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What Is DBT Therapy?

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In the world of therapy and psychology, there are many different ways to treat the various issues that may arise stemming from mental health disorders. The most popular version that the average person imagines when they hear the word therapy is most likely psychotherapy or talk therapy through a individual therapist.

A person sitting in an office and discussing the problems they experience — and their thoughts and emotions on those experiences —  with a licensed therapist who is listening intently is the traditional image of psychotherapy. Although technically correct, the term “talk therapy” falls woefully short of what exactly occurs during a session and fails to define the many versions of what falls under the umbrella of talk therapy. 

What Is Talk Therapy? 

Talk therapy is exactly what it sounds like as it involves talking to a professional therapist about their thoughts and feelings. Often in life, we undergo amateur versions of talk therapy when we vent to family, friends, or significant others. The difference between this and talk therapy is, of course, the training involved of the listener. 

Talk therapy gives people the opportunity to explore their thoughts and feelings along with the effect they may have on their behavior and mood. By describing what is going on in their head and specifically how it makes them feel, they can begin to notice patterns that would be helpful to change. The more focus put on the thoughts and feelings then the easier it will be to figure out where negative feelings and patterns come from and why they exist. Some additional names of talk therapy may include:

  • Talking treatments
  • Counseling
  • Psychological therapy or treatment
  • Psychotherapy
  • Psychoanalysis
  • Clinical therapy

There are several different types of talk therapy, but they can mostly be boiled down to four distinct versions:

  • Cognitive behavior therapy (CBT)
  • Dialectical behavior therapy
  • Psychodynamic therapy
  • Humanistic therapy

What Is Cognitive Behavior Therapy? 

Before we can define dialectical behavior therapy, we must first understand cognitive behavior therapy. While dialectical behavior therapy is its own separate entity, it relies heavily on cognitive behavior therapy and its model. Cognitive behavior therapy is a form of psychological treatment that has been proven highly effective for a range of problems that includes anxiety, depression, suicidal behavior, self-injury, alcohol , and substance abuse, eating disorders, relationship problems, and severe mental illness

There have been numerous studies suggesting that cognitive behavior therapy leads to significant improvements in functionality and quality of life. Cognitive behavior therapy is often proven to be just as effective, if not more effective, than other forms of psychological therapy and even psychiatric medications. These are the core principles on which cognitive behavioral treatment is based on:

  • Psychological problems are the result, at least in part, of unhelpful, flawed, or negative ways of thinking
  • Psychological problems are the result, at least in part, of learned patterns of unhelpful, flawed, or negative behavior.
  • People that suffer from psychological problems can learn better ways to cope with them, which will relieve their symptoms and improve their lives.

The main idea of cognitive behavior therapy is to change the thinking patterns of an individual and therefore alter their behavior, reducing their mental health issues and improving their lives. These are some of the strategies used in order to change negative thinking:

  • Learn how to recognize how their distortions in thinking are creating problems and then to reevaluate these problems in light of reality
  • Gain a better understanding of the behaviors and motivations of other people
  • Use problem-solving skills to cope with the difficult situations faced in life
  • Learn to develop a greater sense of confidence in their own abilities

Other strategies used to directly influence altering behavior may include:

  • Facing their fears as opposed to avoiding them (often called exposure therapy)
  • Using role-playing to prepare for potentially difficult or problematic interactions (often called play therapy)
  • Learning to calm their minds and bodies in the events of stress or anxiety

What Is Dialectical Behavior Therapy

Now that we understand what talk therapy and cognitive behavior therapy are, we can finally get to defining what dialectical behavior therapy means. As mentioned before, dialectical behavior therapy is a type of cognitive behavior therapy. Its main goals are to teach people how to live in the moment, develop healthy ways to cope with stress, regulate their emotions, and improve their relationships with other people. 

What Does Dialectical Behavior Treat? 

Dialectical behavior therapy was originally intended in treating borderline personality disorder. However it has since been adapted in order to treat other mental health illnesses and emotional regulation as well. Other such issues that dialectical behavior therapy and DBT skills can help to treat include: 

  • Attention deficit hyperactivity disorder
  • Bipolar disorder
  • Eating disorders (anorexia, binge eating, bulimia)
  • Generalized anxiety disorder
  • Major depressive disorder
  • Obsessive-compulsive disorder
  • Substance use disorder
  • Post Traumatic stress disorder

History of Dialectical Behavior Therapy

In the late 1980s, Dr. Marsha Linehan and her colleagues discovered dialectical behavior therapy when they noticed that cognitive behavioral therapy alone was not working very well in treatments of outpatients with a borderline personality disorder. As a result, Dr. Linehan and her team added in techniques and new skills to develop a new effective treatment to meet the unique needs of patients suffering from this particular mental illness

One of the additions made was to incorporate the philosophical process known as dialectics. This concept is based on everything being composed of opposites and that change occurs when there is a “dialogue” between the opposing forces. In other words, dialectics is summarized by thesis, antithesis, and synthesis, and the process makes three assumptions:

  • All things are interconnected with one another.
  • Change is a constant and inevitable force.
  • Opposites can be integrated in order to form a closer approximation to the truth.

Another technique Linehan and her colleagues added was validation. They found that when validation was used along with the push for change, patients were much more likely to cooperate and less likely to refute the idea of change.

In practice, the DBT therapist will validate that a patient’s actions “make sense” within the context of their personal experience without necessarily agreeing that these actions are the best approach to problem-solving

How Dialectical Behavior Therapy Works

Since its origins in the 1980s, dialectical behavior therapy has evolved into an evidence-based psychotherapy approach that can be used to treat many different conditions in three separate settings:

  • Group settings: Patients are taught behavioral skills training by completing “homework” assignments as well as role-playing new ways of positively interacting with others
  • Individual therapy: A trained professional will meet with a patient, and their learned behavioral skills are adapted to their own personal challenges in life. 
  • Phone coaching: Patients have the option to call the therapist between sessions in order to receive guidance on how to cope with a difficult situation they are currently facing. 

Each therapeutic setting will naturally result in it’s own structure and goals, but the main characteristics of dialectical behavior therapy will remain the same. These include:

  • Acceptance and Change: Learning strategies to accept and tolerant life circumstances, emotions, and who they are as an individual. They are developing skills, through DBT skills training, that will help them make positive changes in their various behaviors and interactions with others.
  • Behavioral: Learning how to analyze problems or destructive patterns of behavior while replacing them with healthier and effective alternatives. 
  • Cognitive: Focusing on changing thoughts, beliefs, behaviors, and actions that are not effective or helpful in life.
  • Collaboration: Learning how to communicate more effectively and improved ability to work as a part of a team
  • Support: Learning how to recognize positive strengths and attributes within and use them effectively. 

The Strategies of Dialectical Behavior Therapy 

Anyone undergoing dialectical behavior therapy will be taught four different strategies in order to help them effectively change their behavior. They are as follows:

  • Core mindfulness: Arguably, the most important strategy is to develop mindfulness skills. Mindfulness is what helps a person to focus on the present and to better “live in the moment.” This will help someone to pay more attention to what is happening to them in regard to thoughts, feelings, sensations and impulses as well as using their senses to see, hear, smell and touch the world around them. Mindfulness skills will help someone slow down and focus on utilizing healthy coping skills while suffering emotional pain and can help to avoid automatic negative thinking patterns and impulsive behavior. 
  • Distress tolerance: Developing this skill will help someone to accept themself and their current situation. This technique involves learning the four ways for handling a crisis which are: distraction, improving the moment, self-soothing, and thinking of the pros and cons of not tolerating distress. Distress tolerance will help to prepare someone for intense emotions and empower them to cope with more positive long-term outlooks.
  • Interpersonal effectiveness: This strategy will allow someone to become more assertive in their relationships, such as expressing their needs and being able to say “no” while still keeping the relationship healthy and positive. It will also teach the individual how to listen and communicate more effectively, deal with challenging and frustrating people and develop respect for themselves and others. 
  • Emotion regulation: This will help the individual learn to navigate powerful feelings more effectively by helping them identify, name and change their emotions. When someone is able to recognize and cope with an intense negative emotion (such as anger), they are able to reduce their emotional vulnerability toward it.

The Takeaway 

Dialectical behavior therapy is a type of therapy that mixes science and philosophy in order to better help people suffering from various mental illnesses. The ultimate goal is to help a person recognize their negative thinking patterns and behaviors and replace them with better and healthier alternatives. 

Dialectical behavior therapy can be a little difficult to explain, but it is one of the more effective forms of therapy and to bolster self-respect. While on the surface, it may seem like just talking with a medical professional. Underneath, there are lots of changes happening internally. Ultimately, by adjusting negative thinking patterns and behaviors, a person will be able to greatly enhance their quality of life. If you or any of your loved ones would benefit from such treatment or a DBT program or has thoughts of self-harm seek advice from a healthcare provider.

Sources

  1. How Dialectical Behavior Therapy (DBT) Works (verywellmind.com)
  2. Talking therapies (mentalhealth.org.uk)
  3. What Is Cognitive Behavioral Therapy? (apa.org) 

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