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Deep Dive on Dialectical Behavior Therapy: Part 1

Written by Tanisha Herrin · Reviewed by Traci Baxendale, LMSW · January 20, 2024 ·

This is Part 1 of our deep dive into Dialectical Behavior Therapy (DBT). To read Part 2 tap here.

Dialectical Behavior Therapy (DBT) is a form of psychotherapy developed in the late 1980s by Dr. Marsha M. Linehan, designed primarily to treat individuals with borderline personality disorder (BPD) and those displaying self-harm behavior. It emerged as a modification of cognitive-behavioral therapy (CBT) to better address the needs of these patients, incorporating acceptance and mindfulness strategies alongside change-oriented techniques.

The core principle of DBT is its dialectical approach, which balances acceptance of one's situation with efforts to change it. This dual focus helps patients manage intense emotions and reduces harmful behaviors. Dr. Linehan, influenced by her own experiences and understanding of emotional dysregulation, introduced this innovative approach to offer a more effective treatment for challenging psychological issues.

Today, DBT is widely used for various mental health conditions, including depression, eating disorders, and post-traumatic stress disorder, due to its adaptability and comprehensive approach.

Core Philosophies and Comparison with Other Therapies

Dialectical Behavior Therapy (DBT) is a structured form of psychotherapy that combines traditional cognitive-behavioral techniques with mindfulness practices derived from Buddhist traditions. Developed by Dr. Marsha M. Linehan, DBT is primarily aimed at helping individuals with emotional regulation by teaching them skills to manage stress, control their emotions, and improve relationships with others.

Core Philosophies and Principles

  1. Dialectical Philosophy: The cornerstone of DBT is the concept of 'dialectics', which refers to integrating opposite strategies – acceptance and change. This philosophy encourages patients to accept themselves and their current situation while simultaneously working towards changing their negative behaviors and thought patterns.
  2. Mindfulness: Borrowing from Eastern practices, mindfulness in DBT focuses on increasing awareness and presence in the current moment, promoting a non-judgmental stance towards one’s experiences.
  3. Emotion Regulation: DBT teaches skills to manage and alter intense emotions that are causing problems in a person’s life.
  4. Distress Tolerance: This involves techniques to tolerate and survive crises without resorting to self-destructive behavior.
  5. Interpersonal Effectiveness: DBT helps individuals become more assertive in relationships while maintaining respect and dignity for both themselves and others.

Comparison with Other Forms of Therapy

  • DBT vs. Cognitive-Behavioral Therapy (CBT): While CBT focuses on changing harmful thought patterns and behaviors, DBT places equal emphasis on acceptance and change. DBT is often considered more suitable for individuals who experience emotions very intensely, as it provides specific tools for emotional and crisis management.
  • DBT vs. Psychodynamic Therapy: Psychodynamic therapy emphasizes understanding the underlying psychological roots of emotional suffering, often exploring past experiences. In contrast, DBT is more focused on practical skills to manage current emotions and behaviors.
  • DBT vs. Humanistic Therapy: Humanistic therapies focus on self-exploration and personal growth, emphasizing the individual's inherent value and capacity for self-actualization. DBT, while also client-centered, is more structured and skill-based.

DBT's unique blend of acceptance, mindfulness, and skill-based interventions makes it distinct in the therapy landscape, particularly effective for those struggling with intense emotional issues and behavior regulation.

Key Concepts of DBT

Dialectical Behavior Therapy (DBT) is anchored in several key concepts that form the bedrock of its therapeutic effectiveness. At the forefront is mindfulness, a concept borrowed from Eastern spiritual traditions, particularly Buddhism. Mindfulness in DBT is about cultivating a heightened awareness of the present moment, encouraging individuals to observe and describe their thoughts, feelings, and sensations without judgment. This practice aids in breaking the cycle of automatic, negative thoughts and responses, fostering a deeper understanding and acceptance of self.

Another crucial component of DBT is distress tolerance. Life inevitably presents challenging situations, and for individuals struggling with emotional regulation, these situations can lead to extreme distress and harmful behaviors. Distress tolerance skills equip individuals with strategies to endure and survive these emotional crises without resorting to self-destructive actions. It's about accepting the current situation and finding ways to persevere, even when it cannot be immediately changed.

Emotion regulation is a vital aspect of DBT that focuses on teaching clients how to manage and change intense emotions that are causing problems in their lives. It involves understanding and naming emotions, decreasing the frequency of unwanted emotions, and reducing vulnerability to emotion mind. By learning to regulate emotions, clients can better cope with life's ups and downs and respond to situations in a less reactive, more thoughtful way.

Interpersonal effectiveness, the fourth key concept, centers around the idea that personal relationships can be a significant source of stress or support. DBT teaches skills to help individuals interact with others in a way that is assertive, maintains self-respect, and strengthens relationships. These skills include effective communication, setting boundaries, and negotiating solutions to problems. By improving interpersonal effectiveness, individuals can foster healthier and more fulfilling relationships.

Together, these concepts form a comprehensive framework that helps individuals with a variety of psychological challenges. From cultivating a non-judgmental awareness of the present to managing emotions and navigating interpersonal relationships, DBT provides a multi-faceted approach to improving mental health and overall quality of life.

How DBT Works

Dialectical Behavior Therapy (DBT) operates on a structured, multi-faceted approach to treatment, tailored to meet the unique challenges faced by individuals struggling with emotional regulation and distress tolerance. The journey through DBT is a collaborative one, involving significant contributions from both the therapist and the client.

The process typically begins with an assessment phase, where the therapist and client work together to identify the specific challenges and goals for therapy. This collaborative relationship is crucial in DBT, as it emphasizes mutual respect and understanding. The therapist acts as a guide and support, helping the client to navigate through the complexities of their emotions and behaviors while empowering them to take an active role in their healing journey.

Following assessment, DBT unfolds in stages, each with its own set of goals and focuses. The first stage aims at achieving behavioral stabilization, especially in clients who might be engaging in self-harm or other destructive behaviors. Here, the immediate goal is to ensure safety and control over life-threatening behaviors. This stage lays the foundation for the subsequent work in DBT.

In the heart of DBT are the weekly individual therapy sessions and group skills training sessions. The individual therapy focuses on problem-solving and behavioral analysis, helping clients apply the skills they learn in real-life situations. The therapist provides validation and helps the client to understand and accept their feelings and behaviors as understandable within their current life context, while also teaching them skills to change these behaviors.

Group skills training, on the other hand, is educational and focuses on developing specific skills in four key areas: mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness. In these group sessions, clients learn and practice new skills in a supportive setting, which they can then apply to their everyday life challenges.

Apart from these, phone coaching is another component of DBT where clients can contact their therapist between sessions for guidance in applying DBT skills to specific situations in their daily lives. This aspect of DBT underscores its commitment to providing real-time support and reinforcement of skills.

Throughout the process, therapists use various techniques and exercises, such as diary cards (for tracking behaviors, emotions, and skill usage), role-playing (to practice new skills and behaviors), and chain analysis (to understand the sequence of events and thoughts leading to problematic behaviors). These tools help in making the therapy more interactive and effective.

In summary, DBT is a dynamic and interactive form of therapy that requires active participation from both the therapist and the client. Through a structured approach that includes individual and group sessions, along with real-time coaching, DBT equips individuals with the skills and strategies needed to manage their emotions, cope with stress, and improve their relationships.

Part 2 of our deep dive into DBT will cover how it is used for different disorders, its potential benefits, challenges, and limitations.

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