Dialectical Behavior Therapy
Dialectical Behavioral Therapy (DBT) is a type of psychotherapy that was originally developed by Dr. Marsha M. Linehan in the late 1980s. It was initially designed to treat individuals with borderline personality disorder, but it has since been adapted for use with a variety of mental health conditions.
DBT is based on a dialectical approach, which means finding a balance between seemingly contradictory elements. The therapy combines cognitive-behavioral techniques with concepts from Eastern mindfulness practices. South Coast Behavioral Health uses DBT as part of our comprehensive addiction and mental health treatment programs.
How Does Dialectical Behavior Therapy Work?
DBT is especially beneficial for those who struggle to regulate their emotions and communicate with others. Although it’s not the same as CBT that inspired it, DBT is closely related to the therapy.
Like with CBT, you’ll work with a DBT therapist to identify goals you’d like to work on and overcome obstacles that prevent you from achieving these goals. You learn skills to change unhelpful thoughts and behaviors.
Here’s a brief overview of how DBT therapy works:
Core Components
- Skills Training: This often takes the form of group sessions where individuals learn four main sets of skills, which are:
- Mindfulness: Focusing on the present moment and being aware of thoughts, feelings, and sensations.
- Distress Tolerance: Learning to tolerate and survive crises without making the situation worse.
- Interpersonal Effectiveness: Skills for effective communication, assertiveness, and conflict resolution.
- Emotion Regulation: Understanding and managing emotional reactions.
- Individual Therapy: One-on-one sessions with a therapist help participants apply the skills they learn to specific challenges and events in their own lives.
- Phone Coaching: Some DBT programs offer phone coaching, where individuals can call their therapists between sessions to receive guidance on how to handle difficult situations as they occur.
- Therapist Consultation Team: In traditional DBT, therapists meet regularly in consultation teams to support each other and ensure that the therapy is adhering to the principles and techniques of DBT.
- Mindfulness and Acceptance Practices: These happen in all parts of the therapy. Patients receive homework assignments to practice mindfulness techniques.
Four-Stage Treatment:
- Stabilization and Safety: The first stage focuses on decreasing self-destructive behaviors and achieving behavior stability.
- Exploring Emotional Experiences: The focus is on experiencing emotions without immediately acting on them.
- Building Ordinary Life and Solving Problems: At this stage, people work on establishing a “life worth living,” which is a personalized set of goals, experiences, and attributes that make life fulfilling.
- Building Capacity for Joy: This is the final stage, and not everyone reaches it. It involves learning to experience happiness and fulfillment.
The duration of DBT can vary depending on individual needs, but it often involves a commitment of several months to a year or more. While DBT can be intensive, many people find it to be effective for bringing about significant and long-lasting change.
Dialectical Behavior Therapy, or DBT for short, is a discipline or approach within clinical psychology developed to treat personality disorders and other mental health issues. It was founded by mental health professional Marsha M. Linehan as a way to improve upon CBT.
Linehan saw CBT was great for identifying negative thought patterns and changing them, but it lacked a component of how to handle situations when a person’s emotions were heightened. She wanted to develop a form of mental health treatment that could help people when they were experiencing emotional pain. That’s where DBT therapy began.
The word “dialectical” in DBT refers to “dialectic,” meaning two opposing things coming together to form something new. An example might be an optical illusion in which one viewer sees a cup and the other sees two people looking at each other; rather than being two opposing things, both are true.
DBT Treatment Today
Initially, Linehan developed DBT to treat individuals living with Borderline Personality Disorder. However, today it treats a wide range of conditions, including:
- Generalized Anxiety Disorder
- Depression
- Obsessive Compulsive Disorder
- Eating disorders such as binge eating disorder
- Substance abuse issues
- Co-occurring disorders (when someone suffers from a mental health disorder in addition to their substance abuse)
- Self-harm
- Post-Traumatic Stress Disorder
Dialectical Behavior Therapy is useful for anyone who struggles to regulate their negative emotions or compulsions in the moment and would benefit from learning how to be more present. DBT treatment happens in conjunction with antidepressant medications for mental health issues like depression or bipolar disorder. It also happens during individual therapy or group sessions.
Individual DBT Therapy
Individual Dialectical Behavior Therapy is a crucial element in comprehensive DBT treatment, though it can also be effective as a standalone treatment. In individual sessions, clients work one-on-one with a trained therapist to apply DBT skills to their specific life challenges.
These sessions have a set structure, often beginning with the review of a “diary card” that tracks behaviors, emotions, and skill usage. The sessions proceed with an established agenda that includes behavior analysis and cognitive restructuring, designed to help clients understand and modify problematic behaviors and thoughts. Homework assignments and, in some cases, phone coaching between sessions help clients to practice and generalize these skills.
The process is goal-oriented, beginning with addressing life-threatening behaviors and eventually moving to improve the quality of life. Therapists use a hierarchy of treatment targets to prioritize the issues that need urgent attention. In addition, the therapist is often part of a consultation team to ensure adherence to the DBT model and to receive support.
The length of treatment varies but is usually committed and could last a year or more, depending on the individual’s needs and the severity of the symptoms. Overall, individual DBT offers a personalized, intensive approach to treat emotional dysregulation, behavior issues, and relationship challenges.
DBT Group Therapy
You may learn DBT skills in individual therapy, but DBT is commonly received in group settings. As opposed to individual therapy sessions, people in DBT groups talk about their challenges together.
In DBT group skills training patients learn to manage their feelings by hearing from other group members and their experiences. Many people find it helpful to attend group therapy in addition to seeing a therapist one-on-one.
Group skills training sessions are usually led by a certified and trained DBT therapist. Individuals participating in the group will learn the standard components of DBT such as mindfulness, emotional regulation, distress tolerance, and effective interpersonal communication skills together.
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DBT Phone Coaching
Phone coaching allows clients to contact their therapists between scheduled sessions for brief coaching on how to handle challenging or crisis situations using DBT skills.
The primary aim is to provide real-time guidance that helps clients apply the techniques they’ve learned in therapy to their everyday lives. This on-the-spot support aims to generalize the skills learned during individual and group therapy sessions to real-world scenarios, thus making the skills more ingrained and effective.
What to Expect in Dialectical Behavior Therapy?
When an individual enters DBT treatment, they may be struggling to cope with emotional distress. Their pain tolerance could be extremely low. When people have difficulty tolerating emotional pain, they may engage in self-destructive behaviors.
For example, some people who are living with Borderline Personality Disorder, and have a low tolerance for emotional pain, engage in self-harm or harmful behaviors to cope with this distress. If that is the case, the most urgent goal is to get the client to a place where they’re safe. If a client is experiencing suicidal ideation, self-harming, or if they’re using other dangerous behaviors, a DBT therapist will first help them get to a place where they are no longer at risk of harming themselves.
In a typical DBT program, emotional pain tolerance and emotional distress are often the first aspects worked on. Things like mindfulness, self-compassion, self-respect, self-awareness, and interpersonal relationships come a little bit later on. A DBT therapist will help an individual in learning how to cope with negative emotions and acknowledge how they’re feeling without necessarily trying to change it.
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DBT Skills Training
DBT skills training focuses on the following areas:
- Mindfulness skills, or being conscious of and accepting one’s feelings in the present moment
- Emotional regulation, or recognizing painful emotions and controlling them effectively and healthily
- Interpersonal effectiveness, which involves learning how to be a better communicator toward others and navigate relationships
- Distress tolerance, or learning how to deal with stress effectively
These DBT skills are sometimes referred to collectively as “comprehensive DBT.”
Learning these emotional skills helps us gain assertiveness, stand up for ourselves, respect others, draw boundaries, and maintain stable relationships.
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Recover with Dialectical Behavior Therapy
If you are struggling with a mental health or substance use disorder, dialectical behavior therapy may be an effective treatment option for you. It is important to note that DBT requires active participation in order for it to be successful. If you think DBT might be right for you, please reach out to us today! We can help you get better. Call today!
