Dialectical Behavioral Therapy
Dialectical behavioral therapy is an evidence-based type of psychotherapy that can be utilized to treat a variety of conditions. It combines approaches derived from cognitive-behavioral therapy and mindfulness therapy, alongside an emphasis on self-acceptance.
What is Dialectical Behavioral Therapy?
Dialectical behavioral therapy, often known as DBT, is designed to help people cope with difficult emotions and handle the challenges of interpersonal relationships. Dialectical behavioral therapy was originally developed to treat borderline personality disorder, but over time it has proven to be an effective treatment for a diverse amount of other mental health disorders.
Conditions that DBT can help include mood disorders, self-harm, substance use disorder, and other dangerous behavioral patterns. Dialectical behavioral therapy is an approach to talk therapy that is about developing strategies for dealing with emotional challenges and handling difficulties in relationships that often occur for people with mental illnesses.
Dialectical behavioral therapy helps people develop tools and coping strategies in four primary areas: distress tolerance, mindfulness, emotional regulation, and interpersonal effectiveness. In a sense, dialectical behavioral therapy pursues two contradictory goals: helping people to accept the emotions they experience while working simultaneously to change these emotions.
Initially, clinicians begin by helping people to accept their emotions and practice self-compassion. During the course of treatment, however, they begin to implement techniques that are designed to replace negative thought processes with less maladaptive ones.
Where does the term dialectical behavioral therapy come from? Clinicians synthesize two contradictory treatment approaches, acceptance and change, in a manner that is similar to the philosophical approach known historically as “dialectic.” The dialectical approach, which dates back to Ancient Greece, involves synthesizing opposites, known as thesis and antithesis. When they’ve been combined, the result is known as synthesis. The synthetic result is intended to be better than the sum of its parts.
Dialectical behavioral therapy is an evidence-based approach to treatment for mental health disorders. It is intended to address people’s needs in a comprehensive fashion. Despite originally being intended to help people with borderline personality disorder, it is now an important part of a wide variety of treatment programs. Dialectical behavioral therapy is a common treatment approach at most outpatient treatment centers for mental health disorders and substance use disorders.
Origins and History of Dialectical Behavioral Therapy
Technically, DBT treatment is a type of cognitive-behavioral therapy. Cognitive-behavioral therapy, sometimes known as CBT, is an umbrella term that refers to a wide variety of talk therapy approaches. Cognitive-behavioral therapy, unlike older forms of therapy that involved reflecting on the meaning of past experiences to obtain insight, is a present-focused and solutions-oriented treatment modality. CBT emphasizes the relationship between negative thoughts and dangerous behavior patterns.
By working to change people’s thinking and replacing irrational views with less maladaptive ones, CBT helps people overcome emotional distress and escape harmful behavior cycles. Dialectical behavioral therapy utilizes the principles of DBT while placing greater emphasis on emotional and social aspects of the human experience. This allows people to gain the coping tools they need to deal with unstable emotions and unhealthy interpersonal behavior patterns.
Contemporary cognitive-behavioral therapy, sometimes known as 3rd wave cognitive-behavioral therapy, is a combination of two different treatment approaches: behavioral therapy and cognitive therapy. Behavioral therapy was prevalent in the mid-20th century, and it emphasized reconditioning people’s behaviors. While effective for many kinds of neurosis, conditions like depression resisted behavioral therapy treatment.
Cognitive therapy soon emerged and became recognized as an effective tool for replacing distressing thoughts with more adaptive ones. Contemporary cognitive-behavioral therapy was born when these two approaches merged. Most current talk therapists are highly informed by the principles of CBT, which emphasize that unhealthy behaviors are expressions of maladaptive thought patterns.
Dialectical behavioral therapy, a variation of cognitive-behavioral therapy, was developed in the late 1980s by Marsha M. Linehan. Linehan, a trained psychologist and researcher at The University of Washington, had suffered from mental illness herself for many years. Her symptoms of self-judgment, alienation, and self-harm had gotten so severe that she had even been hospitalized several times.
Linehan originally developed dialectical behavioral therapy as a way to treat her own struggles. Linehan subsequently used dialectical behavioral therapy to treat people with borderline personality disorder and individuals experiencing suicidal ideation, but it quickly became apparent that DBT was effective for many people and a variety of conditions.
Types of Dialectical Behavioral Therapy
People who are interested in receiving dialectical behavioral therapy can do so in a number of ways. The skills and coping tools that dialectical behavioral therapy helps people develop can be taught in a systematic way through a variety of different approaches. Treatment modalities that offer dialectical behavioral therapy include:
- Individual therapy. Individual therapy is the most common treatment modality for dialectical behavioral therapy. During individual therapy, DBT practitioners help their clients identify maladaptive thoughts and behaviors. Therapists help their clients accept their emotional distress while developing strategies to better cope with it.
- Group therapy. DBT group therapy is a type of therapy during which multiple clients work together to develop essential skills and coping tools. These skills include distress tolerance, mindfulness, and interpersonal communication techniques. Working together in a group has therapeutic benefits that are unique to group therapy, in part because people can see their own problems through other perspectives.
- Phone-coaching. Dialectical behavioral therapy that occurs over the phone offers people who live in remote areas or people with disabilities an opportunity to recover. Phone coaching is also an effective tool for crisis situations. It is often implemented alongside in-person dialectical behavioral therapy so that people experiencing suicidal ideation can have additional means of support. Today phone-coaching is offered through online video communication platforms as well.
DBT consultation teams. DBT consultation teams were originally developed so that dialectical behavioral therapists could avoid burn-out. DBT can be an intense and emotionally draining practice even for therapists. DBT consultation teams are groups of dialectical behavioral therapy clinicians who practice alongside each other. Working together, they are able to strengthen each other’s skills and synthesize their unique perspectives. DBT consultation teams can be especially effective for patients who are at a high risk of self-harm or experiencing excruciating emotional pain.
How Dialectical Behavioral Therapy Works?
During dialectical behavioral therapy (DBT), the clinician will initially work with their client to help them learn to accept their thoughts and feelings as they are. As such, the foundational core of dialectical behavioral therapy is this principle of acceptance. During the initial sessions of DBT, clients explore their thoughts, emotions, and behavior patterns.
The clinician’s goal is to help their client discuss these issues in a nonjudgmental way. Clients are encouraged to focus on one thought or emotion at a time so that they can break it down and analyze it fully. Learning to articulate and verbalize thoughts and emotions in a clear, accepting, and nonjudgmental manner is a crucial first step in DBT treatment.
During the course of dialectical behavioral therapy, clients learn distress tolerance skills. The focus is not on eliminating emotional distress entirely, but rather accepting it and learning to handle it in healthier ways. By avoiding impulsive or automatic reactions to distressing situations, patients can prevent their conditions from worsening and improve their lives. To that end, DBT clinicians help their clients develop emotional regulation skills.
Emotional regulation techniques are intended to help individuals recognize, accept, and handle their emotions in ways that are productive and safe. Interpersonal skills are also emphasized so that patients can learn to assert themselves, avoid conflict, and navigate potentially distressing social interactions. As such, dialectical behavioral therapy provides people with the tools they need to handle their own subjective states and exist in harmony with other people.
Dialectical Behavioral Therapy Techniques/Practices
Dialectical behavioral therapy addresses clients’ emotional distress from four angles simultaneously. These four aspects of dialectical behavioral therapy are sometimes known as the four modules of DBT. The four modules are mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness. Each module helps people build a set of skills in that area. When these skills are applied together, people can function better in their lives while avoiding dangerous emotions and behaviors. Each DBT session is designed to teach and reinforce skills from all four modules.
Mindfulness techniques help clients center themselves in the present. Regulating attention and limiting it to the present helps clients respond appropriately to their current circumstances without letting past experiencing or automatic reactions interfere. Clinicians encourage their clients to pay attention to their thoughts and feelings in the present moment, to describe them without judgment, and accept themselves as they are. The mindfulness techniques taught in dialectical behavioral therapy are derived from religious practices like Buddhism, but they are secular and evidence-based.
Dialectical behavioral therapy is unique in its focus on tolerating emotional distress. While many therapeutic approaches emphasize changing distressing situations, DBT instead offers people the tools they need to accept and live with pain. Clients are taught to recognize that life inevitably features distressing situations. Learning to accept and find meaning in these situations is crucial. During DBT treatment, clients learn tools to handle these distressing situations skillfully. These techniques include self-soothing strategies and weighing the pros and cons of a course of action.
People with borderline personality disorder and other mental health conditions frequently experience intense and unstable emotions. DBT teaches emotional regulation techniques so that people can more effectively recognize and work through their intense emotions. Dialectical behavioral therapy operates on the theory that people experience intense emotions as a conditioned response to difficult experiences. The emotional regulation skills that DBT teaches help clients become less emotionally volatile and experience more positive emotions. These techniques include:
- Identifying and labeling emotions
- Recognizing obstacles to changing emotions
- Reacting rationally rather than prioritizing the “emotion mind”
- Emphasizing positive emotions over negative ones
- Taking “opposite action” rather than reacting automatically
- Accepting and letting go of negative emotions
- Applying mindfulness and distress tolerance techniques
An important aspect of dialectical behavioral therapy is helping clients learn to live and work effectively with other people. Individuals with mental illness often struggle just as much around other people as they do in their own heads. As such, DBT teaches interpersonal skills that involve problem-solving, saying no, being assertive, and avoiding conflict.
What to Expect During Dialectical Behavioral Therapy
It is normal to be somewhat uncertain or anxious before beginning dialectical behavior therapy. However, it is important to understand that DBT treatment is designed to make things as easy and smooth as possible for clients. DBT therapy begins with an initial evaluation during which the therapist and client will have an opportunity to get to know each other and ask necessary questions.
Therapists practicing DBT strive to have their patients view them as allies rather than adversaries during the course of treatment. Dialectical behavioral therapists recognize that one of the main factors behind many people’s emotional distress is that they were raised in invalidating environments.
For this reason, dialectical behavioral therapists emphasize love, kindness, and acceptance, to build a therapeutic alliance. An important aspect of building this therapeutic alliance, however, is helping patients recognize their own emotional dysfunction and making a commitment to treatment.
The first few sessions of dialectical behavioral therapy emphasize the two contradictory poles of the dialectic: acceptance and change. Clinicians begin by introducing the notion of “radical acceptance,” the idea that every emotion or thought, however distressing or destructive, can be approached in a nonjudgmental and accepting light. Once this notion of radical acceptance has been explored, clinicians begin complementing it with techniques that are designed to alter destructive emotions. Dialectical behavioral therapy pursues emotional change in five stages:
- Precontemplation. During this stage, a patient only has a dim awareness of their problem.
- Contemplation. During contemplation, the patient identifies their problem.
- Preparation. During the preparation stage, a patient prepares to implement changes and move forward. This might mean researching or exploring options.
- Action. During the action stage, the patient takes concrete steps to change their emotional state and receives treatment.
- Maintenance. The maintenance stage involves planning for relapses and reinforcing the skills of prior stages.
Dialectical behavioral therapy often occurs on a weekly basis, though some outpatient treatment centers offer it more frequently. Clients work with one or more trained clinicians during the course of treatment. DBT treatment often takes the form of one-on-one individualized therapy, but it is also offered via group therapy.
It is also frequently offered in both forms simultaneously, so that patients can experience the unique benefits of the group dynamic while also making progress on their own issues. Clients engaged in individual therapy explore their own emotions and behaviors in considerable detail, while group therapy allows them to share their thoughts and learn from the experiences of others.
Dialectical behavioral therapy sessions often end with a homework assignment. Dialectical behavioral therapy worksheets and assignments can help reinforce the themes of the in-person session, and they provide a springboard for discussion at the next meeting.
Goals and Benefits of Dialectical Behavioral Therapy
Dialectical behavioral therapy is a goal-directed therapy that is designed to provide clients with concrete skills that they can implement in their lives. It was originally developed to help people with borderline personality disorder deal with their intense emotions and handle social situations. However, DBT’s emphasis on self-acceptance and change has been found to have a range of benefits for people suffering from a wide range of conditions.
Most mental health conditions cause people to experience unstable emotions and have destructive or unhealthy reactions to distressing situations. The goal of dialectical behavioral therapy is to help people self-regulate their emotions, replace automatic reactions with productive responses, and handle themselves in social situations.
Dialectical behavioral therapy can reduce the symptoms of most major mental health conditions, including substance use disorders. However, its many benefits extend to anyone experiencing emotional distress. Benefits of DBT include:
- Decreasing maladaptive responses to stressful situations
- Improving social connections to other people
- Increasing personal assertiveness
- Decreasing loneliness and feelings of alienation
- Lessening the impact of overwhelming emotions
- Decreasing destructive behaviors
- Increasing confidence and self-esteem
- Strengthening feelings of motivation
Ultimately, dialectical behavioral therapy is designed to help people live their lives more effectively in the present moment. It emphasizes problem-solving and concrete improvements. As such, dialectical behavioral therapy is a treatment approach that comprehensively addresses every aspect of a patient’s life and improves its overall quality.
Effectiveness of Dialectical Behavioral Therapy
DBT has been shown to be effective at treating a wide range of conditions, including self-harming, suicidal ideation, depression, emotional dysregulation, anxiety, and anger. Dialectical behavioral therapy not only reduces the symptomatology of these mental health conditions, it allows people to function better overall in their lives. A large body of research supports the efficacy of DBT treatment.
It was initially studied as a treatment for borderline personality disorder, for which it is considered the most effective treatment. Studies comparing general psychiatric management with DBT have demonstrated that DBT treatment results in fewer incidents of self-harming, fewer hospitalizations, and overall higher quality of life for patients compared to other treatment methods.
The effectiveness of DBT is likely due to the fact that it addresses the underlying issues behind mental health disorders while also working to provide patients with the coping skills they need to function effectively in everyday life. Even after DBT treatment has finished, individuals can continue to implement healthy coping strategies, accept their emotional distress, and replace automatic reactions with adaptive behaviors.
Dialectical Behavioral Therapy in Mental Health and Addiction Treatment
Dialectical behavioral therapy is one of many frequently utilized treatment modalities at outpatient treatment centers. Individuals suffering from mental health disorders as well as substance use disorders can benefit from DBT’s focus on acceptance and change. In fact, dialectical behavioral therapy has been demonstrated to be more effective than antidepressants for the majority of people. One study compared two groups of people: individuals taking an SSRi for depression, and individuals taking an SSRI while receiving dialectical behavioral therapy. The latter group was found to have significantly reduced symptomatology at follow-up compared to the control group.
Mental health conditions for which DBT can be helpful include:
- Major depression
- Anxiety disorder
- Eating disorders, including bulimia and anorexia nervosa
- Attention-deficit hyperactivity disorder (ADHD)
- Sleep disorders, including insomnia
- Postpartum depression
- Anger management disorders
- Bipolar disorder
- Personality disorders
- Obsessive-compulsive disorder
- Post-traumatic stress disorder
- Schizophrenia and psychotic episodes
- Substance use disorders
People suffering from substance use disorders in particular can benefit from dialectical behavioral therapy. Dialectical behavioral therapy is a type of behavioral intervention that can help people suffering from all types of substance use disorders control their substance abuse-related behaviors. It does this by giving them the tools they need to manage not only their cravings, but their automatic reactions to such cravings. By providing individuals with strategies for averting automatic reactions, clinicians can help them choose whether or not to use drugs or alcohol.
Dialectical behavioral therapy emphasizes that it is possible to live in discomfort and handle emotional distress. As such, dialectical behavioral therapy can allow people to live with cravings without necessarily being controlled by them. DBT is therefore an essential tool for both quitting drugs and alcohol, and it helps people remain sober over the long term.
Dialectical behavioral therapy has other benefits for people suffering from addiction that go well beyond helping them remain physically abstinent. The period of early addiction recovery is generally characterized by considerable distress. For most people with addictions, drugs and alcohol actually provide relief from emotional pain — psychoactive substances are used, in that sense, as tools.
When people take away these tools by getting sober, they are often left facing emotional pains that, for the first time, are no longer dulled. Dialectical behavioral therapy provides people in early recovery with a new set of tools, enabling them to accept and change their thoughts, emotions, and habitual behaviors.
Dialectical behavioral therapy also helps people with addictions change their approach to interpersonal relationships. It teaches people how to say no, to assert themselves, and to express their own emotions in a community without creating conflict.
Building strong and healthy social connections is an essential component of maintaining sobriety. Research has shown that individuals with strong social support systems, especially strong sober social support networks, are not only more likely to seek treatment, they are more likely to remain sober in the years subsequent to treatment.
Finding Dialectical Behavioral Therapy Near Me
For anyone suffering from a mental health disorder, an addiction, or any kind of emotional distress, dialectical behavioral therapy is a highly effective tool. It is also widely available at outpatient treatment centers in Los Angeles. Sadly, the vast majority of people suffering from these conditions rarely seek help. Among people with substance use disorders, a measly 11% ever seek outside help for their condition.
A high proportion of individuals with addictions spend years trying to control and manage their substance abuse habits on their own. Unfortunately, left to their own devices, most people are unable to do so for long, since addictions alter people’s abilities to make decisions.
Without seeking treatment, most people find that their addictions and comorbid mental health conditions get progressively worse, endangering their livelihoods, social relations, and health. For people using dangerous drugs or engaging in high-risk behaviors as a result of their substance abuse, getting sober through outside help is a matter of life and death.
Another reason that so few people seek treatment is that many sufferers are reluctant to admit that they are suffering from a mental health condition in the first place. Dialectical behavioral therapy is the ideal tool for these individuals, because this type of therapy is fundamentally about helping people accept themselves exactly as they are. In the process, they learn to cope with their feelings and develop new approaches to living.
DBT Recovery Center in Los Angeles
NuView Treatment Center, an outpatient treatment center located in West Los Angeles, provides dialectical behavioral therapy for people who suffer from a wide range of conditions, ranging from substance use disorders to mental illnesses. Our dedicated clinicians and staff have extensive experience in helping people get sober and develop the tools they need to manage emotional distress.
Our dialectical behavioral clinicians are specifically trained in the techniques necessary for maintaining sobriety and rebuilding ones life. Obtaining DBT treatment at NuView Treatment Center can help people get sober, stay sober, and begin to experience the relief of recovery. A new life and a new way of seeing the world is possible. Reach out today if you’re ready to make a change.