Dialectical behavior therapy (DBT) is a type of cognitive behavioral therapy and evidence-based therapy.
Cognitive behavioral therapy tries to identify and change negative thinking patterns and pushes for positive behavioral changes.
DBT main goals are to teach people how to live in the moment, cope healthily with stress, regulate emotions, and improve relationships with others.
D means dialectical: Dialectics is based on the concept that everything is composed of opposites and that change occurs when one opposing force is stronger than the other.
B stands for behavioral: DBT requires a behavioral approach. This means that we assess the situations and target behaviors that are relevant to our clients’ goals in order to figure out how to solve the problems in their lives.
What Conditions Does DBT Treat?
Dialectical behavioral therapy focuses on high-risk, tough-to-treat patients. These patients often have multiple diagnoses.
A unique aspect of DBT is its focus on acceptance of a patient’s experience as a way for therapists to reassure them — and balance the work needed to change negative behaviors.
DBT was initially designed to treat people with suicidal behavior, borderline personality disorder, mental health problems that threaten a person’s safety, relationships, work, and emotional well-being.
Components of DBT
It helps a person identify their strengths and builds on them so that the person can feel better about him/herself and their life.
Individual weekly psychotherapy sessions :
It emphasize problem-solving behavior for the past week’s issues and troubles that arose in the person’s life. Self-injurious and suicidal behaviors take first priority, followed by behaviors that may interfere with the therapy process. Individual sessions in DBT also focus on decreasing and dealing with post-traumatic stress responses (from previous trauma in the person’s life) and helping enhance their own self-respect and self-image.
Phone coaching, if needed for crises between sessions:
This means that you can call your therapist between your therapy sessions when you need help the most, such as in the following situations:
- When you need help to deal with an immediate crisis (such as feeling suicidal or the urge to self-harm).
- When you are trying to use DBT skills but want some advice on how to do it.
- If you need to repair your relationship with your therapist.
How Does DBT Work?
There are 4 Modules on which Dialectical Behavior Therapy work:
Becoming more aware of self and others and attentive to the present moment.
Observe, Describe, and Participate are the core mindfulness.
2. Interpersonal Effectiveness:
Navigating conflict and interacting assertively. This module focuses on situations where the objective is to change something (e.g., requesting someone to do something) or to resist changes someone else is trying to make (e.g., saying no). The skills taught are intended to maximize the chances that a person’s goals in a specific situation will be met, while at the same time not damaging either the relationship or the person’s self-respect.
3. Distress Tolerance
Feeling intense emotions like anger without reacting impulsively or using self-injury or substance abuse to dampen distress. This module focuses on Four sets of crisis survival strategies Distracting, Self-Soothing, Improving the moment, and Thinking of pros and cons.
4. Emotion Regulation
Recognizing and coping with negative emotions (for example, anger) and reducing one’s emotional vulnerability by increasing positive emotional experiences.
Dialectical behavior therapy skills for emotion regulation include:
- Learning to properly identify and label emotions
- Identifying obstacles to changing emotions
- Reducing vulnerability to “emotion mind”
- Increasing positive emotional events
- Increasing mindfulness to current emotions
- Taking opposite action
- Applying distress tolerance techniques
Is DBT right for you?
Think about these questions:
Is DBT relevant to me?
If you’re mainly interested in talking about your problems in general and trying to understand where they came from, then DBT might not seem relevant to you. In this case, there are various other talking therapies you might like to consider.
Is changing my behavior my priority?
DBT therapists focus very much on enabling you to change your problematic behavior. If changing your behavior isn’t the main thing you want to get out of treatment, then you might feel that your therapist doesn’t accept you, or is being critical of you.
Am I able to put the work in? DBT can sometimes be hard work, and you will be asked to do homework between your individual sessions. If you don’t like doing homework or feel that you don’t have the time, you might find a course of DBT too rigid or demanding, which might be demoralising.
Is group therapy right for me? Group therapy is not for everyone though as it can be quite daunting and sometimes triggering. It is important that you think about whether group therapy is right for you or whether you prefer to just work with a therapist one-to-one.
What if DBT doesn’t work for me?
It’s important to remember that everyone experiences therapy differently. If you don’t get along with DBT then you could:
- Talk to your therapist about any changes that can be made to make you feel more comfortable with the therapy.
- Talk to your doctor about different treatment options that might be better suited to you.
In DBT, the patient and therapist are working to resolve the seeming contradiction between self-acceptance and change in order to bring about positive changes in the patient.