What is DBT?
Dialectical Behavior Therapy (DBT) is a cognitive behavioral treatment designed for individuals with pervasive emotion dysregulation. DBT’s foundational theory, the biosocial theory, proposes that each person is born with an innate emotional temperament that affects how he or she responds to others and experiences. In DBT, it is believed that emotional vulnerability is rarely the sole cause of psychological problems; an invalidating environment is also a major contributing factor. What, though, is an invalidating environment? It can take the form of a family, community or school that does not identify and support an individual’s emotional experience. This lack of emotional validation can inhibit a person from learning how to label and regulate emotions by failing to treat a person in a manner that conveys attention, respect, and understanding. Per the founder of DBT Marsha Linehan, PhD, examples of an invalidating environment can range from physical, sexual or emotional abuse to a mismatch of personalities between children and parents (e.g., a shy child growing up in a family of extraverts who tease her about her shyness).
DBT is a collaborative treatment approach; the therapeutic relationship is one of equals. DBT involves individual therapy, skills group, telephone coaching, and team consultation for the clinicians. During DBT, participants are asked to complete homework assignments, role-play new ways of interacting with others, and practice skills such as self-soothing when upset. The individual therapist helps the participant to learn, apply and master the DBT skills learned in skills group.
Comprehensive DBT programs are the only type of DBT that have been researched and shown to be empirically effective (see below for more information). Comprehensive DBT program consist of four main components:
- Weekly individual therapy sessions with a DBT-trained clinician,
- Weekly Groups with a DBT trained therapist
- Telephone coaching calls with your individual therapist
- Team consultations for the clinicians to ensure the clinicians are giving the highest quality care. The alternative to a comprehensive DBT program is a component-based DBT program, in which a person either does not participate in all programming aspects or a part of the program is not in-line with the DBT manual written by Marsha Linehan, PhD, the founder of DBT. These treatments are not harmful, and at this time we simply do not have evidence that it works like comprehensive DBT.
During individual weekly sessions, the individual therapist emphasizes problem solving for the past week’s target behaviors. Self-injurious and suicidal behaviors always receive priority, followed by behaviors that may interfere with the therapy process. Behaviors involving substance abuse, eating disorders, posttraumatic stress disorder, relationship conflicts, and other quality of life interfering behaviors and barriers are also discussed.
During weekly skills group sessions, mindfulness, interpersonal effectiveness, distress tolerance and emotion regulation skills are taught.
Who benefits from DBT?
Adolescents and adults who benefit from DBT often are described as having some or all of the following characteristics:
- Very intense emotions that feel all consuming
- Impulsive behaviors
- Rapid mood shifts
- Difficulty establishing and keeping relationships
- Fear of abandoment
- Increased state of sensivity and reacvity to feedback or critisim
- Self harm and/or Suicidal actions or thoughts
- Black and white thinking
Since it’s development, DBT has shown success in treating individuals with borderline personality disorder, depression, bipolar disorder, post-traumatic stress disorder (PTSD), anxiety, eating disorders, and alcohol and drug problems.
Insight Counseling Center, PLLC believes that DBT can assist you in overcoming any barrier in your life that is prohibiting you from living the life you desire!
Where did DBT come from and what are dialectics?
DBT is a modification of standard cognitive behavioral treatment. The founder of DBT, Marsha Linehan, PhD, began her clinical career by using standard CBT techniques in treating people with histories of self-injury and suicide attempts. While this approach worked for some people, others were put off by the constant focus on change ever present in the homework assignments and therapy sessions. Clients expressed that their therapists were underestimating their suffering and overestimating how helpful they were being. Clients got frustrated, shut down and dropped out. Dr. Linehan’s research team, which videotaped all their sessions with clients, began to notice Dr. Linehan’s use of new strategies, now called acceptance strategies, that helped clients tolerate their emotional pain and facilitated clients’ developing goals that emphasized the value of life. Once acceptance strategies were programmatically added to the change strategies inherent in CBT, clients expressed that their therapists understood them much better. Clients reported being more committed to therapy and their dropout rate decreased.
This balance between acceptance and change strategies in therapy formed the fundamental ‘dialectic’ that resulted in DBT’s name. In dialectics, opposing ideas and facts are synthesized in order to find a resolution that reflects the truth of both sides. Therapists and clients constantly work to balance change with acceptance, two seemingly contradictory forces. This balance in therapy purposefully mimics the human struggle, for in DBT, the therapist – client relationship is viewed as an equal comparison to any other person – person relationship.
How do we know DBT works?
Comprehensive DBT is an empirically supported treatment, meaning that it has been researched in randomized clinical trials. The scrutiny to which DBT has been examined is comparable to that of a new medication. While the research on DBT was conducted initially with women who were diagnosed with borderline personality disorder, DBT is now being used for individuals who struggle with eating disorders, binge-eating, depressed and suicidal adolescents, and chronically depressed older clients.