Dialectical Behavior Therapy (DBT)

Dialectical Behavior Therapy (DBT)

Introduction

Around the world, mental health has become one of the most worrisome issues. According to the recent stats by NCBI (2017), around 7.4% of US citizens have major depression, 2.8% have bipolar disorder, and 1.7% have been diagnosed with borderline personality disorder.1 There are therapies are to reduce the severity of symptoms in patients. Dialectical behavior therapy (DBT) is a relatively new but one of the most efficient treatments for many psychological issues.

What is Dialectical Behavior Therapy (DBT)?

Dialectical behavior therapy is one type of therapy treatment for psychological illnesses. It is a fully comprehensive approach that deals with thoughts, emotions, and behaviors of people. The major aspects of DBT include acceptance and conflict solving for any kind of problematic issue.

It is mostly concerned with creating a balance between conflicted thought patterns and opposite forces. This is where its name “dialectical” comes in. DBT helps a patient accept the problem and then provides opposite alternatives to help that patient. So, a major part of this type of therapy includes acceptance and change.2

What is Dialectical Behavior Therapy Used to Treat?

Dialectical behavior therapy (DBT) is best for treating and managing the following disorders:

Borderline personality disorder

Addiction/substance use disorders

Bipolar disorder 

Depression

Anxiety

Emotional distress 

Origins of Dialectical Behavior Therapy 

Dialectical behavior therapy (DBT) was established by Marsha Linehan, who is the founder and senior practitioner. It was founded in the late 80s to deal with borderline personality disorder. At that time, Linehan was going through depression and had been diagnosed with borderline personality disorder. She came up with the concept in order to help other people going through the issue in a much better way.

Three Major Concepts of Dialectical Behavior Therapy

Dialectical behavior therapy works on three major concepts:

Change is inevitable in nature

Conflicts arise in life all the time

Many things in life are interconnected either with our emotions or thought process

There are three major components of dialectical behavior therapy  that help the therapist and client to build up a good therapeutic relationship. These include the following:

Dialectical Behavior Therapy is Support-Oriented

Dialectical behavior therapy (DBT) aims to support the needs of the client. The client and therapist work as a team to work towards fixing the problem that the client wants to work on. It helps the client to make sense of themselves and the world around them.

Dialectical Behavior Therapy is Collaborative

Dialectical behavior therapy (DBT) is collaborative in the best possible nature as it requires several relationships when coming to therapy. It requires a relationship between the therapist and client, along with a set of additional professionals who deal with other issues the client has.
It usually entails working with psychiatrists, social workers, and support staff in addition to the therapist. Dialectical behavior therapy also requires the completion of homework assignments and tasks to achieve the goals set at the start of therapy. The therapist guides the patient to put is all together and learn the skills needed to manage the patient’s conditions.

DBT is a Cognitive-Based Approach

A major chunk of dialectical behavior therapy is about working on one’s thoughts. Negative thoughts that hurt a patient need to be looked at and corrected. The techniques in DBT help people have control over their emotions and thoughts.3

Steps in Dialectical Behavior Therapy

Dialectical behavior therapy includes two steps in most cases:

Individual Therapy 

Weekly Group Therapy Sessions

Individual Therapy

Individual therapy is one of the most important aspects of dialectical behavior therapy. At the start, the therapist works on building a collaboration with the client to make the therapeutic process work better. Every session with the therapist is based on an agenda. At times, the session is divided into three parts, namely:

First 10 minutes for previous homework and progress discussion 

25 minutes for the current agenda discussion

10 minutes for overview and any other discussion 

Severe symptoms such as suicidal ideation, self-injury, and other self-harming behaviors are given priority during treatment. These symptoms which can lead to injury and death must be addressed before working on the less severe symptoms.

The relationship built at the beginning of the process helps with every future step. So, the trust developed between the therapist and client helps address the problems and improve the quality of the patient’s life.

Weekly Group Therapy Sessions

One of the reasons dialectical behavior therapy (DBT) is gaining so much praise is its inclusion of group therapy. DBT focuses collaborating with a group so that all group members can help the others. The group therapy sessions are mostly 1 to 1.5-hour sessions which are led by a therapist with training in DBT. Here, people learn skills from the four modules of dialectical behavior therapy, namely:

Mindfulness

Interpersonal Effectiveness

Distress Tolerance

Emotional Regulation

Dialectical Behavior Therapy Myths Debunked

Myth: It Treats the Problem too Slowly
Dialectical behavior therapy is considered as a fast-paced and efficient therapy. It usually goes on for 8-12 sessions depending on the case in consideration.

Myth: It is Hard for a Patient to Learn the Skills
It is a common misconception that dialectical behavior therapy only works those well-versed in therapy approaches.

This is not true, as DBT is an easy approach which is also collaboration-based, meaning the therapist is always there to provide clarification for all concepts.

Four Modules of Dialectical Behavior Therapy

Mindfulness

Mindfulness skills are the most important part that patients are taught in the therapeutic process of dialectical behavior management. Mindfulness generally means acknowledging your thoughts and getting to know what kind of thoughts you are having most of the time. It also means analyzing one’s thoughts without any sort of judgment.

Interpersonal Effectiveness

Interpersonal effectiveness in dialectical behavior therapy (DBT) focuses on the interpersonal skills of people. At times when people are distressed, they tend to avoid socialization, and their personal relationships are also affected. The interpersonal effectiveness skills in dialectical behavior therapy help the person improve his relationships. Clients are encouraged to work on important relationships that can help the client’s therapy and improve his life. Many people are taught assertiveness and problem-solving strategies for personal issues.

There are many people with borderline personality disorder and bipolar disorder who are good at socialization. However, they might not be good at using their interpersonal skills when needed. Many of these people are either too blunt or at times not very assertive, causing them emotional turmoil. Thus, interpersonal skills focusing on those situations and are taught one by one in this module.4

One of the techniques in this module is the DEAR MAN rule:

Describe

Explain

Assert

Reinforce

Mindful

Appear Confident

Negotiate

Distress Tolerance

Distress tolerance is another important module of dialectical behavior therapy (DBT), which moves a person forward with therapy. A client feels distressed due to the emotional turmoil that they face in life. Distress tolerance teaches skills of understanding and acknowledging the distress along with its associated thoughts.

This technique helps the client to validate the distress in a non-threatening and non-judgmental way. The core concept behind this module is that a person will be able to deal with their distress only when they will be able to see it clearly, without judgment.

One of the techniques of distress tolerance include TIPP:

Temperature

Intense Physical Sensation

Paced Breathing

Paired Muscle Relaxation

Emotion Regulation

People who have emotional issues such those with borderline personality disorder, suicidal ideation or depression have a lot of misplaced emotions at times. They might be really frustrated, really sad, anxious, or angry. Dialectical behavior therapy (DBT) in the fourth module helps with regulating emotions. DBT helps by acknowledging emotions and then figuring out how to channel the emotions in a healthy way. 

The goals of emotional regulation include:

  • Identification, labeling, and understanding of emotions
  • Decrease in unwanted emotions
  • Decrease in emotional vulnerability

Emotional regulation skills include the following:

  • Identification and labeling of one's emotions
  • Being mindful of emotions
  • Seeing the facts of emotional responses
  • Behavior analysis of a person
  • Problem solving
  • Respect towards emotions
  • Management of extreme emotions

Dialectical Behavior Therapy is Effective Treatment

According to NCBI (2010), dialectical behavior therapy (DBT) has had promising findings in terms of treatment for bipolar disorder, borderline personality disorder, and addiction.

DBT paired with cognitive behavior therapy (CBT) was found to be 43% more efficient than other popular treatments. Studies have shown that having a couple of dialectical behavior therapy sessions and group therapy increases the recovery rate by 7.5% in patients with borderline personality disorder.

DBT combined with CBT was found to be 43% more efficient than other treatments
43%

The dropout rate for borderline personality disorder patients using DBT is 24.8%, which is less than any other therapy protocol.

Dialectical behavior therapy is effective treatment for several mental health issues. Addiction is one area where dialectical behavior therapy has proven to be extremely useful. If you are facing recovery from addiction, DBT may be a good choice for you.