Dialectical behavioral therapy (DBT) is a cognitive-behavioral approach focusing on the psychosocial aspects to change behavioral patterns. It was developed by Marsha M. Linehan at University of Washington in late 1980s to treat borderline personality disorder. Dialectical behavioral therapy (DBT) is significantly effective to treat many other psychological problems or disorders.
What is Dialectical Behavioral Therapy (DBT)?
Dialectical behavioral therapy (DBT) is an effective tool that increases cognitive and emotional regulation through learning that leads to modifying behavior through changing thoughts and emotions. It helps in diminishing negative emotions and leads to positive outlook towards life. Dialectical behavioral therapy (DBT) is an approach to work towards intense emotions.
What is Dialectical?
The term dialectical is referred to integration of the opposites. The dialectic in DBT is related to acceptance and change, i.e. accepting the current situation and trying to modify or replacing it with newer emotions.
Characteristics of Dialectical Behavioral Therapy (DBT):
The characteristics of Dialectical behavioral therapy (DBT) are as follows:
- Cognitive Approach- Dialectical behavioral therapy (DBT) is a cognitive approach as it helps in regulating emotions by analyzing and evaluating them. The emotions, assumptions and beliefs are made to analyze critically to make life easier.
- Supportive approach- Dialectical behavioral therapy (DBT) helps in identifying strengths in a person making them feel renewed and motivated.
- Collaborative approach- Dialectical behavioral therapy (DBT) is a collective approach as the relationship between the therapist and the client plays a vital role in overcoming the emotions. The regular homework assignments, interaction with the therapist and others are practiced in the group.
Components of Dialectical Behavioral Therapy (DBT)
The components of Dialectical behavioral therapy (DBT) are divided into two based on the individual and group sessions. They are:
- Weekly Group Therapy Sessions: This therapeutic session consists of modifying behavior and developing new skills. This session is undertaken for 2-3 hours in a week.
- Individual Weekly Psychotherapy Sessions: This session helps in working on emotions and accepting them. It helps in treating PTSD- Post traumatic stress disorder and various other psychological problems. The basic goal is to learn and develop new skills.
- Dialectical behavioral therapy (DBT) phone coaching: The telephonic coaching helps in availing in-the-moment strategies to cope with situations occurring in day to day life. The clients can contact their therapists between two consecutive sessions to get strategies for coping daily situations.
- Dialectical behavioral therapy (DBT) therapist consultation team: This team intends to provide therapy to therapists and DBT providers to stay motivated and competent. This helps the therapists in solving their problem and provides best treatments to the clients. The team meets weekly with the therapists, where the therapist can get consultation.
Modules of Dialectical Behavioral Therapy
The Dialectical Behavioral therapy is divided into four modules. They are:
- Mindfulness- The important module is to develop mindfulness skills. It helps in answering the questions related to the skills that are developed through DBT. There are two types of mindfulness skills. They are:
- What skills- These skills answer "what" of the developing skills. This is answered by describing and observing the developing skills.
- How skills- These skills answer "how" of the developing skills. This is answered by defining the goals without being judgmental.
- Interpersonal Effectiveness- This module helps in developing interpersonal behavioral patterns. It includes strategies in coping interpersonal conflict, learning to say no and describing specific behavioral sequences to solve problems with other person.
- Distress Tolerance- It is related to accepting emotions and bearing the emotion. The distress tolerance is a vital tool in analyzing and tolerating distress. This is administered by spiritual leaders or communities where a natural development of pain bearing is done.
- Emotion Regulation- This skill helps in regulating emotions which are intense in people who are suicidal. They may be depressed, frustrated, anxious or aggressive.Emotion regulation includes various hierarchical steps:
- Labeling emotions
- Recognizing the hindrances of frequently changing emotions
- Decreasing vulnerability of emotional mind
- Striving emotional events that are positive
- Including mindfulness to present emotions
- Adapting opposite action
- Applying distress tolerance techniques.
Out of the four modules, the interpersonal effectiveness and emotion regulation are the changing techniques, while mindfulness and distress tolerance are the accepting techniques in DBT.
Stages of Dialectical Behavioral Therapy (DBT)
The Dialectical Behavioral Therapy is divided into four stages based on the acuteness of client's behavior and the relationship between the therapist and client. These are:
- Stage I of Dialectical behavioral therapy (DBT) - This is an important stage in which the behavioral control is attained from an uncontrolled behavioral pattern. The client may be miserable and get indulged into self-destruction. Hence, it is a crucial stage where the goal is to control behavior.
- Stage II of Dialectical behavioral therapy (DBT) - In this stage the client experiences emotions post trauma. The client goes through emotional inhibition from quiet desperation. Post traumatic stress disorder can be aided with stage II.
- Stage III of Dialectical behavioral therapy (DBT) - This stage is a challenge to make the client live a life with the usual happiness and sadness. It helps in finding peace, generate self-respect and define goals in life.
- Stage IV of Dialectical behavioral therapy (DBT) - This stage helps in gaining spiritual fulfillment. The client can find a deeper meaning of life beyond the usual happiness and sadness.
The fourth stage of Dialectical behavioral therapy (DBT) is important for treating those clients who have a sense of incompleteness and are not able to define goals at Stage III.
Treatment Targets of Dialectical Behavioral Therapy (DBT)
The treatment targets of DBT are those clients who have multiple issues. The hierarchical structure of treatment targets helps in determining the sequence of problems that is to be addressed. The problems are addressed in the following sequence during a session:
- Life Threatening Behaviors: This type of behaviors includes self-destruction in the form of self-injury, suicide etc.
- Therapy Interfering Behaviors: This type of behaviors includes the behavior that obstructs the treatment. This could be from both the sides- the client and the therapist.
- Quality of Life Behaviors: This includes behavior that inhibits the client to have a quality life like crisis or interpersonal problems.
- Skills Acquisition: This includes the development of new skills and achieves newer goals in life.
Tools Used During Dialectical Behavioral Therapy (DBT)
The tools that are used to administer Dialectical Behavioral Therapy (DBT) on a client are:
- Milieu: Milieu is referred to the group or community of people involved. The group involved in Dialectical Behavioral Therapy group sessions plays a vital role in efficacy of the therapy.
- Chain Analysis: The chain analysis in Dialectical Behavioral Therapy analyses the behavioral pattern in a sequential order of the events that lead to a particular type of behavior.
- Diary cards: Diary cards help in keeping a weekly record of the progress or interference of the therapy.
Goals of Dialectical Behavioral Therapy
The goal of Dialectical Behavioral Therapy is to make the client manage their emotions by identifying, accepting and experiencing them. Dialectics means to balance between acceptance and change and thus, this balancing technique is administered during DBT therapy.
Hence, the goals of Dialectical Behavioral Therapy can be defined as follows:
- Acceptance Techniques- This technique is related to accepting emotions and deal with them. It helps in critically defining the emotions and the reason behind a particular type of behavior. A Dialectical Behavioral therapist may help in defining these emotions.
- Change Techniques- This technique is related to modifying harmful behavior with new skills that lead to a balanced lifestyle.
These skills may seem conflicting initially, but helps in defining the purpose in the long run.
Difference between Dialectical Behavioral Therapy and Cognitive Behavioral Therapy
The differences between Dialectical Behavioral Therapy and Cognitive Behavioral Therapy are:
- CBT focuses on changing the thought processes and behaviors; while, DBT along with changing behaviors also helps in accepting the emotions and who the person is.
- Moreover, DBT focuses on the relationship between the therapist and the client and this helps in modifying behavior.
Application of Dialectical Behavioral Therapy
DBT is effective on the following group of people with disorders like:
- Borderline Personality Disorder (BPD)
- Alcohol and drug abuse
- Suicide attempts
- Self-harming tendencies
- Eating problems
Dialectical Behavioral Therapy isn't helpful for everyone as the process of modifying emotions maybe conflicting. Hence, the client may drop out of treatment.
The Dialectical Behavioral Therapy is a process which is not easily adopted by all but is very effective in understanding and regulating emotions. The DBT helps in modifying behavior patterns to lead a better lifestyle. The client is made to accept and tolerate the pain and also helped in working out to reduce the pain.