Dialectical behavior therapy: definition, techniques

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Dialectic Behavioral therapy (DBT) is an evidence-based therapy derived from cognitive-behavioral therapy (CBT). The main goal of DBT is to help patients build mentally healthy lives by improving their ability to manage their emotions.

Learn about Dialectical Behavior Therapy, how it works, how to use it, and its basic skills.

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What is Dialectical Behavior Therapy?

In the 1980s, psychologist Dr. Marsha Linehan noticed that CBT did not work well with patients who had suicidal behaviors, self-harming tendencies, or who had borderline personality disorder. CBT’s focus on improving feelings by changing thoughts and behaviors overwhelmed them. Patients felt invalidated, misunderstood and criticized, leading many to abandon therapy.

Realizing that some patients needed a different kind of emotional support and professional training, Linehan created dialectical behavior therapy.

What does dialectic mean?

In DBT, dialectic means that two opposing ideas are true at the same time. Patients with all-or-nothing or black-and-white attitudes are sometimes unable to think otherwise.

DBT emphasizes the dialectic of acceptance and change.

How it works?

DBT requires a fundamental shift in mindset. DBT therapists work to teach patients the necessary skills, such as mindfulness and distress tolerance, to balance their emotions and change their way of thinking.

DBT creates shifts in thinking by teaching acceptance of the present moment and acknowledging the feelings a person may be currently experiencing, while still working towards the change needed to improve their life.

Here are some examples of DBT reflection:

  • In the place of: I can’t get out of bed. I am too tired. I can’t go to work today. In DBT: I don’t want to get out of bed (acceptance). Or: I can still get up and go to work. My thoughts don’t control my life—I do (change).
  • In the place of: I am a failure. I am worth nothing. I will never succeed. In DBT: Sometimes I can fail (acceptance). Or: Sometimes I succeed, and I’m sure I’ll do better next time (change).
  • In the place of: I am an idiot. I never understand anything. In DBT: I made a mistake (acceptance). Or: I can learn from my mistakes and do better next time. This error does not define me as a person. No one is perfect (change).

Basic DBT Skills

There are four main basic skills with DBT. These include distress tolerance, mindfulness, emotion regulation, and interpersonal effectiveness.

Distress tolerance skills

Often when people are overwhelmed by emotions, they can manage the distressing feelings in ways that help them feel better in the moment. This can include substance abuse to numb feelings or some type of immediate self-harm.

But in the long run, these methods can cause even deeper emotional pain. Distress tolerance is about learning to deal with those overwhelming feelings in a healthier way.

DBT skills to improve distress tolerance include:

  • Distraction: Distract yourself from unnecessary thoughts and emotions
  • Radical acceptance: Accept what you cannot change and focus on what you can change
  • Self-soothing strategies: Relax and calm down using your five senses
  • Viewing in a safe place: Imagine a safe and peaceful place, like the beach or the mountains
  • Spirituality: Take responsibility with your family sense of spirituality

Mindfulness skills

The practice of mindfulness is about being aware and focused on the present moment rather than the past.

Some DBT skills for practicing mindfulness include:

  • Focus more on this present moment.
  • Observe your thoughts, emotions, and physical sensations without judgment.
  • Mindful breathing exercises, which can bring you into the present moment.
  • Be kind and compassionate to yourself during mindful meditation.

Emotion regulation skills

Some people experience extreme emotions that they cannot regulate, often when they have a history of trauma or when they feel threatened or abandoned. It’s called emotional deregulation.

When triggered or emotionally overwhelmed, they can become very reactive and self-destructive. Using magnetic resonance imaging (MRI), brain researchers have found that people with emotional dysregulation may have problems with neurocircuit which regulates emotions in the brain.

Some DBT emotion regulation skills include:

  • Recognize your emotions
  • Recognize how your thoughts and behaviors influence your emotions
  • Recognize self-destructive behaviors
  • Increase positive emotions

Manage extreme emotions

Emotions are chemical and physical signals in the body that communicate what you are feeling and what is going on. Extreme reactive emotions are quite effective when a person faces imminent threat or danger, but not as useful in relationships or at work. DBT was developed largely to help people experiencing extreme emotions learn the skills to manage them and improve their lives.

Interpersonal Effectiveness Skills

Interpersonal effectiveness is about improving relationship skills. Managing emotions and emotional reactivity in relationships requires setting boundaries and managing conflict, while respecting others.

Some DBT interpersonal effectiveness skills include:

  • Conscious attention to others to understand their thoughts and feelings
  • Use assertive behavior instead of passive-aggressive behavior
  • Make simple requests for what you want while protecting your relationships
  • Active listening instead of passive listening

How do dialectical behavior therapy sessions work?

The traditional format of DBT is intensive and requires the patient to work between sessions. The four main components of DBT sessions include:

  1. Individual therapy once a week.
  2. Professional training sessions, usually in the form of group therapy for one to two hours per week.
  3. Consultation check-ins between the patient and the therapist outside of the weekly session, as needed.
  4. The therapist meets weekly with other therapists trained in DBT for the supervision of clinical cases. They discuss their DBT cases and get advice, which also helps the client, for one to two hours a week.

When is DBT used?

DBT was originally created for borderline personality disorder (BPD) and people with suicidal behavior and non-suicidal self-harm who may experience extreme emotions. But it’s also been shown to be an effective treatment for other mental health conditions, including:

How does DBT help?

In a DBT study, as participants developed more effective skills to manage their emotions, their substance use also decreased. The researchers believe this happened because their emotional coping skills increased and they had less need to use substances to numb their emotions.

In another study, after the first year of DBT treatment, 77% of patients no longer met the criteria for a borderline personality diagnosis.

Summary

Dialectical behavior therapy is a type of therapy that was developed from cognitive behavioral therapy. It involves skills of distress tolerance, mindfulness, emotional regulation and interpersonal effectiveness. Although designed for people with suicidal behaviors, self-harming behaviors and borderline personality disorder, it is an effective treatment for many other mental health disorders.

A word from Verywell

If you suffer from suicidal ideation, self-harm behavior or another mental health issue, you are not alone. Resources are available to help you. If you are interested in exploring or think you might benefit from dialectical behavior therapy, speak with a healthcare provider or mental health professional to get a referral to a DBT therapist in your area.

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