Dialectical Behavior Therapy (DBT)

Introduction

Dialectical Behavior Therapy (DBT) is an evidence-based psychotherapy. It is based on cognitive behavioral therapy, however, it is typically geared toward those who can find it difficult to regulate emotions and engage in self-destructive behaviors.

The word “Dialectical” means integrating opposing ideas. The underlying concept of DBT is to teach clients to accept the reality of their thinking patterns and behaviors and change them to lead healthier and happier lives.

DBT was developed in the 1970s by Marsha Linehan, and she originally intended it for the treatment of Borderline Personality Disorder (BPD). Since then, DBT has been adapted to treat other mental health conditions as well. 

What Is Dialectical Behavior Therapy (DBT)?

Dialectical behavior therapy is psychotherapy or talk therapy. It is a different version of cognitive behavioral therapy and is an evidence-based practice. It can be used as individual therapy, group therapy, and even in phone coaching.

Originally, it was used in treating borderline personality disorder, as it enables clients who experience intense emotions and engage in self-destructive behaviors to lead healthier and fulfilling lives. Now, it is adapted to treat a wide range of mental health conditions.

DBT has 4 core techniques, which are as follows:

• Mindfulness – Mindfulness is an important skill that clients develop during DBT. It teaches living in the present moment and paying attention to thinking patterns and emotional responses. It also teaches how to use the senses and become more aware of the surrounding environment, and events, and interpret these things in an empathetic way.
• Interpersonal Effectiveness – It follows mindfulness and focuses on how to interact with others in life positively. It involves communicating clearly, learning to say no, focusing on how to communicate feelings without losing any self-worth, and letting go of any hostile feelings.
• Distress Tolerance and Management – By learning how to effectively tolerate distress, clients learn how to manage and deal with any crises in their lives. It involves figuring out the positives and negatives of the distressing circumstances, improving these distressing circumstances, learning how to distract oneself from these distressing circumstances, and learning self-soothing techniques.
• Emotional Regulation – Emotional regulation is usually kept for the last. It involves learning how to manage and control emotions, especially when they are felt intensely. In cases of anxiety, depression, anger, or frustration, this can be an extremely useful skill to possess

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What Are The 4 Stages Of Dialectical Behavior Therapy?

When it comes to treatment, dialectical behavior therapy has 4 stages:

Stage 1 – It is the beginning stage, and in this stage, the most distressing and self-destructive behaviors are addressed. These can even involve something as extreme as self-injury and suicidal behaviors.

Stage 2 – Next, DBT moves its focus toward addressing the factors that affect clients’ lives, like their interpersonal effectiveness, distress tolerance, and emotional regulation.

Stage 3 – In the penultimate stage, DBT focuses on aspects affecting the client’s self-esteem and interpersonal relationships.

Stage 4 – The final stage, here DBT’s focus is to facilitate clients to lead fulfilling lives. This involves finding happiness, strengthening interpersonal relationships, and journeying toward the goals in life.

What Is Dialectical Behavior Therapy (DBT) Used For?

Dialectical behavior therapy is used to treat a wide range of mental health conditions, including:

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

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Benefits Of Dialectical Behavior Therapy

Dialectical behavior therapy is an evidence-based therapy, for borderline personality disorder and beyond. It has many benefits, including:

• Acceptance – 

DBT helps clients accept the reality of their thinking patterns, beliefs, and behaviors and approach them with a sense of understanding and compassion.

• Change – 

While accepting the reality is important, it is only a part of DBT. DBT also helps clients change negative thinking patterns, beliefs, and behaviors.

• Cognitive and Behavioral Changes –

By analyzing maladaptive thinking, emotional, and behavioral patterns, DBT helps clients reshape them into healthier and productive ones.

• New Skills – 

DBT equips clients with new skills like core mindfulness, interpersonal effectiveness, distress tolerance, and emotional regulation.

• Support and Maintenance – 

Clients are encouraged to recognize the positive aspects of lives and build on them to foster long-lasting change and lead fulfilling lives.

Risks Of Dialectical Behavior Therapy (DBT)?

Dialectical behavior therapy is evidence-based, however, it may not be everyone’s cup of tea. It may 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 clients who are not ready to focus on the present and future unless they have processed the past, especially in cases of past trauma.

Time Commitment – 

DBT requires commitment and time, and progress is gradual. Moreover, clients are also required to do homework assignments, which can be difficult to keep up with at times. This can lead clients to drop out.

Focus on Skill-Building – 

Equipping clients with new skills is an integral aspect of DBT. However, this can be overly complicated for some clients.

Religious Values – 

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

Group Settings – 

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

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

How Does DBT Work?

The main goal of dialectical behavior therapy is to combine opposite things. On one hand, it gets clients to accept themselves as they are, with all the different challenges in life. On the other hand, it also brings change into life by improving these challenges.

How DBT is performed can vary from one therapist to another, but basically, it follows this structure –

• Pre-Assessment – Here, therapists seek to understand the client by asking questions, explaining how the therapy works, and establishing whether or not it is the right one for them.
• Individual DBT – It involves one-on-one sessions between the client and therapist, and focuses on keeping the client safe from self-destructive behaviors, limiting maladaptive thinking patterns and behaviors and replacing them, and moving toward a healthy, fulfilling, and meaningful life.
• New Skills Training – This is done in a group setting, and clients are taught new skills like core mindfulness, interpersonal effectiveness, distress tolerance, and emotional regulation.
• Phone Coaching – DBT provides ongoing support to clients through phone coaching; this can range from asking for advice to managing crisis situations.

How to Find a DBT Therapist?

A licensed DBT therapist can be a psychologist, psychiatrist, or social worker with advanced training in dialectical behavior therapy. Finding the right therapist can be a time-consuming task. At Nuview Treatment Center, our medical and clinical team is committed to providing clients with DBT therapists on their journey toward achieving balance and healing.

We take time to assess every client, their unique circumstances, needs, and goals, and find the best way forward with the right DBT therapist.

At the same time, we also encourage clients to ask questions and refer to trusted persons – family members, friends, or a primary healthcare provider.

How Long Do You Need Dialectical Behavior Therapy?

How long might dialectical behavior therapy be needed is something that varies from one client to another, depending on the severity of the problems, personality, needs, and goals. Typically, DBT can take anywhere between 6 months to 1 year. One-on-one sessions with the therapist are weekly sessions, and can last up to 40 minutes each. Progress is gradual, and overnight changes are impossible. Therefore, patience is something that is required with DBT.

Is Dialectical Behavior Therapy (DBT) Effective?

Yes, dialectical behavior therapy is effective. It is evidence-based 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-injury and suicide), hospitalization, improved depressive symptoms, and reduced substance use.

However, it is also important to note that DBT may not be helpful for all. So, the key is choosing the best therapy depending on personality, conditions, needs, and desires.