DIALECTICAL BEHAVIOR THERAPY (DBT)
Dialectical Behavior Therapy (DBT) is a specialized form of cognitive-behavioral therapy (CBT) that was developed by Dr. Marsha Linehan in the 1980s. It was originally designed to treat individuals with borderline personality disorder (BPD) who were experiencing chronic suicidality and self-harm behaviors as a consequence of pervasive emotion dysregulation. Individuals with pervasive emotion dysregulation often experience a heightened emotional sensitivity to situations and their emotions are triggered rather quickly, tend to be very intense, and take a long time to resolve. Frequently, the intense emotions are managed by engaging in behaviors that are effective in the short-term (e.g., making suicide attempts, engaging in self-harm or impulsive behaviors, using alcohol and drugs, bingeing/restricting/purging food, avoiding situations) - but eventually create a life that is painful and unbearable in the long-term. Over the years, DBT has been adapted and proven effective for a wide range of mental health conditions characterized by emotional dysregulation, including depression, anxiety disorders, post-traumatic stress disorder (PTSD), bipolar disorder, substance use disorders, and eating disorders.
HOW DOES DIALECTICAL BEHAVIOR THERAPY WORK?
DBT is based on the dialectical philosophy, which emphasizes finding a balance between seemingly opposing concepts, such as acceptance and change. The therapy integrates principles of cognitive-behavioral techniques with mindfulness practices and concepts from dialectics to help clients build a life worth living. DBT targets out of control behaviors through a balance of acceptance (validation, mindfulness, self-compassion, distress tolerance) and change strategies (emotion regulation, problem-solving, building interpersonal effectiveness, reducing ineffective thinking).
WHAT IS EXPECTED OF DBT CLIENTS AND THERAPISTS?
In full, outpatient DBT, there are 4 main modes of treatment provided:
Clients meet one-on-one with their therapist on a weekly basis to address specific target behaviors and work on achieving treatment goals. The therapist helps clients identify and challenge maladaptive thought patterns and behaviors, while also validating their experiences and emotions.
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Individual Therapy
Clients participate in a 90-minute weekly skills training group, where they learn and practice new skills to manage emotions, improve interpersonal effectiveness, tolerate distress, and increase mindfulness. in 90-minute class-like sessions, DBT clinicians teach new behavioral skills.
Skills Training Group
Clients have access to phone coaching between sessions to receive support and guidance in applying DBT skills to real-life situations. This helps clients generalize their skills and cope effectively with challenging situations as they arise.
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Phone Coaching
DBT therapists participate in a consultation team with other DBT providers to ensure adherence to the treatment model and provide support and guidance to one another in delivering effective treatment.
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Therapist Consultation Team
BEHAVIORAL SKILLS INCLUDE:
Mindfulness
Learning to stay in the present moment nonjudgmentally as well as choosing how to relate effectively to current life circumstances.
Distress Tolerance
Learning new coping skills and strategies to not make intensely painful short-term situations or seemingly intolerable long-term circumstances worse.
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Emotion Regulation
Learning to accurately identify emotions, regulate them effectively, reduce overall emotion vulnerability, and to manage extreme emotions.
Interpersonal Effectiveness
Learning to clarify priorities and use new skills in being assertive, keeping and maintaining good relationships, and increasing self-respect.
WHAT IS THE FOCUS OF DBT TREATMENT?
DBT emphasizes the dialectical balance between acceptance and change, encouraging clients to accept themselves and their experiences while also working towards making positive changes in their lives. The focus of DBT treatment is prioritized in the following order:
01
Life-threatening Behaviors
Suicide attempts, suicidal ideation, self-harm, thoughts of harming others
02
Therapy-interfering Behaviors
Any client or therapist behavior(s) that interfere with positive progress in treatment.
03
Quality of life interfering behaviors
May include substance abuse, eating disorder behaviors, severe depression, high anxiety, financial problems, intense relationship issues, shame, and self-hatred.
04
Increasing behavioral skills
Learning new mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness skills to improve client’s individual skills deficits.
The primary objective of DBT treatment is to increase dialectical thinking and behavior…. moving away from black and white, extreme thinking and rigid problem solving to more flexible, adaptive, and effective ways of thinking and behaving.
Overall, DBT is a highly-structured, evidence-based treatment that has been shown to be effective in reducing suicidal behaviors, self-harm, and other maladaptive behaviors, while also improving overall emotional regulation and quality of life. It is particularly well-suited for individuals who struggle with intense emotions, impulsive behaviors, and difficulty in managing interpersonal relationships.