What is DBT (Dialectical Behavior Therapy)?
Dialectical Behavior Therapy, a form of cognitive-behavioral therapy, incorporates the use of skills or strategies that, when put to use, create a life worth living. Developed in the 1970s by its founder, Dr. Marsha Linehan, it has proven to be effective as an evidence-based practice for a number of mental health issues including anxiety, depression, post-traumatic stress disorder (PTSD), eating disorders, borderline personality disorder, suicidal and self-harm behaviors, substance abuse, and anyone desiring tools for tackling life. DBT operates on the platform of dialectics, meaning there exists at the same time acceptance and the desire for change. It is neither one nor the other and is instead both simultaneously. The overall goal of DBT is to help individuals change behavioral, emotional, thinking, and interpersonal patterns associated with problems in living. The key to success is the client/therapist relationship.
DBT originally operated on a platform set out to tackle 4 main targeted modules: Mindfulness, Interpersonal Effectiveness, Emotion Regulation, and Distress Tolerance. Just recently a 5th, “Middle Path”, was added to help families and teens manage the relevant issues within their relationship. These modules are further divided into sections and then even further into a series of separate skills that are usually taught in sequence but can be pulled out individually so clients do not feel overwhelmed. An explanation of each module is as follows:
Mindfulness Skills
Mindfulness Skills are considered core skills in individual DBT therapy because they help develop an ability to control attention, a skill that is needed before one can learn to regulate emotions. In this DBT skills module, the primary goal is to help clients learn to participate fully in life while being non-judgmental and staying one-mindful. It helps with emotional suffering, worry, and depression by keeping clients in the moment versus in the past (where regret, shame, and grief can live) or the future (where worry and fear live).
Interpersonal Effectiveness Skills
Interpersonal Effectiveness Skills are taught to learn the nuances of effective communication in a range of relationships from work to family to friendships and romantic relationships. Approaching relationships from a different perspective, the skills help balance the ability to be assertive by asking for what one wants and balancing how to say no while maintaining relationships and increasing self-respect. The goal is to decrease interpersonal conflict, improve active interpersonal problem-solving, and build positive social support in individual DBT therapy.
Emotion Regulation Skills
Emotional Regulation Skills help individuals in DBT therapy appreciate the purpose of emotions when encountering different problems and situations. Clients learn to accurately identify and label emotions, change emotional responses to situations, reduce vulnerability to negative emotions, and learn to manage extreme emotions. This helps instill the feeling of being in some degree of control over emotions, rather than feeling that emotions are in control of you. For most clients, the development of emotion regulation DBT skills includes the process of learning an emotion vocabulary that increases the recognition and communication of emotional needs to others.
Distress Tolerance Skills
Distress Tolerance Skills are taught so that clients can learn to cope with periods of intense emotions and stress without behaving in a way that would make the situation or problems worse. These DBT skills provide clients with a more effective way of managing crisis situations by means of distraction, improving the moment, and self-soothing. Distress tolerance skills for chronic problems and stressors help individuals accept reality by practicing the skills of radical acceptance, willingness and turning the mind. A key driver is to make decisions once calmer in “wise mind” (learned in the interpersonal effectiveness module).
Middle Path Skills
Middle Path skills help clients balance acceptance and change so they are able to see that there is more than one way to view a situation or solve a problem. A primary goal of this module is for clients to work on changing painful or difficult thoughts, feelings, or situations while also accepting themselves, others, and current problems.
Since DBT is constructed as a modular intervention, therapists and clients together as a team have the inherent flexibility to zero in on components to meet specific needs. Ultimately, comprehensive treatment strives to 1.) strengthen capability by increasing skillful behavior, 2.) improve and maintain motivation to change and engage with treatment, 3.) ensure that generalization of change occurs through treatment, 4.) enhance therapist motivation to deliver effective treatment, and 5.) assist restructuring or changing the environment to support and maintain progress and advancement towards goals. To accomplish these functions effectively, treatment is spread among a variety of modes that include individual treatment, group or individual skills training, between-session skills coaching, and a therapist consultation team.
DBT is purposefully set up to not be a quick-fix type of therapy. In fact, it takes 24 weeks (6 months of weekly individual sessions and skills training classes) to complete the entire DBT skills training because it goes at a pace to ensure skills are learned, understood and applied to real-life situations. There is an array of new skills that cannot be rushed. Oftentimes, some clients end up repeating the process once completed, finding it to be so beneficial in finding fulfillment in all aspects of their lives. Those who commit fully make the most progress.
If traditional “talk” therapy is something you’ve tried before and didn’t get the results you wanted, or if DBT sounds like something you may be interested in, please give us a call. We’d be happy and honored to answer any questions.
— Jill Dagistino, Registered Mental Health Counselor Intern (Level 2 DBT trained)