Dialectical behavioral therapy (DBT) is a derivative of cognitive-behavioral therapy (CBT). CBT is centered on identifying and changing negative thinking patterns and instead encouraging positive behavioral changes.
The term ‘dialectical’ is deduced from the idea that bringing together two opposite concepts in therapy, acceptance, and change, brings about greater results than either one alone. (Linehan, M.M., 1987)
What Can DBT Help With?
This approach to therapy can help people successfully improve their emotional and mental coping skills and develop effective ways to manage and express intense emotions in a healthy way.
Originally DBT was used to treat symptoms of borderline personality disorder, but it has been adapted to treat other mental health conditions, including:
- Major depressive disorder
- Anxiety disorders (PTSD, GAD, OCD, Panic attack disorder)
- Eating disorders (such as anorexia nervosa, bulimia nervosa, compulsive overeating, and binge eating disorder)
- Bipolar disorder
- Self-destructive/harming behaviors or suicidal ideations
- Substance use disorders
- Extreme emotional/mood distortion (Rizvi, S.L., Steffel, L.M. and Carson-Wong, A., 2013)
How Does DBT Work? Techniques And Modules
DBT has evolved to become an extensively used, evidence-based psychotherapeutic approach to treat several mental health conditions. DBT is often used in various settings such as:
- Individual therapy with a trained professional where a patient’s learned behavioral skills during the course of their therapy sessions is adapted to their personal life challenges.
- Group therapy where patients are taught behavioral skills in group settings.
- Phone coaching wherein patients can call the DBT therapist outside sessions to receive guidance on coping with a distressing situation they might currently be in.
As mentioned above, DBT is based on cognitive behavior therapy, wherein you identify goals that are important to you and overcome the obstacles that prevent you from achieving those goals. You learn skills and techniques to change unhelpful thoughts, emotions, and behaviors.
The same applies to DBT, which is a highly structured treatment that teaches critical skills with the help of these four modules:
1. Core Mindfulness
This skill is considered the foundation of DBT; a patient will not be taught any other skillsets within their sessions until they fully learn how to be a mindful person.
Mindfulness helps you focus on the present and live in the moment. This helps you pay attention to your somatic reactions (your thoughts, feelings, as well as impulses) while also using your bodily senses to tune in to what’s happening all around you (what you see, hear, smell, and touch or any other sensations) in a non-judgmental approach.
An individual will eventually learn to accept all situations, no matter how intense or overwhelming their emotions may become. The strategy can also help you remain calm and avoid engaging in impulsive behavior and automatic negative thought patterns.
2. Distress Tolerance
Within the sessions of distress tolerance, an individual will develop the ability to accept and change. An elemental factor of learning acceptance is first to grasp the concept of radical acceptance.
Radical acceptance will allow you to embrace the idea that you will face both positive as well as negative situations in life. You will then learn how to view situations without being judgmental and learn how to accept whatever the outcome may be, thus preventing self-harming or impulsive behavior.
This skill set heavily incorporates the first skill mentioned, mindfulness. You will further discover four primary techniques within this class that will help you handle any situation or crisis:
- Distracting yourself
- Thinking of the pros and cons of the situation
- Improving the stressful situation
3. Interpersonal Effectiveness
Interpersonal effectiveness will encourage you to become more assertive in relationships (for instance, expressing your actual needs and ability to say “no”) while still maintaining a positive and healthy relationship. You will learn to listen and communicate more efficiently, deal with challenging people or situations while respecting yourself and others.
4. Emotional Regulation
Emotion regulation lets you navigate and comprehend powerful feelings efficiently. The skills you learn here will help you identify, name, and alter your emotions.
When you are able to identify and cope with intense negative emotions (such as anger, frustration, or guilt), it reduces your emotional vulnerability and helps you have more positive emotional responses and experiences.
Sample Exercise: Opposite Action
Understand how you’re feeling and do the opposite. For example, if you feel depressed and want to withdraw from family or friends, make plans to go out and see your loved ones.
Stages And Goals In DBT
DBT therapy is designed to systematically and comprehensively treat issues depending on the severity. Since DBT therapy was initially intended for people with borderline behavioral and emotional problems, treatment progresses in stages. This ensures all concerns are gradually addressed. DBT adheres to the following four stages:
Stage 1: The goal of this stage is stabilization. Individuals in therapy may be dealing with serious issues such as addiction, self-harm, or suicidal thoughts. They often report feeling like they are stuck at an all-time low point in their lives. Therapy is typically centered on safety and crisis intervention aiming to help people achieve control over distressing emotions/behaviors.
Stage 2: The goal of this stage is for individuals in treatment to fully experience and comprehend their emotions instead of silencing or burying them. Here, behaviors become more stable, but mental health issues may still be present. Deep emotional pain is brought to the surface, and traumatic experiences are safely explored.
Stage 3: This stage focuses on enhancing the quality of life through realistic goal-setting and progress maintenance. The goal of this stage is to promote happiness, contentment, and stability.
Stage 4: In this stage, therapists support their patients in advancing their lives to a better phase. People may improve on learned skills or work toward emotion and spiritual fulfillment. This stage aims to help people achieve and maintain an ongoing capacity for happiness and well-being.
Advantages of DBT
The abilities aren't just for people with mental illnesses
DBT's goal is to improve the symptoms of persons with mental disorders, but it doesn't stop there. The techniques taught by a DBT therapist can be used in a variety of situations.
Mindfulness, for example, has been linked to a variety of different elements of health and well-being in studies. Once you've mastered this talent, you'll be able to use it in a variety of situations, including work, home, and play.
It Makes Your Relationships Better
When coping with mental health issues, having a strong support system is essential. Many forms of treatment ignore this, expecting you to figure it out on your own.
However, DBT emphasizes the importance of our social ties in overcoming obstacles. Healthy relationships, characterized by respected boundaries and trust, can benefit one's health and well-being in a variety of ways.
It enhances one's quality of life
One of the main focuses of DBT is to improve the quality of life. The truth is, we can’t always change what happens to us. For some, mental health challenges will be a part of life forever — and acceptance of this fact is, therefore, key to moving forward.
DBT aims to improve quality of life by gently helping people make changes to move them in the right direction, whilst simultaneously letting them know it’s okay to find things difficult.
For those experiencing intense and disruptive emotions, quality of life can be impacted quite severely. Here, the distress tolerance and emotion regulation modules really come into their own.
Things To Consider
You cannot expect instant results as progress with DBT is gradual and requires a significant commitment of time and self-improvement.
In addition to regular therapy sessions, patients are also required to do homework to work on skills outside of their therapy sessions.
DBT therapy may also be extremely challenging and emotionally triggering for some people as they begin to explore their traumatic experiences and emotional pain.
How to Begin Dialectical Behavior Therapy (DBT)
The best approach to determine if DBT is suited for you is to speak with a DBT-trained therapist. To assess if DBT is a suitable fit for you, they'll look at your symptoms, treatment history, and therapeutic objectives.
If you or a loved one thinks DBT may help, speak with a healthcare physician or mental health professional who has been trained in the technique. However, finding DBT therapists isn't always straightforward.
Look for These Qualities in a Dialectical Behavior Therapist
Effective therapy, including group skills training, according to DBT, must pay as much attention to the behavior and experience of clinicians working with clients as it does to the behavior and experience of the clients. As a result, every DBT program should include therapy for the providers, and therapists should practice the skills themselves.
Basic behavior therapy approaches and DBT treatment strategies are required. Look for a therapist who has had specific training and experience in DBT. A non-profit organization called the Linehan Board of Certification has set certification requirements for therapists. Furthermore, it is critical to locate a therapist with whom you feel at ease.
The Bottom Line
We understand that the first step is always the hardest, but we encourage you to get in contact with a specialist if you feel you or your loved one may benefit from CBT treatment and get the help needed.