Dialectical Behavioral Therapy (DBT) is a comprehensive, modular, multi-diagnostic treatment plan, which was initially used to treat those with Borderline Personality Disorder (BPD). DBT consists of four skills; Mindfulness Skills, Interpersonal Effectiveness Skills, Emotion Regulation Skills, and Distress Tolerance Skills.
In spite of its name, Dialectical Behavioral Therapy actually uses cognitive therapy, behavioral therapy, and mindfulness practices.
To disentangle the jargon, let's first examine the term 'Dialectical.' It refers to a philosophy based on the concept of merging opposing opinions or forces to reach a balanced, constructive compromise. In the context of Dialectical Behavior Therapy, this can mean incorporating self-acceptance and change, or emotional and logical thinking simultaneously.
History of Dialectical Behavioral Therapy
Marsha Linehan, PhD developed DBT as a means of helping high-risk suicidal and self-harming patients. She initially used a number of cognitive behavioral therapies to treat a high-risk suicidal population consisting primarily of those with Borderline Personality Disorder (BPD). When her behavioral therapies didn’t work, Linehan didn’t give up but endeavoured to find out what else would work best instead.
DBT is a transactional system rather than an interactional system. It is not only the approach Linehan took in developing DBT but also an approach taught within DBT. This transactional aspect means it is a therapy that continues to evolve. It is configured in such a way that it is adaptable to changing times, changing circumstances, changing people, and different cultures.
4 Stages Of DBT:
1. Stage 1 :–
Crisis mode - When your life is in crisis, the skills can be used alone or with the guidance of a therapist. Mindfulness Skills and Emotion Regulation Skills are used to immediately improve your state of mind. Sometimes when we are very upset (Emotion Dysregulated) we cannot effectively problem solve a situation. Emotion Regulation Skills and Mindfulness Skills help clear the mind so that issues can be dealt with thoughtfully.
2. Stage 2 :–
In Stage 2, skills that help in creating a stable consistent life are learned.
3. Stage 3 :–
In Stage 3, past traumas are dealt with and you continue to master the skills in daily life. At this stage, the circumstances that may have prevented you from originally learning the skills are addressed.
4.Stage 4 :–
In Stage 4, you can use the skills to solve problems that someone else might have.
Mystery of Dialectical Behavior Therapy
DBT is a cognitive-behavioral approach designed primarily for individuals with self-harm behaviors, such as self-cutting, suicidal thoughts, and suicide attempts.
It combines standard cognitive-behavioral techniques for emotion regulation and reality-testing with concepts of distress tolerance, acceptance, and mindful awareness borrowed mainly from Buddhist meditative practice.
With DBT, the following things are happening at the same time, to a different degree:
Ease current emotional and/or physical suffering
Provide skills to help you avoid making bad situations worse
Teach skills so that you learn how not to create new crisis situations
Teach you how to know when and if a situation can be improved
Teach you how to seek out and create positive experiences
Build, strengthen and maintain effective relationships
The rising recognition of DBT as a treatment method
Today, the effectiveness of DBT extends beyond the initial patient population, positively impacting people with eating disorders, substance use disorders, post-traumatic stress disorder (PTSD), and other mental health disorders. Increasingly, DBT is seen as a multipurpose therapeutic tool that can help a wide range of individuals.
Understanding Dialectical Behavior Therapy
1. What is Dialectical Behavior Therapy (DBT)?
Developed in the late 1980s by psychologist Marsha M. Linehan, Dialectical Behavior Therapy (DBT) is a type of cognitive-behavioral therapy designed to help individuals cope with volatile emotions and destructive behaviors. It promotes personal growth and development through the teaching and integration of self-awareness, emotional regulation, distress tolerance and interpersonal effectiveness. This potent therapeutic approach aims to help individuals transform unhealthy habits and emotional patterns, embracing healthier and more balanced lifestyles.
The concept of 'dialectical':
In DBT, the opposing dynamics of Change Skills and Acceptance Skills are what come together to create A Life Worth Living.
Mindfulness Skills and Distress Tolerance Skills are considered Acceptance Skills while Emotion Regulation Skills and Interpersonal Effectiveness Skills are considered Change Skills. The skills aren’t learned one at a time but rather simultaneously. The skills work together, dialectically, to create stability in one’s life while also adding value to life.
DBT is interactive, modular, and comprehensive. Previous therapies have counselled control strategies for those whose lives were in chaos or for impulsive behavior. Instead, DBT teaches acceptance, validation, and gives practical strategies for coping in the real world.
Dialectical, derived from the philosophical concept of dialogue and tension between opposing ideas, is a key aspect of DBT. In therapy, this concept is used to help individuals reconcile two seemingly contradictory truths: the need for acceptance of oneself as they are, and the urgency to change harmful behaviors. Dialectical strategies within DBT allow the patient to balance these realities, encouraging acceptance and change simultaneously.
Principles of Dialectical Behavior Therapy
DBT is anchored by certain fundamental principles that steer its therapeutic approach. Grasping these essentials provides a foundation for understanding this technique's transformative potential.
Core principles of DBT
The conceptual framework of DBT revolves around four main principles:
Acceptance: This involves acknowledging the patient's current state without judgment, affirming their feelings and experiences as valid.
Change: Emphasizing the need to alter negative behaviors and thought patterns for better mental health.
Dialectics: This principle involves balancing acceptance and change through negotiation and compromise.
Mindfulness: Encouraging patients to stay present and focused, boosting self-awareness and alleviating stress.
Skill-building in DBT
DBT is also characterized by its direct emphasis on teaching practical skills to drive effective emotional regulation. These skills are generally categorized into four areas: mindfulness, interpersonal effectiveness, emotional regulation, and distress tolerance. These targeted skills collectively work to foster a more balanced and healthy mental state.
DBT Used to:
DBT has most often been used to treat Borderline Personality Disorder (BPD).
DBT is also used in treating substance abuse, depression, PTSD, and eating disorders. DBT is effective with adults and adolescents.
With DBT, the following things are happening at the same time, to a different degree:
Ease current emotional and/or physical suffering
Provide skills to help you avoid making bad situations worse
Teach skills so that you learn how not to create new crisis situations
Teach you how to know when and if a situation can be improved
Teach you how to seek out and create positive experiences
Build, strengthen and maintain effective relationships
DBT Basics:
For as long as you are learning DBT, you will fill out a Diary Card every day. The Diary Card is used at the end of the day to reflect on what happened. Moods and actions are recorded. Also, it’s a means of keeping track of your use of the skills
Pick three skills to learn and practice each week. Don’t pick three skills from one skill area but one from each of the four DBT skills.
Also, create a crisis plan and write it on the Diary Card. A crisis plan is a plan for avoiding problem behaviors and calming down when emotional situations occur. Distress Tolerance Skills are an important ingredient for a good crisis plan.
Be sure to fill it out every day. If you are not in individual therapy, then at the end of each week, set-aside time to look at your Diary Card. Look for patterns in your behavior and make a note of situations you would like to use for chain analysis.
Techniques of Dialectical Behavior Therapy
Dialectical Behavior Therapy (DBT) encompasses several distinctive techniques that are aimed to help individuals manage their emotions effectively, improve their interpersonal relationships and cope with stressful situations. These techniques bring a dynamic approach to therapy, blending cognitive-behavioral strategies with certain aspects of mindfulness.
Distinctive techniques used in DBT
The key techniques used in DBT include:
Behavior analysis: This involves the exploration and understanding of the triggers and consequences of self-destructive behaviors.
Skill training: This is designed to teach effective strategies for emotional regulation, distress tolerance, and interpersonal effectiveness.
Validation strategies: These techniques aim to confirm emotions are valid and understood, offering empathic understanding.
Incorporation of Mindfulness in DBT
Mindfulness has a pivotal role in DBT, being integrated into every aspect of this therapeutic intervention. The mindfulness skills taught in DBT help individuals observe and describe their feelings, promoting a non-judgmental approach and an increased capacity for emotional self-regulation.
1. Forming a DBT Skills Team
This is when a group of therapists either trained in DBT Skills Training or in the process of DBT Skills Training pool their resources in order to provide group therapy and individual therapy.
Personal and/or professional compatibility is not the only factor to consider when forming a team. The skills preferences and inclinations must also be considered if a dynamic and balanced therapeutic environment is to be created.
Dialectical Behavior Therapy is a highly structured therapeutic model which comprises four main components designed to synergistically contribute to improved mental health and well-being.
Components of Dialectical Behavior Therapy
1. Individual Therapy
In individual therapy, a patient works one-on-one with a trained DBT therapist. In these meetings, the therapist applies DBT principles to specific challenges and events in the patient's life. The aim is to encourage behavioral change, manage distressing or impulsive behaviors, and bolster emotional regulation skills. It is possible to learn DBT from an individual therapist or on an individual coaching basis. This may be done for several reasons. Sometimes there is no group skills learning environment available. Or, sometimes practical issues such as distance or insurance coverage can interfere with someone being part of a group therapy environment. Also, if the individual has social anxiety, it’s often preferable to treat the anxiety before they become a part of the group.
In this situation, a session during the week devoted completely to DBT Skill Training is suggested. Then in another session, there would be individual therapy.
2. Group Skills Training
Group Skills Training usually complements individual therapy. The group setup offers a conducive environment for learning and practicing new skills. During these sessions, participants learn several different skills across four modules: mindfulness, distress tolerance, emotional regulation, and interpersonal effectiveness. These skills empower patients to better handle their emotional struggles and conflicts.
In standard DBT skills training, there are at least 3 group sessions a week and at least 2 individual sessions per week. The four skills are divided between the 3 groups and during individual sessions, therapists discuss how the previous days went, addresses any important issues, and helps you learn how to use the skills in future situations.
DBT programs usually last for at least a year. The length of the programme gives you the opportunity to build a record of success over a wide range of situations and interactions. It also allows you an opportunity to fail, with assistance, and then to get up and try again.
3. Coaching
Phone Coaching is another crucial component of DBT. This allows patients to contact their therapists outside of regular sessions for immediate coaching during difficult situations. The aim of phone coaching is to equip patients with real-time solutions to help them apply DBT skills in complicated, everyday scenarios.
Therapist Consultation Team
Lastly, the Therapist Consultation Team is unique to DBT. This involves a team of DBT therapists meeting regularly to assist, support and motivate each other. This consultation team aids therapists in delivering the most efficacious therapy to their patients, thus making this an essential piece of the DBT puzzle.
Applications of Dialectical Behavior Therapy
DBT's unique focus on mindfulness, emotion regulation, distress tolerance, and interpersonal effectiveness makes it an exceptional therapeutic tool. Over time, its applications have diversified, and it is now employed in treating a variety of disorders.
1. Trauma and PTSD
One primary application of DBT is in the treatment of post-traumatic stress disorder (PTSD) and trauma. People who have survived trauma or struggle with PTSD often grapple with intense, unchecked emotions. DBT helps clients understand and manage these emotions, giving them the tools they need to live more healthily.
2. Substance Use Disorders
Substance use disorders often co-occur with other mental health disorders and each exacerbate the severity of the other. DBT is beneficial in such cases, as it targets both concerns simultaneously. It encourages self-acceptance and helps patients develop healthier coping mechanisms, thus, reducing reliance on substances for emotional regulation.
3. Eating Disorders
DBT has been found to be effective for eating disorders as well. It can help individuals suffering from Bulimia Nervosa or Binge Eating Disorder learn to manage stress and negative emotions, decreasing harmful behaviors related to their relationship with food.
4. Personality Disorders
Finally, perhaps one of the most established uses of DBT is in managing borderline personality disorder (BPD). At the core of DBT is the concept of dialectic, meaning balancing opposites and finding a middle ground. This concept can be particularly beneficial to those struggling with BPD, as they often oscillate between extremes of thought and emotion. DBT provides avenues for change while also promoting acceptance.
Impact of Dialectical Behavior Therapy on Emotional Regulation
Dialectical Behavior Therapy plays a significant role in promoting emotional regulation, which is crucial for mental well-being. Emotions are not fought or suppressed.
An emotion fought or bottled up only gains strength. Instead, a Dialectic perspective on emotions is taught. You learn that it is okay to experience an emotion and not act on it. The emotion can coexist with a lack of action and/or expression.
DBT also teaches us to gauge which emotions should be expressed, how they should be expressed, and when they should be expressed.
Also, one learns to evaluate when an emotion is providing valuable information in terms of relationships, short-term goals, and long-term goals. Often, if this is the case, then some sort of action plan or coping plan must be put into place.
1. How DBT facilitates emotional regulation
DBT employs several strategies that help individuals manage and regulate their emotions effectively. These include:
Mindfulness: This fundamental tenet empowers an individual to stay present and cognizant of their feelings and thoughts without judgment.
Distress Tolerance: DBT learners are taught to endure emotional discomfort without reacting impulsively to it.
Emotional Regulation: Therapy sessions aim to identify, label, and validate feelings, leading to better emotional control.
Interpersonal Effectiveness: DBT boosts skills to assert oneself, communicate effectively and maintain healthy relationships, all of which help in emotional regulation.
2. Real-life examples of DBT's impact on emotional wellness
DBT has proven impact in clinical and real-world scenarios. Take for instance, clients with borderline personality disorder show substantial improvement in mood swings, emotional instability and interpersonal relationships after undergoing DBT. Similarly, DBT has been successful in helping individuals with eating disorders by equipping them with skills to manage negative emotions that often fuel dysfunctional eating habits.
Dialectical Behavior Therapy in Mental Wellness
Psychological wellness goes beyond merely the absence of mental disorders. It means fostering a state of mental resilience and emotional strength. DBT, a cognitive-behavioral approach, holds a potent tool in our arsenal for achieving this goal, addressing issues like emotional instability, self-destructive behaviors, and interpersonal conflicts.
DBT and Mental Health: The Current Evidence
Extensive research has validated the efficacy of DBT for a variety of mental health disorders. To highlight a few:
Borderline Personality Disorder (BPD): Studies show that DBT can significantly reduce suicidal behavior and non-suicidal self-injury in individuals with BPD.
Eating Disorders: Evidence supports the application of DBT in treatment for binge eating and bulimia nervosa.
Substance Use Disorders: DBT has been helpful in inducing abstinence and reducing substance-related problems.
Potential for Future Research and Application Areas for DBT
Despite the existing vast body of evidence supporting DBT, there is still uncharted territory. Future research may focus on expanding the application of DBT to other mental health conditions such as depression, anxiety disorders, and post-traumatic stress disorder (PTSD). In addition, understanding how the principles of DBT can be integrated into preventative mental health strategies represents an exciting area of study.
Conclusion
DBT's transformative approach to mental health, captured in its emphasis on mindfulness, emotional regulation, distress tolerance, and interpersonal effectiveness offers a uniquely supportive framework for individuals contending with various mental health issues. A recap of the critical components of DBT includes:
DBT's emphasis on accepting and changing dysregulated emotional responses.
Its use of techniques like mindfulness to enhance self-awareness.
The fostering of distress tolerance to help manage crises effectively.
The development of interpersonal skills to strengthen relationships and social interactions.
Encouragement for those considering DBT
For those considering DBT, take heart. It's a tested and effective method, and although the journey may seem daunting at first, you are not alone. DBT can offer an empowering process of self-discovery, acceptance, and profound change. Mental health, like any worthy endeavor, is a journey, and every step forward counts. The light of understanding awaits as you demystify and embrace the potential of Dialectical Behavior Therapy.
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