What Is DBT?
Dialectical Behavioral Therapy
Dialectical Behavior Therapy (DBT) teaches how to accept the reality of your life while also learning to change dysfunctional behaviors and thought patterns that have developed over time.
'Dysfunctional' means it is not working in your life, but that behavior may have served you well in the past. For instance, if someone was in a relationship with a person who was abusive and aggressive, then that person might have learned to not speak up for what they wanted or needed because to do so would make them more likely to get yelled at or hurt in some way. Once the person got out of that relationship, and no longer had anyone in their lives who treated them in abusive ways, there is still a good chance that the person had a more passive communication style because of how it protected her in the past.
We ALL have certain patterns that we have developed over our lives, such as how we judge/talk to ourselves, how we are in our relationships (controlling, clinging, co-dependent, insecure, avoidant, etc.), how we take care of ourselves, or how we cope with stress.
Some patterns might help you feel better temporarily, like avoiding putting yourselves in situations that increase your anxiety, but don't serve you longer-term. DBT skills are designed to both help change what isn't working or serving you, AND how to increase your tolerance to discomfort since you do not often have much control of others around you or the circumstances that happen in your life.
DBT was designed to include both individual therapy and a weekly skills training group. It offers the skills to help clients become effective at managing their emotions, changing their thoughts, improving their coping skills and improving their communication and relationship skills.
Dialectical behavioral therapy (DBT) is a type of cognitive behavioral therapy which tries to identify and change negative thinking patterns. DBT may be used to treat self-destructive behaviors, including suicidal behaviors. It teaches patients skills to cope with, and change, unhealthy behaviors.
The term "dialectical" comes from the idea that bringing together two opposites in therapy -- acceptance and change -- brings better results than either one alone. A unique aspect of DBT is its focus on acceptance of a patient's experience as a way for therapists to reassure them -- and balance the work needed to change negative behaviors.
DBT is a research-supported treatment which combines cognitive-behavioral theory and Eastern principles. Developed by Dr. Marsha Linehan and her colleagues at the University of Washington, DBT helps in regulating emotions, behavior, and thinking.
Dialectical behavioral therapy focuses on high-risk, tough-to-treat patients. These patients often have multiple diagnoses. DBT was initially designed to treat people with suicidal behavior and borderline personality disorder. But it has been adapted for other mental health problems that threaten a person's safety, relationships, work, and emotional well-being.
The American Psychiatric Association has endorsed DBT as effective in treating borderline personality disorder. Patients who undergo DBT have seen improvements such as: less frequent and less severe suicidal behavior; shorter hospitalizations; less anger; less likely to drop out of treatment; and improved social functioning.
While DBT was designed for individuals with borderline personality disorder, it is used for patients with other diagnoses as well. Many clients with mood disorders such as depression, anxiety and bipolar disorders find DBT particularly helpful.
Psychotherapy using DBT has been shown to be most effective by doing both individual and group therapy sessions.
Patients agree to do homework to practice new skills.
The FOUR modules of DBT
1) Emotion Regulation: Learning how to understand your emotions and how to reduce the intensity of emotions
2) Mindfulness: Learning how to live more in the present moment and have more control of your mind
3) Interpersonal Effectiveness: Learning how to build and maintain relationships
4) Distress Tolerance: Learning how to tolerate and accept painful times without making things worse.
DBT SKILLS
Decrease problematic, impulsive and/or addictive behaviors, like self-injury, temper outbursts and substance use.
Regulate strong and intense emotions.
Improve social, relationship, and communication skills.
Increase self-awareness, insight and judgment.
The Four Parts of DBT
Individual therapy
Group skills training
Phone coaching, if needed for crises between sessions, and
Consultation group for health care providers to stay motivated and discuss patient care.
About Marsha Linehan
This is a partial story about Dr. Marsha M. Linehan, the founder of DBT, from an article in The New York Times.
Dr. Linehan was sent to the Institute of Living in Hartford, Connecticut at the age of 17. She was kept in the seclusion room, which was reserved for the most severely ill patients. The staff saw no alternative as she attacked herself habitually, burned her wrists with cigarettes, and slashed her arms, her legs, her midsection, using any sharp object she could get her hands on.
Because the small seclusion room had only a bed, a chair and a barred window, there were no weapons that Marsha could use for self-harm. So she did the only thing that made any sense to her at the time - she banged her head, hard, against the wall and the floor.
A discharge summary, dated May 31, 1963, noted that “during 26 months of hospitalization, Miss Linehan was, for a considerable part of this time, one of the most disturbed patients in the hospital.”My whole experience of these episodes was that someone else was doing it; it was like ‘I know this is coming, I’m out of control, somebody help me; where are you, God?’ ” she said. “I felt totally empty, like the Tin Man; I had no way to communicate what was going on, no way to understand it.”’s was driven by a mission to rescue people who are chronically suicidal, often as a result of borderline personality disorder, an enigmatic condition characterized in part by self-destructive urges. “I honestly didn’t realize at the time that I was dealing with myself,” she said. “But I suppose it’s true that I developed a therapy that provides the things I needed for so many years and never got.”