Dialectical behavior therapy

Dialectical Behavior Therapy (DBT) is a comprehensive cognitive-behavioral treatment developed by Marsha M. Linehan in the late 1980s. It was initially designed to treat individuals with borderline personality disorder (BPD) and chronically suicidal individuals. Since its inception, DBT has been adapted for and researched with a variety of populations and is recognized as an effective treatment for a range of mental health issues, including eating disorders, substance use disorders, and post-traumatic stress disorder (PTSD).

Overview

DBT combines standard cognitive-behavioral techniques for emotion regulation and reality-testing with concepts derived from Buddhist meditative practice, such as mindfulness and acceptance. The core philosophy of DBT is the dialectical perspective, which emphasizes the balance between acceptance and change. This approach helps clients increase their emotional and cognitive regulation by learning about the triggers that lead to reactive states and helping to assess which coping skills to apply in the sequence of events, thoughts, feelings, and behaviors to help avoid undesired reactions.

Structure

DBT is structured into four primary modes of treatment delivery:

1. Individual therapy
2. Group skills training
3. Phone coaching
4. Consultation team for therapists

Each mode serves a specific function, contributing to the overall effectiveness of the treatment. The individual therapy focuses on enhancing motivation and helping clients to apply the skills learned in the group sessions to specific challenges and events in their lives. Group skills training sessions are held weekly and are designed to teach skills in four key areas: mindfulness, interpersonal effectiveness, emotion regulation, and distress tolerance. Phone coaching provides clients with real-time support to apply skills effectively in their everyday lives. The consultation team is intended to support therapists in providing the most effective treatment possible.

Core Concepts

1. 1. 1. Mindfulness

Mindfulness is the foundational skill in DBT, based on the concept of being fully aware and present in the moment. This skill is crucial for clients to develop in order to gain control over their mind, rather than being controlled by their thoughts and feelings.

1. 1. 1. Interpersonal Effectiveness

This module focuses on strategies for asking for what one needs, saying no, and coping with interpersonal conflict in a manner that is assertive, maintains self-respect, and strengthens relationships.

1. 1. 1. Emotion Regulation

Emotion regulation skills include identifying and labeling emotions, increasing positive emotional events, increasing mindfulness to current emotions, and taking opposite action.

1. 1. 1. Distress Tolerance

Distress tolerance skills are centered on accepting, finding meaning for, and tolerating distress. This involves understanding and tolerating crisis situations and learning not to make them worse.

Efficacy

Research has shown DBT to be effective in reducing suicidal behavior, psychiatric hospitalization, treatment dropout, substance use, anger, and interpersonal difficulties. Its effectiveness has been demonstrated across a range of settings and populations, making it a versatile tool in the field of mental health treatment.

Training and Dissemination

Training in DBT is available for mental health professionals through various institutes and training centers around the world. The dissemination of DBT has been facilitated by the publication of comprehensive manuals and textbooks, as well as research articles in peer-reviewed journals.

Conclusion

Dialectical Behavior Therapy represents a significant advancement in the treatment of a variety of mental health disorders, offering hope and a path to recovery for many individuals struggling with emotional and behavioral dysregulation.