Dialectical Behavior Therapy (DBT)

What is Dialectical Behavior Therapy? 

DBT is a type of cognitive behavioral therapy (CBT) that focuses on the acceptance of a patient’s experience. It attempts to identify and change negative thinking patterns and behaviors and encourages positive outcomes.

Four Methods of Dialectical Behavior Therapy

Therapists use four methods to administer DBT:

• One-on-one therapy sessions
• Group counseling
• A therapist consultation team
• Phone coaching

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What are the Techniques Used in DBT?

There are a couple of distinct behavioral skills DBT therapists use to treat patients.

These include:

Mindfulness

Mindfulness is a technique adapted from meditation practices. It stresses focusing on one's breathing in order to "live in the present."

People use these breathing techniques to slow down the situation and separate their thoughts from their emotions.

This skill is useful for regaining control over a stressful situation or dealing with painful emotions. It's particularly effective with adolescents.

Distress Tolerance

Distress tolerance is about finding productive ways to distract oneself from difficult emotions until they pass.

Some methods here include:

• Bringing down your body temperature (via turning on the AC or a splash of cold water) to literally "cool off."
• Using intense exercise (ex: sprints, swimming, etc)
• Paired muscle relaxation: tightening and then loosening your muscles, causing your whole body to feel more relaxed
• Controlled breathing exercises

Emotional Regulation

The inability to control one's emotions is called emotional dysregulation. Unlike distress tolerance and mindfulness, emotional regulation is all about preventing painful emotions from bubbling up to begin with.

People are taught to accurately label the emotions they are feeling. Accurately describing the emotion at hand makes it easier to deal with.

The person also learns to distinguish between primary emotions and the harmful secondary reactions which can result. For example, anger from being disrespected can lead to reactions like rapid heartrate, trembling, and tears in the eyes.

Emotional regulation is about learning to not give into those primary emotional impulses.

Interpersonal Effectiveness

Managing interpersonal effectiveness means learning how to deal with interpersonal conflict in a productive manner. The person learns to stop apologizing needlessly and assert themselves, as well as basic social skills. This leads to increased self-esteem.

Some interpersonal effectiveness examples include:

• Listening skills
• Empathy
• Conflict management
• Diplomacy
• Using humor to defuse a tense situation
• Learning non-verbal communication (body language, tone of voice, etc)
• Sensitivity toward the needs of others
• Learning how to give and take feedback

Who Benefits From DBT?

DBT can be used to treat the following:

• Suicidal thoughts: are often the result of stress, depression, or anxiety. People with substance use disorders are at a higher risk of suicidal thoughts.
• Borderline personality disorder (BPD): is a mental health disorder marked by a constant pattern of mood swings and severe changes in self-image, and behavior.
• Substance use disorders (SUD): involve physical or psychological dependence on drugs or alcohol.
• Co-occurring disorders: This is when a person is diagnosed with a mental health disorder as well as an SUD. It's also known as a dual diagnosis.
• Binge-eating disorder (BED): a common eating disorder where a person habitually overeats to the point where it is detrimental to their health.
• Depression in elderly patients: a serious mood disorder that is often ignored or misdiagnosed in elderly patients. 

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Dialectical Behavior Therapy (DBT) vs. Cognitive Behavioral Therapy (CBT)

CBT and DBT are both considered psychotherapy, or talk therapy. 

CBT is structured, short-term, goal-oriented, and focused on the present. It begins with education about the disorder and how it affects the patient.

Then you learn and practice skills to help make changes in your thoughts, feelings, and behaviors. The skills you learn to deal with present problems will help you deal with problems in the future.

DBT is based on CBT, but with a greater emphasis placed on emotions, mindfulness, and social aspects. Validation (accepting yourself) and relationships are cornerstones of DBT. It shows the patient that what they're going through is real and teaches them how to accept their situation.

DBT For Substance Use Disorders

DBT for substance use disorders helps by focusing on the following behavioral targets:

• Decreasing substance abuse
• Helping reduce physical discomfort from withdrawal
• Managing and reducing urges, cravings, and temptations to use
• Avoiding triggers and separating yourself from past people, places, and items that give you opportunities to use
• Reducing behaviors conducive to substance use
• Building community reinforcement of healthy behaviors and relationships

There are 4 main stages of DBT treatment for substance use disorders:

1: Out of control to in control

The first stage focuses on decreasing reckless and dangerous behaviors. Patients also practice valuable skills like distress tolerance and mindfulness.

2: Emotionally unavailable to emotionally engaged

People often shut off emotions when they become too difficult to manage. In this stage, patients practice experiencing emotions fully without using substances to escape them.

3: Building a normal life and solving normal problems

In this stage, the treatment shifts from focusing on extreme symptoms to more common problems such as relationships, work problems, life goals, and other emotional issues.

4: Feeling incomplete to feeling complete/connected

While the first three stages aim at reducing harmful or unwanted symptoms, step 4 focuses on building happiness. DBT accomplishes this by connecting with the world around you.

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What Should You Expect During Dialectical Behavior Therapy?

DBT therapy usually involves individual therapy sessions and skills groups.

Individual therapy meetings consist of one-on-one contact with a professionally trained therapist to address your therapeutic needs.

Your therapist will help you:

• Remain motivated
• Apply DBT skills into everyday life
• Address obstacles or problems that may occur during treatment

In skills groups, members learn and practice skills with others. Participants are encouraged to share their experiences and provide support. Groups are led by one expert therapist conducting exercises and teaching skills.

Participants are assigned homework, like practicing mindfulness exercises. Each group session lasts for around two hours, and groups usually meet weekly for about six months. Groups can be shorter or longer, depending on the requirements of participants.

There are various ways DBT therapists can provide treatment. For example, some people attend one-on-one therapy sessions without participating in weekly skills groups. Others may decide to meet with the group without consistent one-on-one sessions.

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