Dialectical Behavior Therapy
What is Dialectical Behavior Therapy?
Dialectical behavior therapy was first developed to try and find a better therapeutic framework to speak to patients who are highly suicidal. In that regard, dialectical behavior therapy aimed to help people who would accept no other help and move them not towards a dedicated long-term goal of betterment, but a mindset of positive (and, in time, constructive) acceptance of one’s self, one’s thoughts, and one’s circumstances.
Dialectical behavior therapy was primarily used in patients with borderline personality disorder (BPD) – this is partially because BPD overlaps heavily with higher suicidality, and because a specific diagnosis was needed as a focal point to receive the support needed to develop DBT as a therapeutic framework. Today, DBT can be used in the treatment of multiple different mood disorders and anxiety disorders, as well as eating disorders, substance use disorders, PTSD, and other personality disorders
Here at the Arrow House, we utilize DBT in cases where clients respond best to the central elements of its framework: dialectics, interpersonal relationships, mindfulness, and the Zen mentality. To understand how these elements are unique aspects of DBT, we need to delve shortly into the history of this modality.
How Was DBT Developed?
DBT was first developed by Marsha M. Linehan, who aimed to refine behavioral models of psychotherapy for patients with suicidal behavior, borderline personality disorder, and drug abuse. Its core tenet was to help people “build a life worth living”.
Behavioral models ran into problems with a lot of people with high suicidality – focusing entirely on problem-solving became frustrating, because it would be very difficult for many clients to make the positive changes that are being asked of them, leading them to be alienated and find the treatment plan pointless.
Focusing too much on warmth and acceptance, on the other hand, would feel disingenuous or patronizing, as there were no real solutions on the table.
The move, then, was to work on a client’s tolerance for distress, explore their realistic limitations, and move on from a healthier mental baseline. Rather than work immediately on solving material problems or working on one’s self in a constructive way, DBT aims to tell people that it’s okay to exist, to be mindful of the moment, to be aware without feeling bad about it. As such, DBT incorporated elements from existing mindfulness concepts and theories of acceptance of circumstance, such as stoicism and Zen philosophy, to create a unique therapeutic framework.
From there, treatment moves along a path based on regular assessments made of a client’s state of mind.
Who Can Benefit from Dialectical Behavior Therapy?
Dialectical behavior therapy was first developed with high suicidality in mind, and was then focused on borderline personality disorder, to begin with. However, it has shown great promise in the treatment of other personality disorders, as well as:
- Substance use disorder.
- Post-traumatic stress disorder.
- Eating disorders
The Components of Dialectical Behavior Therapy
DBT works with a client through four stages and utilizes several important elements to achieve this.
- If they’re a danger to themselves, the focus is on changing that (Stage 1).
- If they stabilize, then the next step is to allow them to feel the full range of emotions for their situation without fear of suicidality (Stage 2).
- From there, it’s time to work on the problems that continue to affect their daily lives (Stage 3).
- Finally, to work on ideas of contentment and joy (Stage 4).
Formally, the skill-building elements of DBT are:
- Mindfulness Skill-Building: Focusing on developing an individual’s awareness of the present moment, and the development of non-judgmental observations – learning to combat and silence negative thinking and anxious thought patterns.
- Interpersonal Effectiveness Skill-Building: Enhancing assertiveness, healthy communication, and the development and maintenance of boundaries in relationships. This is especially important in people with borderline personality disorder, but can also be helpful in the treatment of other mental health issues.
- Emotion Regulation Skill-Building: Recognizing, acknowledging, and feeling intense emotions without losing function, as well as exploring different healthy coping mechanisms.
- Distress Tolerance Skill-Building: Learning to cope with higher levels of stress, deal with difficult emotions and stressors, endure situations without resorting to self-destructive behavior, and build mental resilience.
FAQs about Dialectical Behavior Therapy
Here at the Arrow House, we often field questions about our modalities and treatment plans. Some of these questions for dialectical behavior therapy include:
What should I expect during a DBT session?
A DBT session will usually last about an hour. As with other modalities, therapists will set their own per-session goals working towards a long-term goal within the framework of the modality. For DBT, it may be to help clients move past each stage, from suicidality to contentment. Individual session goals might include limiting behavior that is counter-productive to a person’s mental health, focusing on specific triggers for suicidal thinking, or developing some of the skills noted above.
Does DBT involve individual therapy, group sessions, or both?
There are both individual and group sessions that use DBT. Whether an individual may benefit from one more than the other might depend on how they respond to individual vs. group therapy.
Can DBT be used in conjunction with medication?
Yes, medication may be part of a long-term holistic mental health treatment plan that can also include a talk therapy method such as dialectical behavior therapy.
Is virtual DBT possible?
As a talk therapy modality, DBT can be performed successfully via teletherapy, or telehealth services. In some cases, individuals might not be comfortable with one-on-one sessions held in person, at least to begin with. However, in-person DBT can be helpful specifically for developing better interpersonal relationship and communications skills.
Dialectical Behavior Therapy at the Arrow House
Dialectical behavior therapy can be an excellent approach for individuals with a variety of mental health problems. We at the Arrow House work with clients to determine which modalities are most appropriate for their needs and circumstances.
In cases where a client might benefit from dialectical behavior therapy versus other psychotherapy modalities, such as cognitive behavioral therapy (CBT), we also continue to provide long-term support via a plethora of post-treatment resources, as well as family therapy to help build up a client’s support network at home.