What is DBT (Dialectical Behavioral Therapy)?

What is DBT (Dialectical Behavioral Therapy)?

There are different kinds of therapeutic approaches a therapist may use to help address a client’s needs. One of these therapeutic approaches is called DBT, or dialectical behavioral therapy. This type of therapy was developed to address the needs of patients with borderline personality disorder and was developed in the late 1980s. 


DBT is a type of talk therapy that utilizes cognitive-behavioral approaches and emphasizes the psychosocial aspects of treatment. 


The theory is that some people’s emotional swings go much further and take much longer to return to baseline than other people’s, especially when it comes to romantic, family, and friend relationships. Because few people can relate to these surges of emotion that are sustained at a much higher degree and for much longer than normal, people afflicted with this high level of emotional arousal do not have the opportunity to learn coping skills related to these emotional highs and lows. 


DBT is meant to teach skills that help.


Components of DBT


There are three main components of DBT.


  • Support-oriented: DBT helps a person identify their strengths. DBT also helps people build on these strengths in order to support their self-esteem and positive feelings about their life as they move through it. 


  • Cognitive-based: DBT introduces rationality into the emotional process by identifying the distortions in thoughts, beliefs and assumptions that make life harder. It helps people learn different ways of thinking that help make life more bearable. 


  • Collaborative: DBT requires a strong relationship between the client and the therapist. When pursuing a DBT approach, people work out problems in their relationship with their therapist. There’s homework, role-play around new ways of interacting with others, and the practice of skills such as calming down when upset. These skills are a crucial part of DBT and they are built by weekly lectures, homework groups, and group study sessions. The individual therapist helps the client learn, apply and master their DBT skills. 


There are two main ways that DBT can be delivered to the client. First is in individual weekly psychotherapy sessions that emphasize problem-solving for the past week’s issues, triaged by how severe or self-injurious they are. Individual sessions can also focus on overcoming past trauma response issues and helping enhance the client’s self-respect and self-image


Second is in weekly group therapy sessions taught by a trained DBT therapist. In these sessions, skills from one of four modules are taught: interpersonal effectiveness, distress tolerance/reality acceptance skills, emotion regulation, and mindfulness skills. 


The 4 Modules of DBT


  • Mindfulness: This is the core of all the skills taught in DBT. The idea is to teach patients both what mindfulness is and how to use it. In order to practice mindfulness, patients are taught to observe, describe and participate. In order to use mindfulness, they are taught to practice non-judgmentally, one-mindfully, and effectively. 


  • Interpersonal Effectiveness: People who suffer from borderline personality disorder often have good interpersonal skills up until they encounter an emotionally fraught situation. For example, a client may be able to describe perfectly what another person should do when encountering a particular situation but be completely unable to apply that same skill and insight to their own emotional encounters. These skills include asking for what you need, asserting boundaries and saying ‘no’, and learning to cope with conflict, all without damaging either the relationship or the client’s self-respect. 


  • Distress Tolerance: This module has to do with the ability to accept both oneself and the current situation one is in, in a non-judgmental fashion. Non-judgmental does not mean approval; it only means acceptance. In this module four sets of crisis survival strategies are taught: distracting, self-soothing, improving the moment, and thinking of pros and cons.


  • Emotional Regulation: This module is all about modulating the highs and lows of the client’s emotional experience. This involves a great deal of activity on the client’s part, such as: 


  • 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


While dialectical behavioral therapy may be meant for patients who suffer from borderline personality disorder, much of its conclusions and strategies have been incorporated into cognitive behavioral therapy, making them more widely applicable to a broad range of patients. 


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