What is Dialectical behavior Therapy (DBT)?
Dialectical Behavior Therapy (DBT) is a mode of psychotherapy rooted in the principles of Cognitive Behavioral Therapy (CBT), yet with a number of modifications. The DBT treatment style was originally developed to work with individuals suffering from Borderline Personality Disorder(s)(BPD), but has since gained ground in the successful treatment of a number of disorders, including:
• Depressive disorders.
• Bipolar disorder.
• Posttraumatic stress disorder.
• Anxiety disorders.
• Eating disorders.
• Substance use disorders.
Much like CBT, DBT is an evidence-based treatment modality, that is, an approach that is studied and researched to demonstrate its efficacy in given therapeutic situations and relationships. It is shown to be more effective than other treatment modalities, or no interventions at all.
The History of DBT
Developed in the late 1980s and early 1990s by Dr. Marsha Linehan, Dialectical Behavior Therapy was a new and altered approach to CBT. While working with clients that engaged in self-injury and had suicidal thoughts and ideations, Dr. Lenehan found standard CBT practices to be limited, as they maintained a continual emphasis on altering behavior. As a result, she developed DBT to increase the emphasis on acceptance/validation and dialectics, and added it to the existing CBT frame.
Validation is added to CBT to balance the desire for change with acceptance of internal and external situations. Validation is not used to encourage or even permit unhealthy or unwanted behaviors, but rather to facilitate non-judgmental understanding
The addition of dialectics expands on the notion of validation. Dialectics is the idea that:
• Everything is connected.
• Change is constant.
• Opposing forces can be brought together in harmony/balance.
DBT: Viewpoints and Beliefs
Dialectical Behavior Therapy shares several views, principles and beliefs with CBT, noting that unhealthy and unwanted thought and behavior patterns are learned and reinforced. DBT asserts that the interaction between two factors increases the likelihood of persistent mental health issues and problems. For example:
• Emotional vulnerability.
• Invalidating environments.
A person who is emotionally vulnerable may feel that their life is “turbulent” and “Extreme”, and will often be quick to respond with potent emotional reactions. This vulnerability may be caused by traumatic events, or else from the person’s natural disposition (heredity).
An invalidating environment is a situation or relationship in which an individual is made to feel as though their feelings are “wrong” “bad” or unfounded. Lacking kindness, respect, and acceptance can lead to an invalidating environment.
Dialectical Behavior Therapy (DBT) generally includes a degree of clinical optimism that is rarely found in its cognitive counterpart. It conveys that:
• People are doing the best they can, in whatever their situation currently is
• People desire opportunities and situation that facilitate improvement
• People can and do learn new behaviors and change their lives
• Even is a problem isn’t always an individual’s fault, it’s their duty to resolve it and recover.
Core DBT Skills
As we mentioned before, Dialectical Behavior Therapy focuses on cultivating an effective environment for patients to learn and practice skills. The core skills-training areas in DBT are:
Mindfulness. Rooted in the ancient spiritual tradition of Zen Buddhism, mindfulness is the practice of being completely aware and engaged in a present setting or situation. Individuals with mental health or addiction issues often spend increased time distracting themselves, ruminating on the past, or worrying about the future. Mindfulness brings you into Now. It is a practice on being fully immersed in the present, with a kindness, openness, and curiosity toward one’s life experience.
Distress Tolerance. When people are distresses, there is a tremendous urge to alter circumstances immediately. Using substances during periods of stress is one example of an unhealthy way to manage personal distress. Distress tolerance teaches patients how to accept and tolerate distress, which lays the foundation for resolution… instead of escape.
Interpersonal Effectiveness. This skill set is an example of another dialectical approach. When people lack skills in communication and conflict resolution, problems tend to increase. Dialectical Behavior Therapy teaches patients how to have happier, more effective and fulfilling relationships through effective interaction with others.
Emotion Regulation. The dialectic end of the DBT approach to distress, emotional regulation works to identify unwanted feelings and find new and healthy ways to change them.
Dialectical Behavior Therapy skills are so overwhelmingly effective in the treatment of mental health and substance use disorders, that other therapeutic styles and modalities have adopted them for use in a number of settings.
Even as DBT is a relatively “new” approach in the psychology community, it has evolved as the gold standard in treatment of borderline personality disorder, and its efficacy has spread to significantly influence the treatment of many issues, including substance abuse.
It’s about overall well-being. Holistic health. True change.