Dialectical Behavior Therapy

Dialectical Behavior Therapy

Developed in the late 1980s, Dialectical Behavior Therapy (DBT) is a specific type of Cognitive Behavioral Psychotherapy (CBT). Psychologist Marsha M. Linehan developed DBT with the intent to treat Borderline Personality Disorder (BPD). Since the therapy’s development, it’s also been used as treatment for various mental health disorders.

What Exactly Is DBT?

DBT treatment is a specific type of psychotherapy, or talk therapy, that utilizes a CBT approach. It highlights the psychosocial parts of treatment.

Some individuals are prone to react to emotional situations in an intense manner that often appears out of the ordinary. If the emotional situation involves family, friends, or romantic relationships, the arousal is often heightened to a more dangerous level.

This occurs because arousal response levels differ from one individual to another. Those struggling with heightened responses have the ability to increase their emotional state at a more rapid pace and reach a higher level of emotional stimulation. It will also take longer for these individuals to return to baseline levels.

Patients diagnosed with BPD experience emotional swings, often jump from one crisis to another and perceive the world in black and white. Few individuals understand these types of reactions, so coping methods to handle these intense emotional surges are limited. However, DBT is a method of therapy that addresses these needs.

Components of DBT

• Support-Oriented – DBT helps individuals identify their strong points and build upon them to feel better about them and their life.
• Cognitive-based – DBT helps individuals identify beliefs, thoughts and assumptions that simply make life more difficult than it needs to be. For example, individuals believe they need to be perfect at everything, or for individuals who feel they become terrible when they get angry, DBT can help them learn new ways of thinking that make life a lot more bearable. With this type of therapy, individuals learn to realize that they don’t have to be perfect for others to care about them and that getting angry is a common, normal reaction.
• Collaborative – DBT requires constant attention to the relationship between staff and clients. Individuals are encouraged to work out their relationship problems with the therapist, and therapists are encouraged to do the same. Patients are tasked with homework assignments to be completed and role-playing to be conducted to help examine new ways of interacting with people. Additionally, these practices help instill brand-new skills to soothe them when they are triggered and upset. These types of skills are taught on a weekly basis as part of the therapy’s lecture portion as well as being reviewed weekly during homework groups. Therapists will help individuals learn, apply and even master these skills.

As a general rule, DBT can be considered having two primary components, which are as follows:

1. Individual Weekly Psychotherapy Sessions – These sessions put an emphasis on problem-solving behavior for the prior week’s issues. The first priority is suicidal and self-harming behaviors, followed by behaviors that could interfere with the therapy process. Other behaviors that may be discussed include quality of life issues and behaviors of generally improving life. Individual DBT sessions will also focus on dealing with and decreasing post-traumatic stress responses as they relate to one’s life as well as helping enhance an individual’s self-image, self-respect and social skills.
2. Group Weekly Therapy Sessions – These 2.5-hour sessions are led by a trained therapist of DBT. In these weekly group therapy sessions, individuals will learn various skills from one of the following four different units:
   1. Distress Tolerance/Reality Acceptance Skills
   2. Mindfulness Skills
   3. Emotion Regulation
   4. Interpersonal Effectiveness

The Four Units of Dialectical Behavior Therapy

Unit 1: Distress Tolerance/Reality Acceptance

Many approaches to mental health treatment focus on changing distressing circumstances and events. However, they fail to pay attention to accepting, tolerating and finding meaning for the distress. This particular task has often been tackled by spiritual and religious leaders and communities. DBT adopts this focus adjustment and emphasizes learning to bear pain skillfully.

Distress tolerance skills represent a natural development of mindfulness skills (Unit 2). It focuses on the ability to accept the current situation and oneself in a nonjudgmental and non-evaluative fashion. While the stance here is nonjudgmental, it does not mean it is one of approval. Acceptance of reality is not synonymous with approval of realty.

Behaviors of distress tolerance are concerned with tolerating and surviving a crisis as well as accepting life as it is right now.

The following are the four sets of crisis survival tactics that are taught in DBT:

1. Distracting
2. Soothing Oneself
3. Improving the Moment
4. Thinking of the Pros and Cons.

The acceptance skills are radical acceptance which switches the mind to focus on acceptance and willingness versus willfulness.

Unit 2: Mindfulness

The necessary part of all the skills that are taught in skills groups are the foundation mindfulness skills.

Patients often ask what they can do to practice foundation mindfulness skills.

The three basic mindfulness “what” skills are as follows:

1. Observe
2. Describe
3. Participate

Additionally, patients often ask how they can practice foundation mindfulness skills.

The three basic mindfulness “how” skills are as follows:

1. Non-Judgmentally
2. One-Mindfully
3. Effectively

Unit 3: Emotion Regulation

Individuals who may be suicidal or who have been diagnosed with BPD are often considered emotionally intense, labile, intensely frustrated, frequently angry, anxious and depressed. If these symptoms and reactions are present, it typically suggests the individual could benefit from assistance in learning to control their emotions.

DBT skills for emotion regulation include the following:

• Learning to appropriately identify and label emotions
• Identifying obstacles for emotions that change
• Reducing vulnerability to “emotion mind”
• Increasing mindfulness to current emotions
• Increasing positive emotional events
• Taking opposite action
• Applying techniques of distress tolerance

Unit 4: Interpersonal Effectiveness

Interpersonal response patterns are how one interacts with others, particularly in personal relationships. DBT’s teaching of these skills has similarities to those taught in interpersonal problem-solving classes. These skills consist of effective strategies for the following:

1. How to ask what you need
2. How to say “no” assertively
3. How to properly cope with inevitable interpersonal conflict

Individuals with BPD often have good interpersonal skills. However, they often have problems applying these skills in certain situations, especially when they are particularly vulnerable or in a volatile situation. Individuals may effectively describe proper behavioral sequences when talking about another individual encountering a challenging situation, but they may be unable to carry out those same behaviors when they find themselves in a similar situation.

This unit focuses on situations where something needs to be changed. Teaching these skills is intended to help individuals meet or exceed their situational goals without damaging their self-respect or relationship.

If you are interested in learning more about DBT and how it may benefit you or a loved one, contact us at Shadow Mountain Therapy.

STEP 7: ASKING GOD TO REMOVE SHORTCOMINGS

Then, it is recommended to move on to Step 7, which is to humbly request God’s help remove one’s shortcomings. When it comes to reviewing your shortcomings, you are essentially revealing your effect on other individuals, and the process will awaken empathy for those individuals you have caused harm to.

Compassion for Others

STEP 8: LISTING WRONGS AND BECOMING WILLING TO MAKE AMENDS

STEP 9: MAKING DIRECT AMENDS WHEN IT IS NOT HARMFUL TO DO SO

For Steps 8 and 9, it is suggested you make amends with those individuals that you had shortcomings with and caused harm to (Step 7), one step further in building a more solid and stable self, compassion, humility, and self-esteem.

Tools for Growth

Spiritual growth and recovery are two things that you have to continuously work on and toward. Luckily, the 12 steps offer daily tools.

STEP 10: SEEKING DAILY ACCOUNTABILITY FOR ACTIONS

Step 10 recommends a continuous inventory and prompt amends as they are necessary. This ultimately builds responsibility and awareness for your attitudes and behaviors while also maintaining a peace of mind.

STEP 11: PRAYING TO IMPROVE CONTACT WITH GOD AND CARRY OUT WHAT IS RIGHT

Step 11 recommends prayer and meditation. These tools help strengthen oneself, improves your mood, increases awareness and honesty, promotes new behavior, and even reduces anxiety. As past behavior as well as ego structures begin to fall away, you will build tolerance for your emptiness experiences that support yourself.

STEP 12: EXPERIENCING A SPIRITUAL AWAKENING AND CARRYING THE MESSAGE TO OTHERS

Step 12 suggests working with other individuals and doing service, and practicing these specific principles in all your affairs. This particular step will lessen your self-centeredness and help you develop compassion. It is self-reinforcing to communicate what you have learned to others around you. It also helps you remember spirituality can’t be practiced in only one part of your life, especially without contamination from other parts. For instance, dishonesty in any part of your life can and will often undermine self-esteem and serenity, which will affect all your relationships.

For more information about the 12 Steps and how they can help you through your recovery, contact us at Shadow Mountain Recovery today.