Reviewing DBT

PsychCentral reports that Dialectical Behavioral Therapy (DBT) is treatment that psychologist Marsha M. Linehan developed in the late 1980s to address borderline personality disorder (BPD). Since its development, it has also been used for other mental health disorders, and today it is a key element of Cognitive Behavioral Therapy, an umbrella for many treatment methods.

What Is DBT?

Reviewing DBT

DBT is a key element of Cognitive Behavioral Therapy, an umbrella for many treatment methods

PsychCentral continues that DBT emphasizes the psychosocial aspects of treatment. The theory behind the approach is that some people are prone to react in intense, abnormal ways toward certain emotional situations, primarily those found in various relationships between romantic partners, friends and/or family. DBT suggests that some people’s arousal levels can increase far more quickly in such situations than the average person’s, which means they can become more emotionally stimulated and need considerable time to relax. For instance, people with BPD experience extreme swings in their emotions, they tend to see the world in black and white and they seem to jump constantly from one crisis to another. Because few people understand such reactions and find such people intolerable, patients tend to lack any way to cope with these sudden, intense surges of emotion. In response, DBT can teach them to control themselves.

Characteristics of DBT

DBT imbues the following qualities:

  • Support-oriented – DBT helps people identify and hone their strengths to feel better about themselves and their lives
  • Cognitive-based – DBT identifies thoughts, beliefs and assumptions that make life hard, such as the following examples: I must be perfect at everything; if I get angry, then I am a terrible person. It replaces these thoughts with the following ones: I do not need to be perfect for people to care about me; everyone gets angry, because it is a normal emotion.
  • Collaborative – Patients are encouraged to work out problems in their relationships with their therapists. DBT asks people to complete homework assignments, to role-play ways of interacting with others and to practice skills, such as self-soothing during emotional difficulties. These skills are taught in weekly lectures, reviewed in weekly homework groups and referred to in nearly every group; therapists help patients learn, apply and master them.

Generally, DBT has the following two main components:

Individual weekly psychotherapy sessions help solve problems from the past week. Self-injurious and suicidal behaviors take first priority, followed by behaviors that may interfere with the therapy process. Quality-of-life issues and general issues may also be discussed. Individual sessions in DBT also focus on decreasing and dealing with posttraumatic stress responses to enhance self-respect and one’s self-image. Both between and during sessions, therapists teach and reinforce adaptive behaviors, especially within the therapeutic relationship, because patients can then learn to manage their emotions rather than reducing or exploding during crises. Telephone contact with the individual therapist between sessions is part of DBT procedures, but the therapist and client work to identify and improve basic problems with social skills during individual therapy sessions.

Weekly group therapy sessions last generally 2-1/2 hours a session and are led by a trained DBT therapist. During these sessions, people learn skills from one of four different modules: interpersonal effectiveness, distress tolerance/reality acceptance, emotion regulation and mindfulness.

What Does “Dialectical” Mean?

More than a couple of decades ago, Marsha Linehan, Ph.D., developed a unique approach to the treatment of Borderline Personality Disorder (BPD) which she chose to call “Dialectical Behavior Therapy”. Research has established that DBT appears to help reduce some of the worst problems associated with bi-polar disorder (BPD), such as repeated suicidal behaviors, therapy interfering behaviors, etc.

In brief, “dialectics” represent the mind’s way of understanding concepts by appreciating polar opposites (love and hate, yin and yang and introvert and extrovert). Dialectics are important unifying concepts that reflect how the mind understands and perceives core concepts. The field of psychology contains an abundance of such concepts, including self-esteem, trust, courage, honesty, rage, passivity, withdrawal, impulsivity, inhibition, blameworthiness, guilt, risk taking and on and on, so dialectics are based in part on the fact that we cannot fully understand abstract concepts without appreciating their opposites.

When a patient apply this dualistic view to DBT, she can see how her self-view (or schema) may look completely different to someone else, but both parties can see strikingly similar – yet unsatisfying – outcomes. Here are just a few seemingly opposite perspectives that people could hold about themselves or the world that can lead to telling behaviors:

  • People who feel unworthy of having their needs met and those who feel entitled both often push people to avoid meeting their needs
  • People who fear attaching to others and those who are too proud to attach to generally end up in estranged, unfulfilling relationships
  • People who feel overly dependent upon others and more independent types often fail to obtain help when necessary
  • People who tend to throw others for their behavior and those who blame themselves both fail to accept appropriate blame

The list of examples is endless, because opposing views of the self, others and the world are usually rigid, so they produce tumultuous feelings. These feelings can compel behaviors that damage relationships, harm one’s health and create unrealistic expectations of oneself and others. Fortunately, a moderate, integrated, middle ground can help.

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