Dialectical Behavior Therapy, or DBT, is a specific form of psychotherapy derived from the well-known Cognitive Behavior Therapy (CBT). DBT was initially developed as a treatment for individuals diagnosed with Borderline Personality Disorder (BPD) or who were experiencing severe suicidal behaviors. It was later discovered that DBT was an effective treatment for other mental health disorders. Among the many areas DBT is valuable, some of the most common are self-harming behaviors and substance abuse in adolescents and adults, bipolar disorders, eating disorders, and depression.
Dialectical Behavior Therapy is a structured method of psychotherapy broken down into four specific building blocks. Mindful Living Group’s therapists with experience in DBT provide patients with a compassionate, validating model of therapy that encourages them to reach their fullest potential. In following DBT protocol, therapists and counselors can lead therapy sessions in a one-on-one setting, telehealth (or “phone coaching”), or group setting. Because individuals undergoing DBT therapy often face severe mental health challenges and disorders, the DBT method often calls for the patient to be under the care of a “DBT Consultation Team.” Essentially, this group of professionals typically consists of your psychotherapist, psychiatrist (if medications are necessary), and other professionals you may see, such as social workers, counselors, and medical doctors (if/when needed). The DBT consultation team works together to provide the most appropriate, personalized, and effective care for each patient.
Fundamentals Of Dialectical Behavior Therapy
DBT was developed in the 1970s and 1980s by Dr. Marsha Linehan after many failed attempts to treat borderline personality disorder and/or chronically suicidal individuals with CBT. BPD is a severe mental health disorder in which a person experiences extreme turbulence and instability in mood, self-image, relationships, and role in the world. Over time, DBT has been adapted to effectively treat various other mental health disorders in both adolescents and adults.
What does dialectical mean? Simply stated, it’s the internal thought process, or dialogue between two or more people, seeking to find truth or synthesis in two or more opposing propositions (theses and antitheses). DBT aims to help individuals find a synthesis between acceptance and change through four distinct components, mindfulness, distress tolerance, interpersonal effectiveness, and emotional regulation. The primary goals of DBT are to improve behaviors and relationships, increase motivation to change, and help individuals create a life they are happy living.
The heart of dialectical behavior therapy is the first component, Mindfulness. Skills and techniques used in mindfulness practices create the foundation of DBT and exist in every aspect. Practicing mindfulness allows individuals to address difficult emotions, which may arise as they work on changing behaviors and later in their therapy sessions. The mindfulness module focuses on acceptance and the dialectic between acceptance and change.
The natural evolution from mindfulness leads to the next component, Distress Tolerance. Through mindfulness, we are to release judgments of our thoughts, feelings, and emotions, accepting everything as it is in the present moment. Accepting without judgments does not equate to approval or resignation; it’s merely acknowledgment and abstaining from attachments or ruminations. Using mindfulness in conjunction with distress tolerance, the goal is to recognize negative events, emotions, and triggers while maintaining a calm demeanor. From this point, you are able to make decisions from your wise mind and respond appropriately.
Building off of distress tolerance, Emotional Regulation is introduced. In its most simplistic meaning, this third component undertakes the position that we can manage the emotions that arise in us and respond accordingly and that “intense emotions are a conditioned response to troublesome experiences.” The skills used to develop and build on emotional regulation are divided into four groups, (1) identifying, naming, and understanding emotions; (2) changing unwanted emotions; (3) reducing one’s vulnerability to the emotional mind; (4) managing in extreme conditions.
Individuals who live with borderline personality disorder, bipolar disorder, OCD, or other mental health disorders often struggle with their emotions “taking control,” resulting in an interference with creating and building healthy relationships. The fourth component may begin emerging as a person learns emotional regulation and consistently practices it. Interpersonal Effectiveness skills do not come naturally; they must be learned and consciously implemented. These skills are difficult to adopt if a person’s emotions are still in control. Interpersonal effectiveness is the synthesis of the dialectic of personal needs, others’ needs, and self-respect. This module’s goals are to help a person strengthen existing relationships (considering they are not harmful), learn to make new connections with boundaries and stability, and terminate unhealthy, toxic relationships.
The Roles of the Therapist/Counselor and Patient
First and foremost, before anything begins in DBT, the therapeutic relationship must be established. The alliance dynamics are intricate, and it is crucial to the therapy’s likely hood of success for this relationship to exist. Without the therapeutic alliance, patients are unable to commit to the work or maintain honesty with the therapist and themself.
In DBT, the therapist and patient individually have their own responsibilities. When everyone commits to their role, the success of therapy increases. Therapists accept the responsibility of a guiding role to help patients find and create a balance (or synthesis) between acceptance and change. A synthesis is discovered by implementing evidence-based skillsets and validating the patient. Validation is a distinguishing factor that sets DBT apart from other therapies.
DBT consists of several functions, one of which is the therapist consultation team. This particular function does not directly involve the patient. Because DBT generally treats individuals with severe mental health conditions over an extended period of time, therapists are at risk of reaching a point of burn-out. They are human. The consultation team works together from different specialties to ensure the therapist is at their best and can provide positive, practical input and motivation. Ultimately, the consultation team ensures each patient is receiving the utmost care.
How DBT Can Enhance Your Life
The integration of dialectic thinking allows a person to view a situation or emotions from multiple perspectives instead of “black or white.” The philosophy behind dialectic is that everything is composed of opposites, and these opposites can co-exist. To fully understand something, it’s essential to know both sides. Observing different perspectives encourages us to open our minds and increase our awareness. Using mindfulness in dialectical thought processes is to practice acceptance of what is. It emphasizes that a person may accept the current emotions, circumstances, and environment, and they can continue to work at creating change.
Nothing is absolute. Through mindful dialectical methods, we may become capable of facing thoughts, emotions, situations, and triggers that trouble us with adaptability. The ability to acknowledge that all things are dualistic provides us the knowledge that there is another side even in the worst of times. The dialectic and mindfulness approaches reassure and teach us to release attachments to emotions or events; all things change, and this change is an inevitable part of life. The bad won’t always be bad. Everything continues moving – like the clouds in the sky.
Acknowledging the complete picture increases the capacity to respond instead of reacting to what is going on around us. Behaviors become intentional, not impulsive. Continual practice of considering multiple assessments and opinions encourages us to relinquish judgments, stress, or pressure that we put on a situation, others, and ourselves. We learn compassion, empathy, and emotional and cognitive flexibility. From this flexible state, we build our resilience to distress and instill deeper levels of peace within ourselves. The intensity of emotions decreases so that they do not have control over us. We begin to operate through the place of the wise mind.
Getting Started With Dialectical Behavior Therapy
Dialectical Behavior Therapy is a profound evidence-based modality for treating personality and mood disorders. Many illnesses, substance abuse, suicidal ideations, and self-harming behaviors often arise in people during their adolescent years. DBT is a safe, effective therapy for all ages. It can be employed in several settings, such as individual therapy sessions, group therapy, and phone or video calls.
If you are ready to commit to change and creating a fulfilling life, contact Mindful Living Group to schedule an appointment or any questions you may have.