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Dialectical Behavior Therapy (DBT)

Friday, 16 June 2017 06:00  by Courtney W.

You may be struggling with trauma and thinking about where to turn next for help. If you’ve been looking into treatments for borderline personality disorder or other mental health issues, you may wonder, what does DBT stand for? Dialectical behavior therapy, or DBT, was first developed to treat chronically suicidal people with borderline personality disorder, or BPD. The treatment is the most common cognitive behavioral therapy for this population.

Marsha Linehan, a Professor of Psychology at the University of Washington developed DBT. She was diagnosed in her younger years with BPD and suffered from self-harming behaviors, who later drew on her experiences to develop the therapy.

Multiple studies have proved DBT to be an effective treatment for BPD and other related problems. One research article concluded that, at the end of the first year of treatment, 77 percent of the patients studied no longer met borderline personality disorder criteria after DBT treatment.

Understanding the components of DBT and how it works can help you understand how it can help those who suffer from BPD and other mental health issues.

What Is DBT?

DBT is a cognitive behavioral therapy treatment for people suffering from borderline personality disorder (BPD) and self-harm behaviors, as well as other mental health disorders.

You’re probably thinking — how does DBT work? Dialectical behavior therapy was the first psychotherapy to integrate mindfulness as its fundamental component. The therapy is based on a triad of philosophical positions.

Behavioral science is at the root of the development of the DBT bio-social model as well as the dialectical behavioral therapy behavioral change protocols and strategies. DBT therapy techniques are commonly used to treat suicidal people with borderline personality disorder, but can also be useful for treating other mental health disorders.

It is an effective treatment for other disorders, including:

  • Depression
  • Eating disorders
  • PTSD
  • Alcohol and substance dependencies
  • Eating problems
  • Self-harm
  • Suicidal tendencies
  • Impulsivity
  • Offensive behavior

Dialectical means an integration or synthesis of opposites. The therapy stands out from others of the 1970s and 1980s as it involves acceptance and change.

DBT can help change unhelpful behaviors

DBT is a form of talking treatment that helps to change any unhelpful behaviors while simultaneously accepting who you are as a person. You learn to accept yourself and make positive changes in your life. By learning to understand and accept yourself, your emotions and experiences, you learn to deal with your feelings in a healthy manner.

What Are the Components of DBT?

There are four standard elements of DBT. These are a consultation team, phone coaching, individual therapy and the skills training group. Here is how each element typically works and contributes to the overall success of the treatment:

  1. Consultation team. A DBT therapist consultation team works as therapy for the therapists. Supporting DBT providers in their work with clients who often present with complex, difficult to treat and severe disorders is one of the goals of the consultation team. The team helps therapists remain motivated and engaged so they can do the best job possible. These teams usually meet on a weekly basis and are made up of group leaders and individual therapists.
  2. Phone coaching. Phone coaching is often part of DBT therapy, and allows clients to contact their therapists when they need their help and guidance the most.
  3. Individual therapy. Individual therapy helps individuals apply DBT skills to specific events and challenges within their lives as well as enhancing motivation. In the standard DBT model, this treatment takes place one day per week and runs alongside skills groups for the duration of the treatment.
  4. Skills Training. DBT skills training focuses on teaching you key behavioral skills. Each group is run in a class format. The group leader teaches skills and gives homework where individuals practice applying the skills learned in everyday situations. Each group meets once a week for 24 weeks for around two and a half hours. Sometimes, the curriculum is repeated to create a 12-month program. Shorter schedules are also available depending on the setting and on the client.

These are the standard components of DBT, though they may vary depending on both the treatment program and on your need.

What Skills Are Taught in DBT?

Dialectical behavior therapy includes four sets of behavioral skills. These are:

  1. Mindfulness. Working on being present and aware in this one moment is at the core of mindfulness. The essential skill taught in skills group is mindfulness. The core mindfulness “what” skills are to participate, observe and describe. These answer the question, “What do I do to be mindful?” The core “how” skills are: effectively, non-judgmentally and one-mindfully. These answer the question, “How do I practice being mindful?”
  2. Emotion regulation. This DBT behavioral skill involves working on how to change any negative or unhelpful emotions. When you attend DBT, many often feel emotionally fragile and intense. Individuals could also be anxious, depressed, frustrated and angry. This is why learning how to regulate emotions is beneficial. DBT emotion regulation skills include:
    • Taking opposite action
    • Reducing vulnerability to emotions
    • Identifying and naming emotions
    • Pinpointing obstacles to changing emotions
    • Increasing mindfulness to present emotions
    • Applying distress tolerance techniques
    • Increasing positive emotional happenings
  3. Distress tolerance. Working on how to cope with pain in various situations, not changing it is the key skill learned in distress tolerance. The majority of mental health treatments focus on changing distressing circumstances and events, whereas DBT works on learning to cope with pain skillfully. It involves accepting, finding meaning for and coping with distress.
  4. Interpersonal effectiveness. Learning how to ask for what you want, how to say no while keeping self-respect and maintaining healthy relationships with others are essential interpersonal response patterns taught in DBT. These skills are similar to ones taught in many assertiveness classes. They give participants effective strategies to say no, cope with conflict and ask for what they need.

You may already have good interpersonal skills in general. However, you might have problems applying those skills to specific situations. For example, you might know what another person should do in a particular problematic scenario, but you may be incapable of carrying out that behavior yourself when you are faced with something similar.

DBT helps you focus on change

With DBT, you can learn to focus both on resisting changes another person is making and on situations where you want to change something. The skills you learn maximize the chances that your personal goals in a specific situation are met while not damaging the other person’s self-respect or your relationship with them.

How Does DBT Prioritize Treatment?

When a client is suffering from multiple problems that need treatment, DBT may help. As outlined by Marsha Linehan, the founder of the treatment, DBT employs a system of treatment targets. Furthermore, the objectives are especially useful if the therapist is enabled to decide on the issues that need to be examined and addressed.

DBT can help treat co-occurring problems

The length of time each stage lasts is determined by a highly trained and qualified therapist as well as the individual’s needs.

Treatment targets in order of prime concern are:

Life-threatening behaviors. Before anything else, your therapist addresses any behaviors that could threaten your life, including:

  • Suicide communication
  • Non-suicidal and suicidal self-injury
  • Suicidal ideation
  • All other behaviors that could cause physical harm

Therapy-interfering behaviors. Therapy-interfering behaviors, as the term suggests, are any methods of behaving that get in the way of treatment. For example:

  • Being non-collaborative with the therapist when working towards treatment goals
  • Turning up late to sessions or cancelling appointments

Therapy-interfering behaviors can be on the part of the therapist and/or of the client.

Quality of life behaviors. Quality of life behaviors include any other kinds of behavior that interfere with the client enjoying a reasonable living standard. These include:

  • Financial crises
  • Housing crises
  • Mental disorders
  • Relationship problems

Skills acquisition. Skills acquisition involves learning new and positive behaviors to replace those that are ineffective, helping individuals to reach their goals.

In a DBT session, the client and therapist tackle needed improvements in the above order. For instance, if they are feeling suicidal and also tell their therapist they have an eating problem, the suicidal behaviors are addressed first. Working on life-threatening behaviors is crucial to getting back on the path to mental health again.

The Stages of DBT Treatment

There are four DBT stages of treatment. Each stage is defined by how severe the client’s behaviors are. Together with the designated therapists, individuals work towards reaching each stage’s goals, all the while progressing towards a better life.

Work to accomplish the stages of DBT

Stage One

The beginning is often the most challenging, and stage one is arguably the most difficult period. Many feel at rock bottom throughout stage one. Behaviors may be uncontrollable, and people often feel miserable and can see no way out. At this point, they may be engaging in self-destructive behaviors, including, but not limited to, using alcohol and drugs and self-harming. The end goal for this stage is to regain control over behaviors.

Stage Two

Although behavior is under control by the time participants move on to stage two, they likely still feel depressed and sometimes desperate, often because of prior invalidation and trauma. They are often unable to express and feel a full range of emotions, particularly positive ones. Therefore, this stage’s goals are to help remove individuals from the mire of desperation and enable them to feel a full range of emotions. If post-traumatic stress disorder (PTSD) needs to be addressed, it will be at this stage.

Stage Three

Participants begin to feel a lot better throughout this stage. The challenge now is to learn to live again. They work on finding happiness and peace through building up self-respect and defining life goals. The central aim of this period of treatment is to live an ordinary and content life.

Stage Four

Some people may feel a need to continue through to a fourth stage of treatment. Stage four helps if even though they have found a balance, they still feel spiritually unfulfilled. The goal of this phase of treatments to feel happy and complete again and to have the capacity to enjoy life moving forward.

Commonly Asked Questions About DBT

While DBT has been around for several decades, it has recently become a more common form of treatment for mental health issues. Here are some commonly asked questions regarding DBT:

What Does Dialectical Mean?

Dialectical means an integration or synthesis of opposites. The main dialectic in this therapy is the seemingly opposing strategies of change and acceptance. Every strategy and skill in DBT are balanced regarding the two.

What Is the Difference Between DBT and CBT?

If you’re considering the differences between DBT vs. CBT, DBT is a specific form of CBT — cognitive behavior therapy. There are three main differences:

  • The severity of problems in some clients makes it impossible to use standard cognitive behavioral therapy (CBT) whereas DBT has been proven to work.
  • In CBT, people who met the criteria for borderline personality disorder (BPD) punished their therapists when their therapy was effective and reinforced ineffective treatment.
  • Clients of traditional CBT found that the treatment’s focus on change makes them feel angry and invalidated.

How Long Does DBT Take?

There is no set timeline for treatment. Every individual is different.

What Skills Does DBT Teach?

DBT treatment process teaches crucial life skills, like how to:

  • Regulate and change any emotions that have negative impacts
  • Handle pain and not work to change it when faced with trying situations
  • Be fully present and aware in the moment
  • Say no and ask for what is desired while maintaining both relationships and self-respect

Brookhaven Retreat

Here at Brookhaven Retreat, we understand how hard struggling with a mental health disorder is. This is why we train our staff to the highest levels of knowledge and care. We are fully committed to providing you with the fundamental skills to manage your feelings, thoughts, and behaviors so you can move forward and create stable, healthy relationships and a good, positive life.

We believe in best practices, and education is what gets our compassionate staff the skills they need. We offer consistent education for our team through seminars and conferences; when we provide them with the latest techniques, knowledge, and skills, you are better equipped to get back on the road to full health.

You will enjoy a safe haven with us. Together, we will work towards your self-acceptance and on healing you emotionally. Perhaps you feel over or under-stimulated and are self-destructive or self-harming. You may feel there is no way out. We are here to tell you there is. We have successfully helped countless women to regain control of their lives, and we can help you too.

We follow a 12-week schedule that focuses on equipping you with the tools to think, feel and experience life positively again. The actual course of treatment and how DBT is used will depend on the individual, their needs, and the overall treatment program as outlined by their dedicated team after admission.

Create a life worth living. If you are seeking mental health treatment, contact us here at Brookhaven Retreat today at 844-323-0700.

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Last modified on Wednesday, 14 March 2018 18:03

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