Dialectical Behavioral Therapy: Explained

History of DBT

DBT was developed in the late 1980s by Dr. Marsha Linehan (an American psychologist living with BPD herself) and colleagues when they discovered that cognitive-behavioral therapy (CBT) alone did not work as well as expected in patients with BPD. It’s also the first psychotherapy to incorporate mindfulness, a mental state achieved by focusing one's awareness on the present moment, while calmly acknowledging and accepting one's feelings, thoughts, and bodily sensations.

Dialectics of DBT

DBT incorporates a philosophical process called dialectics. Dialectics is based on the concept that everything is composed of opposites and that change occurs when there is a "dialogue" between opposing forces. as expected in patients with BPD.

The process of dialectics The process makes three basic assumptions: all things are interconnected, change is constant and inevitable, & opposites can be integrated to form a closer approximation of the truth.

In DBT, a patient and therapist work to resolve the apparent contradiction between self-acceptance and change to bring about positive changes in the patient through dialectics.

How DBT Works

DBT is primarily used in three therapeutic settings:

Group settings 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.

DBT mainly focuses on and/or provides a patient with the following:

Acceptance and Change: Learning learn strategies to accept and tolerate life circumstances, emotions, and yourself. A patient will also develop skills that can help them make positive changes in their behaviors and interactions with others.

Behavioral: A patient will learn to analyze problems or destructive behavior patterns and replace them with more healthy and effective ones.

Cognitive: A patient will focus on changing thoughts, beliefs, behaviors, and actions that are not effective or helpful.

Collaboration: A patient will learn to communicate effectively and work together as a team with their therapist, group therapist, and psychiatrist.

Skill sets: A patient will learn new skills to enhance their capabilities

Support: A patient will be encouraged to recognize their positive strengths and attributes and develop and use them.

DBT Strategies

DBT is made up of 4 core modules: mindfulness, distress tolerance, interpersonal effectiveness, and emotional regulation

Mindfulness

Mindfulness helps you focus on the present or “live in the moment.” This helps you pay attention to what is happening inside you (your thoughts, feelings, sensations, and impulses) as well as using your senses to tune in to what's happening around you (what you see, hear, smell, and touch) in nonjudgmental ways.

Mindfulness skills help you slow down and focus on using healthy coping skills when you are in the midst of emotional pain. The strategy can also help you stay calm and avoid engaging in automatic negative thought patterns and impulsive behavior.

Distress Tolerance

Distress tolerance skills help you accept yourself and your current situation. You will four techniques for handling a crisis: distraction, Improving the moment, self-soothing, thinking of the pros and cons of not tolerating distress

Distress tolerance techniques help prepare you for intense emotions and empower you to cope with them with a more positive long-term outlook.

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. It help you to learn how to listen and communicate more effectively, deal with challenging people, and respect yourself and others.

Emotional 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.

Who is DBT for?

DBT has proven to be the most effective treatment for people with Borderline Personality Disorder, but it can also be an effective treatment for other mental health conditions like the following:

Attention-deficit
hyperactivity disorder
Bipolar disorder
Eating disorders
Generalized anxiety disorder
Major depressive disorder
Obsessive-compulsive disorder
Post-traumatic stress disorder
Substance use disorder