Application and purpose of Dialectical Behavior Therapy (DBT) in counseling

Dialectical behavior therapy (DBT) is a powerful, evidence-based treatment that aids people in creating a life they find meaningful. Many of these people struggle with serious mental health issues.

What Is Dialectical Behavioral Therapy?

A modified form of cognitive behavioral therapy is dialectical behavior therapy (DBT). Its major objectives are to educate individuals on how to be present, create healthy coping mechanisms for stress, control their emotions, and enhance interpersonal connections.

DBT helps you define this type of life for yourself and acquire the tools to make it happen.

DBT has been modified to treat a variety of mental health issues even though it was developed to address borderline personality disorder (BPD). It can benefit those who have trouble controlling their emotions or are engaging in damaging habits (such as eating disorders and substance use disorders). Post-traumatic stress disorder may occasionally be treated with this kind of therapy (PTSD).

History Of DBT

In the 1970s, Marsha Linehan created DBT. Through her work with two mental health populations—those with recurrent suicidal thoughts and those with a borderline personality disorder—she created DBT. The growing popularity of cognitive behavioral therapy attracted Linehan (CBT). She made the decision to apply conventional CBT in her practice. After performing research on the efficacy of CBT in her target demographic, Linehan and her colleagues encountered challenges. They identified three significant issues with the use of conventional CBT:

  • The change-focused treatments were perceived as invalidating by the participants. These emotions frequently led to therapeutic withdrawal, hostility toward therapists, or a swing between the two extremes.
  • Participants and the therapists imitated a pattern of reinforcement in which avoidance and redirection were encouraged while positive work was stopped. Participants reacted angrily when therapists pressed for change. Participants responded warmly and positively when therapists permitted a shift in topic. This loop appeared to deceive the subject and the therapist into believing they were on the correct path when, in reality, they were not.
  • Because crisis circumstances were so intense, therapists spent a lot of time talking to clients about safety issues including suicidal thoughts or actions, aggression, threats directed towards the therapist, or self-harming behavior. There was frequently not enough time to address behavioral functioning or educate coping mechanisms.

Linehan examined these issues and came up with a number of CBT modifications. These specifically met the population’s demands. Before participants were encouraged to concentrate on change, acceptance-based strategies were used to make sure they felt supported and valued. Dialectics were also used to help participants and therapists concentrate on the synthesis of polar opposites like acceptance and transformation. They were able to avoid falling into severe position-taking habits because of this.

The application of CBT now includes these and other modifications. The first recognized treatment guide, Dialectical Behavioral Treatment of Borderline Personality Disorder, was released by Linehan in 1993. The popularity of DBT has increased since that time. The effectiveness of DBT has been widely established by studies over the past few decades.

Read Blog: Difference between DBT and CBT

DBT Theory

The foundation of DBT is a combination of three main theoretical frameworks. These include the Zen Buddhist practice of mindfulness, a behavioral science biosocial model of the genesis of chronic mental health difficulties, and the dialectical philosophy.

The biosocial hypothesis makes an effort to explain how borderline personality disorder-related problems arise. According to the notion, some people are predisposed to have weak emotional responses from birth. A person’s negative emotional reactions may be amplified in environments that lack strong organization and stability. They have the power to change negative interaction habits. In all circumstances, these tendencies can be detrimental to relationships and functioning. They frequently lead to borderline personality disorder diagnosis and/or suicidal conduct.

DBT uses mindfulness practices from Zen Buddhism to cultivate present-moment awareness. This could enable patients in treatment to evaluate things calmly and objectively. People who practice mindfulness may reflect on their current situation, assess the evidence, and pay attention to one issue at a time.

Dialectics are used in therapy to help the patient and the therapist. They draw on an issue’s two polar opposites. Dialectics is a technique used by therapists to help clients accept the aspects of themselves they do not like. Additionally, they employ dialectics to inspire and motivate people to deal with such changes. Polar opposites can be synthesized to ease stress and advance healing.

Dialectical Behavior Therapy Techniques

DBT has evolved to become an evidence-based psychotherapy approach that is used to treat many conditions. Settings in which DBT is often used include:

  • Patients learn behavioral skills in a group environment during group therapy.
  • The process of adapting newly acquired behavioral skills to a patient’s unique set of life circumstances occurs in individual therapy with a qualified practitioner.
  • Patients can call the therapist between sessions to gain advice on coping with a challenging circumstance they are currently in through phone coaching.
  • DBT therapists work with consultation teams because helping persons who exhibit life-threatening behaviors can be difficult. A consultation team is a collection of DBT experts that get together on a regular basis to support one another in managing stress, maintaining motivation, and providing effective therapy.

Some of the strategies and techniques that are used in DBT include the following:

  1. Core Mindfulness

The improvement of mindfulness abilities is a significant advantage of DBT. Living in the moment or focusing on the here and now is made easier by mindfulness. This supports your ability to pay attention to your internal experiences—your thoughts, feelings, sensations, and impulses—as well as your external surroundings—what you see, hear, smell, and touch—in a nonjudgmental manner.

Read Blog: 14 most effective exercises for mindfulness

When you are experiencing emotional distress, mindfulness skills can help you slow down and concentrate on employing appropriate coping mechanisms. The technique can also assist you in maintaining your composure and preventing impulsive conduct and habitual negative thought patterns.

  1. Distress Tolerance and Emotion regulation

Distress tolerance skills help you accept yourself and your current situation. DBT teaches several techniques for handling a crisis, including:

  • Distraction
  • Improving the moment
  • Self-soothing
  • Thinking of the pros and cons of not tolerating distress

Distress tolerance techniques help prepare you for intense emotions and empower you to cope with them with a more positive long-term outlook.

Read Blog: 9 ways to stop feeling distressed- DBT

DBT also talks about emotion regulation which highlights the importance of being accepting of our emotions and how we are feeling. It involves the following:

  • Accept your emotions
  • Acknowledge your emotions
  • Allow yourself to feel the emotions, don’t suppress them.
  • Accept how you feel
  1. Interpersonal Effectiveness

Your ability to articulate your demands and say “no” in a relationship and still maintain a nice, healthy connection depends on your interpersonal efficacy. You will have the ability to respect yourself and others, listen and communicate more effectively, and handle difficult individuals.

A few tactics to improve interpersonal effectiveness are as follows:

  • Be kind: Never criticize, threaten, or attack people.
  • Exhibit interest: Show interest by paying attention and refraining from interjecting when someone else is speaking.
  • Validate: Recognize the feelings and ideas of the other person.
  • Stay calm: Try to maintain a relaxed demeanor (smile often and be light-hearted)
  • Practice emotion control: It will help you deal with strong emotions more successfully. Your ability to recognize, name, and modify your emotions will be aided by the abilities you acquire. Your emotional susceptibility is decreased and you are able to experience more pleasant feelings when you are able to detect and manage strong negative emotions, such as rage.

Stages of DBT

Treatment phases in dialectical behavior therapy are separated into four categories.

Stage 1: The most severe and self-destructive behaviors are addressed first at the start of treatment. This may involve problems like self-harm or suicidal tendencies.

Stage 2: Next, the focus of treatment shifts to problems that have an impact on a person’s quality of life, such as social competence, emotional control, and distress tolerance.

Stage 3: The attention now shifts to problems with self-worth and social interactions.

Stage 4: At this stage, treatment focuses on assisting patients in making the most of their lives, including identifying strategies for enhancing happiness, preserving relationships, and pursuing their life objectives.

Components of DBT

DBT can be used in a variety of mental health settings. It incorporates the following five components:

  • Capability enhancement

DBT enables the improvement of current skills. Four fundamental skill sets are taught throughout therapy. These include distress tolerance, mindfulness, effective interpersonal communication, and emotion management.

Read Blog: 7 mindfulness-based exercises to try when you feel chaotic

  • Generalization

DBT therapists employ a variety of strategies to promote the application of acquired skills in all contexts. In therapy, patients learn how to put their newfound knowledge into practice at home, at school, at work, and in the community. For instance, a therapist could advise the patient to discuss difficulties with a spouse while in therapy. Before and after the conversation, the person can control their emotions.

  • Motivational enhancement

To lessen troublesome behaviors that impair quality of life, DBT employs tailored behavioral therapy regimens. For instance, therapists may employ tracking sheets for self-monitoring so that sessions may be modified to focus on the most serious problems first.

  • Capability and motivational enhancement of therapists

In order to avoid concerns like vicarious traumatization or burnout, therapists receive a lot of monitoring and support because DBT is frequently given to patients who face persistent, severe, and profound mental health disorders. For instance, regular treatment-team meetings give therapists a venue to offer and receive support, education, and therapeutic direction.

  • Structuring of the environment

Making ensuring that constructive, adaptable actions are rewarded in all contexts is frequently an aim of treatment. For instance, the therapist may ensure that each program was designed to reinforce all the beneficial skills and behaviors developed if a person participated in many therapy programs within one organization.

Read Blog: A guide to DBT counseling

What Dialectical Behavioral Therapy Can Help With

Though developed with BPD in mind, DBT might also be an effective treatment for:

  • Attention-deficit/hyperactivity disorder (ADHD)
  • Bipolar disorder
  • Borderline personality disorder (BPD)
  • Eating disorders (such as anorexia nervosa, binge eating disorder, and bulimia nervosa)
  • Generalized anxiety disorder (GAD)
  • Major depressive disorder (including treatment-resistant major depression and chronic depression)
  • Non-suicidal self-injury
  • Obsessive-compulsive disorder (OCD)
  • Post-traumatic stress disorder (PTSD)
  • Substance use disorder8
  • Suicidal behavior

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Benefits of Dialectical Behavioral Therapy

The goal of DBT is to help the person receiving therapy experience positive changes by resolving the apparent tension between self-acceptance and change. Offering affirmation is a step in this process that makes individuals more receptive to cooperation and less prone to feel upset by the prospect of change.

In reality, the therapist affirms that a person’s behaviors “make sense” in light of their unique experiences but does not necessarily concur that they are the best course of action for resolving an issue. Although each treatment context has its own structure and objectives, group skills training, individual psychotherapy, and phone coaching all share some DBT traits.

A few things that a therapist using the DBT technique can assist you with are:

  • Change and acceptance

You’ll pick up techniques for putting up with your situations in life, your feelings, and yourself. Additionally, you will learn abilities that will enable you to alter your conduct and social relationships for the better.

  • Behavioral

You’ll learn to identify issues or harmful behavioral patterns, then swap them out for more positive and productive ones.

  • Cognitive

You’ll concentrate on eradicating unhelpful and ineffective attitudes and beliefs.

  • Communication and cooperation

You’ll develop teamwork skills and effective communication (therapist, group therapist, psychiatrist).

  • Skill sets

You’ll pick up additional powers to improve your abilities.

  • Support

You’ll be inspired to acknowledge your positive traits and strengths, help them grow, and put them to good use.

Read Blog: How to set morning routine with the help of DBT

Effectiveness of Dialectical Behavior Therapy

People who effectively enhance their coping abilities with the use of this therapeutic technique may create efficient means of controlling and expressing intense emotions. Additionally, studies have shown that DBT works for people of any age, sex, gender identity, sexual orientation, or race/ethnicity.

  • DBT is beneficial in treating borderline personality disorder (BPD) and lowering the risk of suicide in people with BPD, according to studies. According to one study, more than 75% of BPD patients no longer satisfied the diagnostic criteria for the illness after receiving therapy for a year.
  • According to different research, treatments that included skills training as a component of therapy seemed to be more successful in lowering suicidality 
  • DBT may be a useful treatment for a variety of mental health issues, but much of the research has focused on how well it works for persons with borderline personality disorder who have suicidal and self-harming thoughts. For instance, studies have shown that this kind of therapy appears to be successful in treating PTSD, depression, and anxiety.

Things to Consider About Dialectical Behavior Therapy

DBT demands a considerable time commitment. Individuals are expected to work on skills outside of the individual, group, and phone counseling sessions in addition to their regular treatment appointments. For those who often struggle to keep up with these duties, this might be problematic.

For some people, using some of their abilities might be difficult. People examine traumatic events and emotional anguish at various phases of treatment, which may be upsetting.

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