What is Dialectical Behavior Therapy?

Dialectical Behavior Therapy (DBT) is a type of psychotherapy that teaches people new skills to help manage their emotions and decrease conflict in relationships. It focuses specifically on therapeutic skills in 4 key areas. There are 4 main skills that are focused on in DBT and they are:

1. Mindfulness: Focuses on improving the ability to accept and be present within the moment
2. Distress tolerance: Aimed towards increasing the tolerance for negative emotions rather than trying to escape them.
3. Emotional regulation: A method and a strategy used to manage and change emotions that are high intensity and causing problems in a person’s life.
4. Interpersonal effectiveness: Techniques that allow the individual to communicate with others assertively. This allows for maintaining self-respect and strengthens relationships.

When is Dialectical Behavior Therapy Used?

Originally used to treat borderline personality disorder, it is also commonly used to treat:

• Depression
• Binge-eating
• Bulimia
• Post-traumatic stress disorder (PTSD)
• Bipolar disorder
• Any form of substance use disorder (SUD)

DBT skills are believed to help people improve and regulate their emotions. Therefore, allowing for more tolerance of distress and negative emotions. This then allows the person to be mindful and present in the moment, improving communication and the ability to interact with other people better.

What is Dialectical Behavior Therapy Like?

Typically, DBT treatment is made up of individual therapy sessions and DBT skills groups. Of course, individual therapy sessions are one-on-one contact with a trained therapist, making sure that all beneficial needs are being met. The therapist will help the individual stay motivated, use the DBT skills in daily life, and discuss obstacles that might come up during treatment.  People who take part in DBT skills groups learn and practice skills along with others.  Group members are encouraged to share their experiences and provide support. Groups are led by one trained therapist who teaches skills and leads exercises. The group members are assigned homework such as practicing mindfulness exercises. Each group session lasts about two hours and usually meets weekly for six months. However, groups can be shorter or longer depending on the needs of the members. But DBT can be delivered by the therapist in different ways. For example, some people complete individual therapy sessions without the weekly skills group. And others might choose the skills group only, without the regular one-on-one sessions.

What is Cognitive Behavioral Therapy?

Like DBT, cognitive behavioral therapy (CBT) is also a form of psychotherapy that aims to change impaired emotions, behaviors, and thoughts by questioning and uprooting negative and illogical beliefs. CBT is a “solutions-oriented” form of talk therapy based on the idea that your thoughts and impressions influence your behavior. In some cases, feeling distressed can distort your vision of reality. CBT helps you identify harmful thoughts and determine whether they are an accurate picture of reality. If they aren’t, you will learn to use strategies to challenge and overcome them.

How Are CBT and DBT Different?

CBT and DBT are two forms of talk therapy. In both cases, you work with a mental health professional to learn more about the challenges you have and to learn new skills to help you handle the challenges on your own. Cognitive-behavioral therapy focuses on the way your thoughts, feelings, and behavior influence each other. For example, if you believe that people don’t like you (thought), you might avoid social situations (behavior) and end up feeling lonely (feeling). However, CBT teaches you how to use these relationships to your advantage. For instance, a positive change in one factor (changing a thought or behavior) can lead to positive changes in all factors. It’s structured, short-term, goal-oriented, and focused on the present. Although DBT also works on these things and is based on CBT, it puts more emphasis on emotional and social aspects. It was developed to help people cope with extreme or unstable emotions and harmful behaviors. Additionally, dialectical behavior therapy helps people find ways to accept themselves, feel safe, and manage their emotions. The purpose is to help regulate possibly harmful or destructive behaviors.

How Does Dialectical Behavior Therapy Work?

DBT is a cognitive behavioral treatment developed by Dr. Marsha Linehan in the 1980s to treat people with borderline personality disorder (BPD). People diagnosed with BPD often have extremely intense negative emotions that are hard to manage. These seemingly uncontrollable emotions typically occur when interacting with others — friends, romantic partners, and family members. 

Dialectics — Acceptance, and Change

DBT is influenced by the abstract view of “dialectics,” which means the integration of opposites. The therapist works with the individual to try to find ways to hold two seemingly opposite viewpoints at once. Doing this promotes balance and avoids the black and white, the all-or-nothing styles of thinking. To support this balance, DBT promotes a “both-and” instead of an “either-or” outlook. The dialectic at the core of DBT is the seemingly opposite strategies of acceptance and change. Dr. Linehan developed DBT to treat continually suicidal individuals. Later on, it was adapted for use with people with both severe substance use disorder and borderline personality disorder — one of the most common dual diagnoses in SUD and mental health clinical practice. The person’s therapist is the main treatment provider in DBT. The therapist takes the responsibility for developing and maintaining the treatment plan.

Five Functions of Treatment

DBT treatment includes five necessary functions:

• Improving motivation to change
• Enhancing individual’s capabilities
• Generalizing new behaviors
• Structuring the environment
• Improving therapist capability and motivation

The Four Elements of DBT

In therapy, the previous 5 functions are expressed through these 4 elements:

1. Skills Training Group: A DBT skills training group is focused on improving individuals’ capabilities by teaching them behavioral skills. The group is like a class where the group leader teaches the skills and assigns homework.
2. Individual Therapy: Individual therapy is focused on improving the individual’s motivation and helping them apply the skills to certain challenges and events in their lives.
3. Phone Coaching: Phone coaching is aimed at providing people with in-the-moment coaching on how to use skills to effectively deal with real situations that occur in their everyday lives. People can call their therapist to receive coaching when they need help the most.
4. Therapist Consultation Team: The therapist consultation team is meant to be therapy for the therapists and to support DBT providers in their work. The consultation team helps therapists stay motivated and capable so they can provide the best treatment possible.

What Are Dialectical Behavior Therapy Treatment Targets?

People who receive dialectical behavior therapy usually have several problems that need treatment. DBT prioritizes treatment targets to help the therapist decide in what order the problems should be handled. The treatment targets in their order of priority are:

• Life-threatening behaviors: First of all, behaviors that could lead to death are targeted. This includes suicide communications, suicidal ideas, and any forms of suicidal and non-suicidal self-injury.
• Therapy-interfering behaviors: Any behavior that interferes with the person receiving effective treatment. This can be on the part of the individual being treated or the therapist. These include coming late to sessions, canceling appointments, and being non-cooperative in working towards treatment goals.
• Quality of life behaviors: This includes any other type of behavior that interferes with having a reasonable quality of life such as SUDs, mental disorders, relationship issues, and financial or housing problems.
• Skills acquisition: This is the need for individuals in treatment to learn new skillful behaviors to replace behaviors that weren’t effective and help them achieve their goals.

DBT Treatment Targets for Individuals with SUD

For people with SUD, substance use is the highest order target within the category of behaviors that interfere with the quality of life. SUD-specific behavioral targets include:

• Decreasing the use of substances including illicit drugs and prescribed drugs that are being misused
• Relieving physical discomfort related to abstinence and/or withdrawal
• Lowering urges, cravings, and temptations to use
• Avoiding triggers and cues to use drugs or alcohol
• Reducing behaviors that contribute to drug use
• Increasing community reinforcement of healthy behaviors such as, finding new friends, getting involved in social and vocational activities, and finding environments that support abstinence

The DBT Approach to Abstinence

In the search for abstinence, the DBT dialectic takes the form of pushing for the immediate and permanent end of drug use (change). At the same time, understanding the fact that a relapse, if it happens, doesn’t mean that the individual with addiction can’t achieve the wanted result (acceptance). The therapist relays the expectation of abstinence in the first session by asking the individual to commit to stop drug use immediately. But a lifetime of abstinence might seem impossible to reach, so the therapist encourages a commitment to a length of time that the person believes is achievable. At the end of the period, the person renews the commitment again. Eventually, he achieves long-term abstinence.

Coping Ahead

Another strategy teaches people to “cope ahead.” This involves learning the behavioral skill of recognizing possible triggers in the coming moments, hours, or days and then preparing responses to high-risk situations. In addition, the individual is encouraged to “burn the bridges” to his drug-using past. 

Encouraging Acceptance

DBT sees relapse as a problem to solve. It is not the result of personal inadequacy or failure of the treatment. If the person does have a “slip” and relapse, the therapist guides the individual in recognizing the events that led to and followed the relapse. Thereby learning all that can be learned and applied to future situations. This way the therapist can help the individual make a quick recovery from the relapse.

Can Dialectical Behavior Therapy Help You?

Are you a woman suffering from a substance use disorder? Is someone close to you suffering from a drug dependency? New Directions for Women is a female-only facility dedicated to helping women recover from addiction and any co-occurring disorder. And DBT was specifically developed for that purpose. Our licensed therapists are prepared to help you understand the nature and extent of your disorder. We are experienced in helping women who are pregnant, and women with dependent children. Contact us now. We are available to answer your questions or just talk. New Directions can set you on the road to life-long abstinence and your opportunity to live a full life. References: www.betterhelp.com www.psychologytoday.com www.heretohelp.bc.ca www.depts.washington.edu www.ncbi.nlm.nih.gov/pmc