBT, Dr. Petracek stressed the importance of mindful and deliberate communication. By taking a momentary pause between stimulus and response, clients become less prone to launching assaults. They can convey emotions by expressing such sentiments as, “Dad, I didn’t appreciate what you said.” This intentional responsiveness, characterized by thoughtful consideration, leads to improved conversation outcomes and fosters healthier interpersonal dynamics.

Looking for practical everyday tools? This print-friendly handout is just what you need. Click on the following link to download the PDF:

DBT Mindfulness Strategies for Substance Abuse: A Therapeutic Guide

This guide explores the transformative power of mindfulness within the framework of dialectical behavior therapy (DBT) for those grappling with substance abuse. It underscores the significance of anchoring in the present moment and cultivating a heightened awareness of one’s thoughts and emotions. Through a curated set of techniques, therapists get an overview of how to guide clients in harnessing these skills to respond more adeptly to life’s challenges, thereby reducing their reliance on substances as a coping mechanism. Addressing the automatic negative thought patterns often associated with substance dependence with practical mindfulness exercises, this guide offers an integrated approach to fostering resilience and enhancing overall well-being.


To use this therapeutic guide, start by familiarizing yourself with the five core techniques outlined. While each strategy offers standalone value, integrating them into a holistic treatment plan can maximize their efficacy. When introducing a technique, gauge the client’s initial comfort level and receptivity, making modifications as needed. For instance, the box breathing exercise serves as both an introduction to mindfulness and a grounding tool; consider this an entry point. Remember to emphasize the real-world application of each strategy, highlighting how they can act as buffers against triggers and relapses. Lastly, while working with clients, encourage continuous reflection and feedback to ensure the strategies remain relevant and effective throughout their therapeutic journey.

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DBT Mindfulness Strategies for Substance Abuse

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DBT Training Pathway: From Foundations to Specific Applications (32 CE credits)

Embark on your journey beginning with the ‘what’ — the basic foundations of DBT, and gradually progress by learning the ‘how’ — the application of these principles.