Dialectical Behavior Therapy (DBT)

Dialectical Behavior Therapy (DBT) is one of the most powerful therapies out there. It is an evidence-based therapy built on the principles of cognitive behavioral therapy. DBT has been very effective in the treatment of substance use and mental health challenges.

At the NuView Treatment Center, we believe in using a DBT-informed approach to break negative thinking patterns and instill life skills, positive relationships, and a meaningful life. Now, let us explore more about this therapy, and how it can facilitate your journey toward healing and recovery.

Dialectical behavior therapy (DBT) is a type of psychotherapy specifically meant to treat emotional dysregulation, relationship conflicts, and impulsive behavior. It was developed by Marsha Linehan in the 1970s for the treatment of borderline personality disorder (BPD). Since then, it has greatly expanded and is used to treat a broad spectrum of substance use disorders, mental health disorders, or a dual diagnosis of both.

DBT has four core techniques, which are as follows:

1. Mindfulness:

Just being connected to your present without judgment or resistance is known as mindfulness technique. One of the core techniques, it allows you to become aware of your thinking, emotional, and behavioral patterns. As you begin to understand them, you begin to better manage them.

Typically, mindfulness uses the following:

• Meditation
• Breathing techniques
• Grounding techniques.

2. Distress Tolerance and Management:

Often, with substance use or mental health challenges, distressing emotions and circumstances can become overwhelming. DBT teaches you the skills to manage these distressing emotions and circumstances using productive coping mechanisms. Common techniques used are:

• Accepting reality as it is.
• Reframing the negative into positive.
• Using self-soothing techniques like deep breathing or meditation.
• Distracting yourself with interests or hobbies.

3. Emotion Regulation:

Emotion regulation is when you identify and label your emotions. By recognizing your emotions, you learn to manage and control them, especially when you experience intense emotions.

Emotion regulation techniques used are:

• Decreasing negative emotions by identifying and challenging unhealthy feelings.
• Changing emotional responses by reevaluating circumstances and responding to them in a different way.
• Increasing positive emotions by engaging in positive activities, like engaging in your interests and spending time with your loved ones.

4. Interpersonal Effectiveness:

With substance use and mental health challenges, relationship conflicts are common. DBT teaches you the skills to enhance communication and maintain positive relationships.

Interpersonal effectiveness uses the following techniques:

• Open communication to effectively connect and engage with others.
• Using “I” statements to effectively communicate your emotions.
• Learning to say “No” and drawing healthy boundaries.

Dialectical behavior therapy has 4 stages:

Stage 1:

It is the beginning stage. In this stage, you address distressing and self-destructive behaviors. This can be even something as extreme as self-harm and suicidal behaviors.

Stage 2:

Next, you move your focus toward addressing the factors that affect your lives, like distress tolerance, emotion dysregulation, and interpersonal effectiveness.

Stage 3:

In the penultimate stage, DBT focuses on aspects affecting your self-esteem and interpersonal relationships.

Stage 4:

The final stage, here you will focus on facilitating a fulfilling life. You will seek to find happiness, strengthen your interpersonal relationships, and journey toward your goals.

Dialectical behavior therapy is used to treat a wide spectrum of behavioral and mental health conditions, such as:

• Borderline personality disorder (BPD)/personality disorders
• Substance use disorders
• Major depressive disorder (depression)
• Bipolar disorders
• Attention-deficit hyperactivity disorder (ADHD)
• Obsessive-compulsive disorder (OCD)
• Post-traumatic stress disorder (PTSD)
• Eating disorders
• Self-harm and suicidal behaviors.

Dialectical behavior therapy offers the following benefits:

Dialectical Thinking:

Dialectical actually means integrating opposing ideas. In dialectical thinking, you learn there is more than one way of looking at an experience or event. On the one hand, you accept your fears and anxieties; on the other hand, you recognize this and take steps to get better.

Change:

While you accept your reality, you also change your negative thinking, emotional, and behavioral patterns.

Cognitive and Behavioral Changes:

By identifying your maladaptive thinking, emotional, and behavioral patterns, DBT also enables you to reshape them into productive ones. This is very similar to cognitive behavioral therapy (CBT).

New Skills:

DBT equips you with new skills like mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness

Support and Maintenance:

You are encouraged to recognize the positive aspects to foster lasting positive changes and lead a fulfilling life.

Dialectical behavior therapy does come with certain risks, but they are pretty low-risk.

Limited Focus On Past Experiences:

Unlike psychoanalytic therapy or psychodynamic therapy, DBT does not delve into the past. This might not be beneficial for you if you are ready to focus on your present or future unless you have successfully processed your past.

Time Commitment:

DBT requires time as it is a gradual process. Moreover, you will be required to do homework assignments, which can be difficult to keep up with at times.

Focus on Skill-Building:

New skills are at the core of DBT. However, this can be overly complicated for some clients.

Religious Values:

DBT incorporates certain Eastern religious values in therapy, and some might object to the same.

Group Settings:

DBT may require some sessions to be carried out in group settings, and not all can be comfortable with it.

While there are certain risks associated with this kind of a therapy, they are minimal. With licensed and skilled therapists, these risks can also be reduced to a great extent.

The main goal of dialectical behavior therapy is to combine opposite things. On the one hand, you will come to accept yourself as you are, with all the different challenges in life. On the other hand, you will also bring change into your life by improving these challenges.

How the therapy is performed can vary from one therapist to another, but basically, it follows this structure:

• Pre-Assessment: Here, your therapist will seek to understand you by asking questions, explaining how the therapy works, and establishing whether or not it is the right one for you.
• Individual DBT: It involves one-on-one sessions between you and your therapist. It focuses on:
  • Keeping you safe from self-destructive behaviors.
  • Limiting maladaptive thinking patterns and behaviors.
  • Moving toward a healthy, fulfilling, and meaningful life.
• New Skills Training: This is done in a group setting, where you learn new skills like mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness with others on a similar journey as you.
• Phone Coaching: DBT provides ongoing support through telehealth services like phone coaching; this can range from asking for advice to managing crisis situations.

A licensed DBT therapist can be a psychologist, psychiatrist, counselor, or other mental health practitioner with advanced training in dialectical behavior therapy. Finding the right therapist can be a time-consuming task. However, we are here for you.

At NuView, our team seeks to understand you and provide you with DBT therapists who are aligned with your needs and goals.

At the same time, you can also seek referrals from trusted persons - your primary healthcare providers, family members, and friends.

How long you need dialectical behavior therapy varies depending on the severity and duration of your condition, as well as your unique needs, goals, and other personal factors. Typically, DBT can take anywhere between six months to one year. One-on-one sessions with the therapist are weekly sessions and can last up to 40 minutes each.

Yes, dialectical behavior therapy is effective. It is an evidence-based therapy and has especially been useful in the treatment of borderline personality disorder. Studies have also shown that DBT has been effective in reducing self-destructive behaviors (self-harm and suicide), hospitalization, depressive symptoms, and substance use as well.