Dialectical behavior therapy (DBT)
Dialectical behavior therapy (DBT)
Developed for helping clients to regulate emotions and behavior associated with depression, this paradoxical treatment not only helps the clients to accept their emotions but also to change their emotional experience (Morgan, 2005).
What to expect?
The practice of acceptance exclusively include being in the present moment, perceiving reality as it is without distortions, without evaluation, without judgment, and without trying to hang on to an experience or to get rid of it. It involves involving fully into activities of the present moment without separating oneself from ongoing events and interactions. Conceptualized by Linehan (1993a, 1993b) , DBT is a ambitious and promising blend of behavioral and psychoanalytic techniques which was actually for treating borderline personality disorders (BPD).
How does it works?
DBT is composed of affect regulation, distress tolerance, improvement in interpersonal relationships, and mindfulness training. DBT employs behavioral techniques, like a form of exposure therapy in which the client is helped to learns to tolerate painful emotions without involving self-destructive behaviors. DBT integrates its cognitive behaviorism with analytic concepts as well as with the mindfulness training of “Eastern psychological and spiritual practices (primarily Zen practice)”
A unique thing about DBT is its focus on acceptance of a patient's experience as a therapeutic way to reassure them and balance the work which is required to change negative behaviors. A Standard and comprehensive DBT has the following parts:
- Individual therapy
- Group skills training
- Phone coaching, as and when required during the crises between sessions.
Patients agree to do homework which is to make them practice new skills. This sometimes includes filling out daily "diary cards" so that track of more than 40 emotions, behaviors, urges, and skills, such as lying, self-injury, or self-respect. This part is adapted from Cognitive Behaviour Therapy. A Comprehensive DBT focuses on the following ways to enhance life skills:
- Distress tolerance: The patients are encouraged to feel intense emotions like anger without reacting impulsively or substance abuse or using self-injury to dampen distress.
- Emotion regulation: One should successfully learn to Recognize, label, and adjust emotions.
- Mindfulness: Clients are encouraged to think about their thought.
- Interpersonal effectiveness: Clients are encouraged to navigate conflict and interact with them assertively.
DBT offers a multistage approach for treating the clients:
Stage 1: Begins with targeting the most self-destructive behavior, like suicide attempts or self-injury.
Stage 2: Involves addressing to the quality-of-life skills, which includes distress tolerance, interpersonal effectiveness and emotional regulation.
Stage 3: This stage focuses on improved relationships with significant others and self-esteem.
Stage 4: The therapist in the final stage promotes more joy and relationship connection.
When is it used?
Initially, DBT was designed to treat people with suicidal behavior and borderline personality disorder. But then onwards, it has been adapted for other psychological health problems that threaten a person's emotional well-being.
The American Psychiatric Association has endorsed that BPD patients who undergo DBT have seen improvements in their emotion well-being and have also exhibited improved social functioning. DBT has been found helpful for treating individual’s suffering from mood disorders, ADHD, binge eating and post-traumatic stress disorder.
Role of therapist:
DBT stresses upon the importance of the validation of the client, psychotherapeutic relationship, the etiologic importance of the client having experienced an “invalidating environment” as a child, and confrontation of resistance. DBT skills training is not a “quick fix” approach like Solution Focused Behaviour Therapy. It usually involves a year of treatment at minimum and includes both individual therapy and skills training done in a group. A DBT therapist makes a behavioral contract.