Dialectical Behavioral Therapy

What is Dialectical Behavioral Therapy?

DBT combines standard cognitive-behavioral techniques for emotion regulation and reality-testing with concepts of mindful awareness, distress tolerance, and acceptance, largely derived from Buddhist meditative practice. The key elements of DBT are conventional behavioral therapy and cognitive therapy, along with its signature concepts of dialectics and mindfulness.
DBT is a cognitive-behavioral treatment approach with two key characteristics: a behavioral, problem-solving focus blended with acceptance-based strategies, and an emphasis on dialectical processes.
DBT is a type of cognitive-behavioral therapy. Its main goal is to teach the client skills to cope with stress, regulate emotions and improve relationships with others.
DBT expands on the methods of cognitive-behavioral therapy by including techniques and skill sets that encourage validation, respect, and equality within the client-therapist partnership. Dialectics is a discussion aimed at integrating seemingly incompatible concepts. In this case, therapists and clients work together on strategies of change and acceptance that lead to safe and productive methods of managing conflict.
DBT combines the basic strategies of behavior therapy with eastern mindfulness practices, residing within an overarching dialectical worldview that emphasizes the synthesis of opposites.
DBT is a blend of change (behavior therapy) and acceptance (mindfulness training) approaches woven together by a set of philosophical assumptions, a biosocial theory, and multiple modes of treatment. DBT integrates both behavioral change and acceptance throughout all aspects of treatment.
o As a behavioral treatment, DBT relentlessly pursues changing a range of maladaptive behaviors using standard behavioral principles and procedures (contingency management, shaping, stimulus control).
o As an acceptance-based treatment, DBT provides an unwavering emphasis on client validation, mindfulness skills, and an underlying assumption, that, in some moments of life, efforts to change what inherently cannot be changed may exacerbate problems, rather than solve them.

What is the goal of DBT?

• The pragmatic goal is to identify and implement an optimal solution to each problem that arises in a fluid context, while being completely willing to let go of any solution, as needed, in response to new problems or evidence that any one solution does not appear to be helpful.
DBT helps people that react abnormally to emotional stimulation and who don’t have any strategies for coping with these sudden, intense surges of emotion. DBT is a method for teaching skills that will help in this task.
DBT emphasizes balancing behavioral change, problem-solving, and emotional regulation with validation, mindfulness, and acceptance of patients.
DBT is a comprehensive cognitive-behavioral treatment for complex, difficult-to-treat mental disorders.
DBT serves 5 fundamental functions for the patient
1. enhances behavioral capabilities (skills training)
2. improves motivation to change (by modifying inhibitions and reinforcement contingencies/individual behavioral treatment plans)
3. assures that new capabilities generalize to the natural environment
4. structures the treatment environment in the ways essential to support client and therapist capabilities (programmatic emphasis on reinforcement of adaptive behaviors)
5. enhances therapist capabilities and motivation to treat clients effectively.

In DBT, these functions are divided among modes of service delivery, including individual psychotherapy, group skills training, phone consultation, and therapist consultation team.

How It Works? The 4 Key Elements of DBT
1. mindfulness
• The core component of DBT
mindfulness is the awareness of one’s thoughts, feelings, motivations, and actions
• The practice of mindfulness involves focusing one’s awareness on the current moment
mindfulness is about living in the moment, experiencing your emotions and your senses, and being aware of them
2. Interpersonal Effectiveness
• Communicating personal needs
• Learning effective strategies to say “no”
• Minimizing/coping with interpersonal conflict
3. Emotion Regulation
• Identifying and labeling emotions
• Increasing behaviors that lead to positive feelings
• Taking action based on reason rather than emotion
4. Distress Tolerance
• Overcoming difficult periods of discomfort through acceptance of current situations
• Learning crisis survival strategies: distracting, self-soothing, improving the moment, thinking of the pros and cons)

Who benefits from DBT / What does DBT treat?
• Depression
• Substance Use Disorders (addiction/alcoholism)
• Bipolar Disorders
• Eating Disorders
• Impulse-control Disorders
• Anxiety Disorders
• Obsessive-Compulsive Disorder
• Post Traumatic Stress Disorder
• Psychotic Disorders
• Borderline Personality Disorder