Dialectical Behavior Therapy (DBT)
Dialectical behavior therapy (DBT) is a type of Psychotherapy. Its main goals are to teach people how to live in the moment, develop healthy ways to cope with stress, regulate their emotions, and improve their relationships with others.
DBT was originally intended to treat borderline personality disorder (BPD), but it has been adapted to treat other mental health conditions. It can help people who have difficulty with emotional regulation or are exhibiting self-destructive behaviors (eating disorders and substance use disorders). This type of therapy is also sometimes used to treat post-traumatic stress disorder (PTSD).
DBT was the first psychotherapy shown to be effective in treating borderline personality disorder- BPD in controlled clinical trials, the most rigorous type of clinical research. DBT is considered the “gold standard” first-line treatment for borderline personality disorder.
While DBT is no longer the only therapy to have shown effectiveness in controlled trials, it has grown a large evidence base and is considered one of the best treatments for BPD in terms of documented success rates.
Research suggests that DBT is effective in reducing psychiatric hospitalization, substance use, and suicidal behavior. Participants in the study also had significant reductions in hospital stays, self-injurious behaviors, and the severity of borderline symptoms.
DBT is based on Dr. Linehan’s theory that the core problem in BPD is emotion dysregulation, which results from mixing biology, including genetic and other biological risk factors, and an emotionally unstable childhood environment, for instance where caregivers punish, trivialize, or respond erratically to the child’s expression of emotion.
Techniques
DBT has evolved to become an evidence-based psychotherapy approach that is used to treat many conditions. Techniques that are often used include:
• Group therapy where patients are taught behavioral skills by completing homework assignments and role-playing new ways of interacting with others.
• Individual therapy with a trained professional where a patient’s learned behavioral skills are adapted to their personal life challenges.
• Phone coaching in which patients can call the therapist between sessions to receive guidance on coping with a difficult situation they are currently in.
Some of the strategies and techniques that are used in DBT include:
Core Mindfulness
One important benefit of DBT is the development of mindfulness skills. Mindfulness helps you focus on the present or “live in the moment.” These skills center on learning to observe, describe, and participate in all experiences, including thoughts, sensations, emotions, and things happening externally in the environment, without judging these experiences as “good” or “bad.” These are considered core skills that are necessary in order to implement other DBT skills successfully.
For example, people with BPD may find themselves overwhelmed with emotions during an argument and may then act out on those feelings without considering the consequences. Mindfulness skills help people learn how to interpret and regulate these emotions, allowing them to step back and respond more appropriately.
Distress Tolerance
The distress tolerance skills module promotes learning ways to accept and tolerate distress without doing anything that will make the distress worse in the long run, for instance, engaging in self-harm. There are four techniques for handling a crisis:
o Distraction
o Improving the moment
o Self-soothing
o Thinking of the pros and cons of not tolerating distress
When faced with strong emotion, a person with BPD may engage in impulsive or risky behaviors in order to escape what feels like an intolerable feeling. Substance use, violence, excessive alcohol use, and other risky actions are just a few examples of behaviors someone might engage in to temporarily feel better. The problem is that these behaviors make things worse in the long-term. Distress tolerance skills allow people to learn how to better cope with such emotions and respond in ways that are more adaptive.
Interpersonal Effectiveness
Interpersonal effectiveness helps you to become more assertive in a relationship (for example, expressing your needs and be able to say “no”) while still keeping a relationship positive and healthy. You will learn to listen and communicate more effectively, deal with challenging people, and respect yourself and others.
Emotion Regulation
Emotion regulation lets you navigate powerful feelings in a more effective way. The skills you learn will help you to identify, name, and change your emotions.
When you are able to recognize and cope with intense negative emotions (for example, anger), it reduces your emotional vulnerability and helps you have more positive emotional experiences.
DBT was developed in the late 1980s by Dr. Marsha Linehan and colleagues when they discovered that cognitive-behavioral therapy (CBT) alone did not work as well as expected in patients with BPD. Dr. Linehan and her team added techniques and developed a treatment to meet the unique needs of these individuals.
DBT might be an effective treatment for:
• Attention-deficit/hyperactivity disorder (ADHD)
• Bipolar disorder
• Borderline personality disorder (BPD)
• Eating disorders (such as anorexia nervosa, binge eating disorder, and bulimia nervosa)
• Generalized anxiety disorder (GAD)
• Major depressive disorder (including treatment-resistant major depression and chronic depression)
• Non-suicidal self-injury
• Obsessive-compulsive disorder (OCD)
• Post-traumatic stress disorder (PTSD)
• Substance use disorder
• Suicidal behavior
Benefits of Dialectical Behavioral Therapy
In DBT, a patient and therapist work to resolve the apparent contradiction between self-acceptance and change to bring about positive changes in the individual in treatment. Part of this process involves offering validation, which helps people become more likely to cooperate and less likely to experience distress at the idea of change.
In practice, the therapist validates that a individual’s actions “make sense” within the context of their personal experiences without necessarily agreeing that they are the best approach to solving a problem.
Each therapeutic setting has its own structure and goals, but the characteristics of DBT can be found in group skills training, individual psychotherapy, and phone coaching.
- Acceptance and change: You’ll learn strategies to accept and tolerate your life circumstances, emotions, and yourself. You will also develop skills that can help you make positive changes in your behaviors and interactions with others.
- Behavioral: You’ll learn to analyse problems or destructive behavior patterns and replace them with more healthy and effective ones.
- Cognitive: You’ll focus on changing thoughts, beliefs, behaviors, and actions that are not effective or helpful.
- Collaboration: You’ll learn to communicate effectively and work together as a team.
- Skill sets: You’ll learn new skills to enhance your capabilities.
- Support: You’ll be encouraged to recognize your positive strengths and attributes and develop and use them.
Effectiveness
Because this approach to therapy is able to help people successfully improve their coping skills, they are able to develop effective ways to manage and express strong emotions. Researchers have also found that DBT is effective regardless of a person’s age, sex, gender identity, sexual orientation, and race/ethnicity.
For BPD: Studies have found that DBT is effective in the treatment of borderline personality disorder and at reducing suicide risk in individuals with BPD. One study found that after a year of treatment, more than 75% of people with BPD no longer met the diagnostic criteria for the condition.
For suicidal behavior: Another study found that interventions that incorporated skills training as a treatment component appeared to be more effective in reducing suicidality than DBT without skills training.
For other conditions: Most DBT research has focused on its effectiveness for people with borderline personality disorder who have thoughts of suicide and self-harm, but the method could also be a successful treatment for other mental health conditions. For example, research has found that this type of therapy also appears to be effective in the treatment of PTSD, depression, and anxiety.
Research also suggests that DBT may also be useful in the treatment of children with disruptive mood dysregulation disorder.
DBT requires a significant commitment of time. In addition to regular therapy sessions, people are also required to do “homework” to work on skills outside of the individual, group, and phone counseling sessions. This may pose a challenge for people who have difficulty keeping up with these assignments on a regular basis.
Practicing some of the skills may also be challenging for some people. At different stages of treatment, people explore traumatic experiences and emotional pain, which may be upsetting.