In this blog, we will define Dialectical Behavior Therapy and understand its theoretical framework, goals, and stages. We will then explore the DBT modules and answer the question ‘What are the benefits of Dialectical Behaviour Therapy?’ We will also discuss where it is predominantly used and outline some of its limitations and criticisms.
Dialectical Behaviour Therapy techniques:
The techniques used in Dialectical Behavior Therapy are:
- Interpersonal effectiveness
- Emotional regulation
- Distress tolerance
These skills are taught in;
- Individual therapy
- Group skills training
- Phone coaching, and
- Consultation teams
What is Dialectical Behavior Therapy?
Dialectical Behavior Therapy (DBT) is full-fledged cognitive-behavioral therapy (CBT). Marsha Linehan, Ph.D., a cognitive-behavioral psychologist developed Dialectical Behaviour Therapy while working with mostly women who were suicidal and had self-harm tendencies.
The main goals of Dialectical Behaviour Therapy are,
- To help people learn the art of living in the moment.
- To help people learn healthy emotional regulation, healthy coping mechanisms to deal with stress, and how to improve their relationships with others.
DBT was originally developed to treat borderline personality disorder (BPD), but it has been adapted to treat other mental health conditions over time.
Dialectical Behaviour Therapy focuses on both problems solving and Acceptance. It derives its name DBT from this approach. Dialectical refers to bringing opposite concepts together. Here the two opposing concepts are acceptance and change.
What is the theoretical underpinning of DBT?
Dialectical Behaviour Therapy is strongly grounded in three major theoretical frameworks. These are
- The biosocial model of the development of chronic mental health issues,
- The mindfulness practice of Zen Buddhism, and
- The philosophy of dialectics.
The biosocial theory attempts to explain how issues related to borderline personality development and other emotional dysregulation arise and are maintained.
The theory posits that some people are born with a predisposition toward emotional vulnerability. An invalidating environment (that which aggravates or maintains the emotional. Note: it need not be an abusive one) can intensify a person’s negative emotional responses.
With time, people develop patterns of interaction that can be destructive. It can harm interpersonal relationships, result in suicidal behaviors and other mental health concerns like BPD
The mindfulness techniques from Zen Buddhism are used to help people be in the here-and-now.
Mindfulness is beneficial as it teaches individuals to be in the present moment, to accept the situation in a non-judgemental manner.
This will help in objectively and calmly assessing a situation. It helps us evaluate facts without being clouded by our emotions and focus on one thing at a time.
The philosophy of Dialectics: Dialectics refers to bringing together opposite concepts. In DBT the therapists use dialectics to help people accept the situation or parts of them as well as to help them change those unhelpful parts
Dialectical Behaviour Therapy is a comprehensive treatment, which is adapted for various mental health concerns. Since DBT addresses suicidal and extreme emotional issues, treatment is often structured and happens in stages to ensure all concerns are addressed and no stone is left unturned.
Dialectical Behaviour Therapy happens in four stages:
During this stage, individuals often report and are experiencing suicidal thoughts, self-harm, and or addictions. They are at an all-time low in their lives.
Thus the focus of the sessions is stabilization and on safety and crisis intervention. The main goal here is to gain some control over issues on hand.
In this stage, while the problematic behaviors are most often in control. The focus shifts from crisis management to the exploration of emotional trauma.
The main goal here is to help people experience emotional pain by providing a safe space.
Here, the focus is on improving the patient’s quality of life. In treatment, the goal is to maintain the progress made so far and stabilize it.
This we could call a support stage. Patients learn to apply the skills they learned in therapy in real life and work towards achieving and maintaining a continuous capacity for happiness and success.
What are the four main modules of Dialectical Behaviour Therapy?
Dialectical Behaviour Therapy has four core skills which we call modules. These skills are used in effective emotional regulation. Linehan calls these four skills the “active ingredients” of Dialectical Behaviour Therapy. The Four core skills include:
Mindfulness involves being present in the moment and aware of our experience at that particular moment. It involves accepting our experiences and being non-judgemental. Mindfulness can lead to radical acceptance of our situation.
Distress Tolerance skills
Distress tolerance skills can help you distract yourself till you could calm yourself to deal with the crisis and your emotional experience
Distress tolerance skills can help you soothe yourself and relax. It helps create a peaceful physical sensation and helps you find ways to improve the moment despite it being distressing.
For people experiencing Borderline personality disorder and other similar mental health concerns, emotional dysregulation might be a huge issue. Further intense emotions and rapid mood changes can make it extremely hard to relate to others.
Interpersonal effectiveness skills can help build healthy interpersonal relationships by learning healthy communication, effective conflict resolution, and learning self-respect and healthy boundaries.
Humans are emotional beings. We experience emotions throughout our lives. While distressing emotions are unavoidable, they could be effectively managed and regulated.
Emotion regulation skills teach you to identify your emotions, be mindful of them and learn to effectively express them without giving in to impulses.
While Mindfulness and distress tolerance skills help you work toward acceptance of your thoughts and behaviors. Emotion regulation and interpersonal effectiveness skills help you work toward changing your thoughts and behaviors.
What are some of the techniques used in DBT?
Dialectical Behaviour Therapy aims to teach the patients core skills that can be applied in real life. Most often three techniques are used for this purpose.
Here patients learn the DBT skills in a group setting and practice each skill with one other, by talking through situations with other people in the group.
Individual therapy with a trained professional:
Here the patients learn behavioral skills and adapt them to their personal life challenges.
Here patients can call the therapist between sessions to receive guidance on coping with a difficult situation they are currently in.
Consultation teams comprise of 3 to 8 DBt providers who work as a team to provide the best possible care to the patients. They work in collaboration with other team members who have different roles or professional credentials (e.g., psychologists also working on a team with a psychiatrist).
Who benefits from Dialectical Behaviour Therapy?
DBT was originally designed for the treatment of Borderline Personality Disorder. However, with time, DBT is adapted to treat other mental health conditions such as:
- Binge eating disorder
- Individuals dually diagnosed with intellectual disabilities and mental illness
- Substance use disorders etc.
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How does Dialectical Behaviour Therapy Work?
Dialectical Behaviour Therapy seeks to help individuals through capability enhancement, application of skills, motivational enhancement, capability and motivational enhancement of the therapist, and structuring the environment.
DBT is a skill-based therapy. In therapy, individuals are taught four core DNT skills, namely, Distress tolerance, emotional regulation, interpersonal effectiveness, and Mindfulness.
DBT is not about only learning skills, but it emphasizes on application of these skills in real life, thus DBT therapists use various techniques to help the clients apply the skills learned in various settings.
DBT uses treatment plans customized for the individual client to help them reduce problematic behaviors and learn effective coping mechanisms. For instance, the client’s most pressing and immediate concern is assessed and looked into.
Capability and motivational enhancement of therapists:
DBT is often provided to people who experience serious mental health concerns. As such, there is a greater chance for the therapist to experience vicarious trauma and burnout. Thus DBT therapists receive a lot of supervision and support.
Structuring of the environment:
DBT believes that invalidating environment maintains and exacerbates symptoms. Thus one of the goals of therapy is to restructure the client’s environment to ensure positive, adaptive behaviors are reinforced.
In brief, DBT is a skill-based comprehensive cognitive-behavioral treatment used with patients who experience BPD, PTSD, eating disorder, substance abuse disorder, etc. It is based on the biosocial theory, behavioral theory and the philosophy of dialectics, a unique aspect of DBT is its focus on acceptance as well as change.
In this blog, we defined Dialectical Behavior Therapy and understood its theoretical framework, goals, and stages. We then explored the DBT modules and answered the question ‘What are the benefits of Dialectical Behaviour Therapy?’ We also discussed where it is predominantly used and outlined how DBT works.
Frequently Asked Questions:
Who does DBT help the most?
DBT was originally developed to treat people with a borderline personality disorder.
It can be used with individuals who experience intense emotional vulnerability and emotional dysregulation, and those having suicidal thoughts and self-harm behavior as seen in substance use disorder, eating disorder, and depression.
What are the skills taught in DBT?
Four core skills are taught in DBT to reduce problematic behaviors and enhance the quality of life. They include:
- Distress tolerance
- Emotional regulation
- Interpersonal effectiveness, and
What are the DBT treatment modalities?
The treatment modalities used in DBT are:
- Individual therapy
- Group therapy
- Phone coaching, and
- Consultation teams.
How does a DBT session look like?
DBT sessions occur once every week and last for 45-60 minutes. In the session, the focus is on the sequence crisis intervention, learning skills, and application of these skills.
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