Dialectical Behavior Therapy (DBT) is a form of Cognitive Behavioral Therapy that was originally developed to treat individuals who were chronically suicidal and had borderline personality disorder. The National Institute of Mental Health reports that as many as 80 percent of people suffering from BPD have suicidal tendencies. According to the National Alliance on Mental Illness, psychologist Marsha Linehan used her own experience with borderline personality disorder to develop DBT. Dialectical Behavior Therapy is now commonly used to treat the population for whom it was developed, as well as to treat those who are suffering from substance use disorder, post-traumatic stress disorder, depression, and eating disorders.
Validation: The Foundation of DBT
Dialectical Behavioral Therapy differs from traditional Cognitive Behavioral Therapy in its focus on validation, which occurs when the therapist helps the client accept uncomfortable thoughts, behaviors, and feelings instead of fighting against them. Once the client validates a thought, behavior, or feeling, the idea of changing it is no longer overwhelming or seemingly impossible. DBT helps clients experience a gradual transformation, and “dialectics” refers to Dr. Linehan’s original goal of finding the balance between acceptance and change. Once clients find that balance, they can develop the coping skills needed to combat the symptoms of their illness that are most disabling.
There are four main components of standard Dialectical Behavior Therapy. They are:
- Skills training group: This part of DBT attempts to teach clients behavioral skills to increase their coping capabilities. The skills training group is run like a regular class, during which the leader demonstrates the skills and gives homework assignments that get the clients practicing the skills outside of the group setting. The group is typically held on a weekly basis for 2.5 hours at a time. It take approximately 24 weeks for the group leader to get through the entire skills curriculum. Shorter programs that focus on a portion of the skills are available in certain settings.
- Individual therapy: In the individual portion of DBT, the therapist focuses on increasing the client’s motivation when it comes to applying the skills to everyday life situations. In most programs, clients attend individual therapy sessions once a week for as long as the skills training group lasts.
- Phone coaching: Through phone coaching, clients have access to guidance on how to use their new skills in difficult situations as they arise. Phone coaching occurs between therapy sessions when the client is in need of immediate help.
- Therapist consultation team: The therapist consultation team provides support to the DBT providers who are working with individuals with complex disorders that are difficult to treat. The team helps the therapists stay motivated so they can continue providing the best treatment possible for their clients. Teams are usually composed of individual therapists and group leaders, and they meet on a weekly basis.
Behavioral Skills Taught in DBT
In Dialectical Behavior Therapy, group leaders focus on teaching four sets of behavioral skills: mindfulness, distress tolerance, interpersonal effectiveness, and emotion regulation.
According to a review originally published in Psychiatry MMC, mindfulness helps clients focus on the present and remain fully aware of each moment. Clients working on mindfulness skills learn how to participate fully in their present activity and to observe their current experience in a nonjudgmental way.
Through distress tolerance, individuals learn how to tolerate pain rather than attempt to change it. Distress tolerance is especially important for individuals who are struggling with substance abuse because it helps them accept uncomfortable withdrawal symptoms rather than attempt to eliminate those symptoms by using again.
Interpersonal effectiveness refers to the skills that individuals need in order to ask for what they want and to decline what they do not want while maintaining healthy relationships with others.
Emotional regulation skills help clients learn how to identify and address emotions they want to change.
Benefits of Dialectical Behavior Therapy
Dialectical Behavior Therapy is a comprehensive form of treatment that requires a significant level of participation and commitment from clients. Individuals suffering from a number of mental illnesses are well suited for it.
DBT can be used to treat people with a variety of signs and symptoms, including:
- Continuous conflict in their relationships
- Intense mood swings
- Reacting impulsively and regretting it later
- Bottling up feelings and then losing control
Though it was not originally developed to treat substance use disorders, a review originally published in Addiction Science & Clinical Practice reports that Dialectical Behavior Therapy can successfully decrease substance abuse in clients who have borderline personality disorder; however, nearly anyone can benefit from the skills that are taught in DBT.
For example, mindfulness is essentially living in the moment, and practicing mindfulness is an effective way to identify emotions and then use those emotions to make healthy, informed decisions. Likewise, learning to accept reality as it is, including the most painful or traumatic events that have occurred, can help anyone lead a more productive and fulfilling life.
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DBT Success Rates
According to the American Psychological Association, up to 30 percent of individuals who need mental health services are suffering from at least one personality disorder. There is an entire spectrum of maladaptive feelings and behaviors that characterizes personality disorders, but most individuals suffering from one have something in common: Their mental illness is unlikely to improve without professional help.
Dialectical Behavior Therapy is an intensive form of treatment, and it is more effective for some individuals than others. Extensive research has been done on DBT for BPD, but there is not enough information to accurately assess its effectiveness for people with substance use disorders. However, Cognitive Behavioral Therapy in general has proven to be an effective part of treatment programs for addiction, and research has shown that DBT is most effective for clients who actually finish the program.
Because Dialectical Behavior Therapy is so comprehensive, it is one of the more expensive forms of therapy used to treat substance use disorders.
According to a review published in Psychotherapy and Psychosomatics, DBT is effective at reducing self-harm among individuals with BPD, but it can result in higher total treatment costs. Many insurance plans cover DBT for the treatment of borderline personality disorder though, and many other plans cover rehabilitation programs that offer DBT as part of their care plan. Dialectical Behavior Therapy is just one form of treatment for addiction, but it has helped a lot of people change their mindset in a positive way and ultimately enter long-term recovery.
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