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Sunday, June 24, 2018

Dialectical Behavioral Therapy

What is Dialectical Behavioral Therapy (DBT)?

 

Dialectical Behavior Therapy was originally developed by Marsha Linehan (1993) as a treatment for Borderline Personality Disorder (BPD). The focus in DBT is on an integration of acceptance and change. A primary component is Mindfulness, which originates in the practice of Buddhism and entails a present-centered approach and emphasis on moment-to-moment experience. Essentially, Cognitive Behavioral Therapy (CBT) was integrated with this concept of mindfulness to help patients with BPD, who usually have histories of invalidation from one or more caretakers, to balance their need for validation with practical strategies for change. Many patients with BPD suffer from chronic emotion dysregulation, and Linehan’s model was created primarily to deal with this issue, which she was finding much resistance to using classic CBT.  DBT treatment involves four significant modules: Core Mindfulness Skills, Interpersonal Effectiveness Skills, Emotion Regulation Skills, and Distress Tolerance Skills.

 

Since its inception, Dialectical Behavioral Therapy has been shown to be useful for a variety of conditions and disorders besides BPD, ranging from depression to substance abuse, to anger management. It has also been extremely beneficial for those who want some help with regulating their emotions and increasing their repertoire of coping skills for life circumstances.

 

Dialectal Behavioral Therapy was designed to treat people with suicidal and para-suicidal behaviors and is also used in working with people that have borderline personality disorder.  Since then, literature has shown that components of DBT can be helpful in treating people with addictions. “Dialectics” is an old term from ancient Greece that refers to finding truth by synthesizing a concept with its opposite.  By first examining the opposing side of an issue, you can synthesize the two, and in the synthesis, you find the truth. This is very helpful to people that tend to be polarized and think regarding all good or all bad, which can certainly be true for many people in early recovery.

 

DBT stresses the concepts of the following as tools for positive change:
    • Mindfulness
    • Self-Acceptance
    • Non-Judgmental Observation
DBT is made up of several components.  It requires highly trained individual therapists, to monitor and guide clients through the therapeutic process. It involves skills training, which consists of mindfulness training, emotional management, and other procedures. It requires telephone consultations so that the therapist can be accessed frequently to help support and encourage clients so that they can apply their recently-learned skills in real-life scenarios.

 

The final component is the consultation team, which consists of us therapists—all of those folks who are providing the DBT—working together and staffing cases.  Collaboration helps us to be mindful and effective while applying the techniques. Here’s an example of how DBT can be useful to those working to overcome addiction. One of the reasons that people relapse is that they have difficulty managing anxiety, and one of the things that DBT teaches is emotional management skills. If somebody can learn how to build and use these skills with the help of a therapist or skills coach, they can then apply these skills at the moment they’re experiencing the anxiety, so that anxiety doesn’t turn into a relapse trigger.

 

Family therapy sessions are also conducted to help the family cope with a BPD family member and deal with the situation. In some instances where the individuals suffering from BPD might be a threat to themselves or others. Psychiatric medications are often prescribed based on specific target symptoms shown by the individual patient. Antidepressant drugs and mood stabilizers may be helpful for depressed and labile mood. Anti-Psychotic drugs may also be taken when there are distortions in thinking.

 

According to the National Mental Health Institute, treatments for BPD have improved in recent years. They suggest that group and individual psychotherapy are at least partially effective for many patients. Within the past 15 years, a new psychosocial treatment termed dialectical behavior therapy (DBT) was developed specifically to treat BPD, and this technique has looked promising in treatment studies.

 

Integration of Cognitive Behavioral Therapy and Dialectical Behavioral Therapy with an underlying psychodynamic model of conceptualization to be very beneficial for most patients.