The greatest healing therapy is friendship and love
– Hubert Humphrey
What is Dialectical behavior therapy (DBT)?
Dialectical behavior therapy (DBT) is a type of cognitive-behavioral therapy. Its primary goals are to teach people to live in the moment, develop healthy ways to cope with stress, regulate emotions, and improve relationships.
DBT developed over the years to treat borderline personality disorder (BPD). It has adapted to treat other mental health conditions.
DBT can help people who have difficulty with emotional regulation or are exhibiting self-destructive behaviors (eating disorders and substance use disorders). DBT is sometimes used to treat post-traumatic stress disorder (PTSD).
We use DBT at our luxury rehab centre in Marbella.
What is the history of Dialectical behavior therapy?
DBT was developed in the late 1980s by Dr. Marsha Linehan and colleagues after discovering cognitive-behavioral therapy (CBT) alone did not work with BPD. Dr. Linehan and her team added techniques and developed a treatment to meet these patients’ needs.
DBT incorporates a philosophical process called dialectics. Dialectics is a concept that everything is composed of opposites and that change occurs when there is a “dialogue” between opposing forces.
In more academic terms, three basic assumptions:
- All things are interconnected.
- Change is constant and inevitable.
- Integrating Opposites can help 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 patient changes.
Another technique offered by Linehan and her colleagues was validation. When a client is validated and pushed to change, clients are more likely to cooperate and are less likely to suffer distress.
In practice, the therapist validates that a patient’s actions “make sense” within the context of their personal experiences without necessarily agreeing that they are the best approach to solving a problem.
What is the difference between Dialectical and Cognitive-Behavioral Therapy?
DBT has evolved to become an evidence-based psychotherapy approach to treat many conditions. DBT in three therapeutic settings.
- Group settings where clients 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 client’s learned behavioral skills adapted to their 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 experiencing.
In DBT, individual therapists also meet with a consultation team to help them cope with their patients’ emotional demands. Consultation teams also help therapists navigate difficult and complex issues related to providing therapy.
- Acceptance and change. You’ll learn strategies to accept and tolerate your life circumstances, emotions, and yourself. You will also develop skills that can help make positive changes in your behaviors and interactions with others.
- Behavioral. You’ll learn to analyse problems or destructive behavior patterns and replace them with more healthy and effective ones.
- Cognitive. You’ll focus on changing thoughts, beliefs, behaviors, and actions that are not effective or helpful.
- Collaboration. You’ll learn to communicate effectively and work together as a team (therapist, group therapist, psychiatrist).
- Skill sets. You’ll learn new skills to enhance your capabilities.
- Support. You’ll be encouraged to recognize your positive strengths and attributes and develop and use them.
What are effective DBT Strategies?
People undergoing DBT change their behavior using four main strategies effectively.
Perhaps the most important strategy used in DBT is developing mindfulness skills. Mindfulness helps you focus on the present or “live in the moment.” DBT allows you, a client, to pay attention to what is happening inside you (your thoughts, feelings, sensations, and impulses) and 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.
Sample Exercise: Observe Mindfulness Skill
Pay attention to your breath. Take note of the sensation of inhaling and exhaling. Watch your belly rise and fall as you breathe.
Distress tolerance skills help you accept yourself and your current situation. Four techniques for handling a crisis:
- Improving the moment
- 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 a more positive long-term outlook.
What Is Distress Tolerance?
Sample Exercise: Putting Your Body in Charge
Run up and down the stairs. If you’re inside, go outside. If you’re sitting, get up and walk around. The idea is to distract yourself by allowing your emotions to follow your body.
Interpersonal effectiveness helps you become more assertive in a relationship (for example, expressing your needs and saying “no”) while still keeping a relationship positive and healthy. You will learn to listen and communicate more effectively, deal with challenging people, and respect yourself and others.
Sample Exercise: GIVE
Use the acronym GIVE to improve relationships and positive communication:
- Gentle. Don’t attack, threaten, or judge others
- Interest. Show interest with good listening skills (don’t interrupt someone else to speak)
- Validate. Acknowledge the other person’s thoughts and feelings
- Easy. Try to have a straightforward attitude (smile often and be light-hearted)
Emotion regulation lets you navigate powerful feelings more effectively. The skills you learn will help you to identify, name, and change your emotions. When you can recognise and cope with intense negative emotions (for example, anger), it reduces your emotional vulnerability and has more positive emotional experiences.
Sample Exercise: Opposite Action
Identify how you’re feeling and do the opposite. If you feel sad and want to withdraw from friends and family, make plans to see your loved ones.
Is DBT Right for You?
Most DBT research has focused on its effectiveness for people with borderline personality disorder who have thoughts of suicide and self-harm, but the method could also be a successful treatment for other mental health conditions.1
DBT might be an effective treatment for:
- Attention-deficit/hyperactivity disorder (ADHD)
- Bipolar disorder
- Eating disorders (such as anorexia nervosa, binge eating disorder, and bulimia nervosa)
- Generalized anxiety disorder (GAD)
- Major depressive disorder (including treatment-resistant major depression and chronic depression)
- Obsessive-compulsive disorder (OCD)
- Post-traumatic stress disorder (PTSD)
- Substance use disorder