Dialectical Behavior Therapy

What Is Dialectical Behavior Therapy?

If you’re familiar with cognitive behavioral therapy (CBT), dialectical behavior therapy (DBT) is a modified version of it. The primary objective of this therapy is to teach individuals how to live in the moment, learn healthier ways of coping with stress, regulate their emotions, and improve relationships with others. This is extremely important, especially when we’ve been locked down for so long. Many of us have forgotten how to communicate with others healthily, which has caused us to adapt dangerous behaviors to cope with stress.

Dialectical behavior therapy was initially developed to treat individuals struggling with borderline personality disorder (BPD), but the approach has been tailored around treating other mental health conditions. It also has the ability to treat those who have challenges with regulating their emotions or those exhibiting self-destructive behaviors. These include substance use disorders or eating disorders. DBT can also be used to treat post-traumatic stress disorder (PTSD). 

DBT has come a long way from its creation in the late 1980s and evolved out of CBT. It’s a form of therapy that helps individuals identify negative patterns and adjust them for more positive outcomes. Its creator, Dr. Marsha Linehan, noticed that patients with borderline personality disorder did not respond well to CBT. 

The focus on changing behavior made some of her patients feel like they were misunderstood, criticized, or attacked, so she started working on a more collaborative type of therapy for those with stronger emotions. Instead of telling a patient their thinking is incorrect, the therapist guides them to integrate their way of thinking with healthier thoughts. With this, dialectical behavior therapy was born.

Dialectics is a form of dialogue between people with opposing forces, and all dialectical discussions involve three vital assumptions:

1. Everything, including opposing ideas, share some type of connection
2. Change always occurs
3. To find the truth, you must integrate opposing ideas

When this approach is used in therapy, it involves a therapist with certain ideas of healthy behavior and an individual whose ideas have led to physical or mental harm. As the treatment progresses, the therapist will guide the individual toward healthier ways of thinking.

Dialectical behavior therapy has become an evidence-based psychotherapy approach used in the treatment of many conditions. It takes place in various settings.

What Does Dialectical Behavior Therapy Treat?

Although dialectical behavior therapy was initially designed with borderline personality disorder in mind, it’s also an effective treatment for the following:

• Attention-deficit hyperactivity disorder (ADHD)
• Bipolar disorder
• Eating disorders, including anorexia nervosa, bulimia nervosa, and binge eating disorder
• Borderline personality disorder (BPD)
• Generalized anxiety disorder (GAD)
• Non-suicidal self-injury
• Major depressive disorder (MDD), including chronic depression and treatment-resistant major depression
• Post-traumatic stress disorder (PTSD)
• Obsessive-compulsive disorder (OCD)
• Substance use disorder (SUD)

Dialectical Behavior Therapy Techniques

The following is where dialectical behavior therapy is most often used:

• Individual therapy: Individual therapy for DBT is when a trained professional helps a patient’s learned behavioral skills and adapts them to their personal life challenges. 
• Group therapy: This is where individuals learn behavioral skills in a group setting. 
• Phone coaching: Phone coaching is when individuals call their therapist between sessions to get guidance on coping with a challenging situation. 

Core Mindfulness

One crucial benefit of dialectical behavior therapy is the development of mindfulness skills. Mindfulness enables you to live in the moment or focus on the present. This allows you to pay close attention to what’s occurring inside of you, including your feelings, thoughts, impulses, and sensations, as well as using your senses to focus on what’s happening around you, such as hearing, seeing, smelling, and touching in a nonjudgmental fashion.

Mindfulness skills help you slow down and focus on what matters using healthy coping skills. For some, they might use drugs or alcohol to ease anxiety, but that’s a very unhealthy way to cope. Fortunately, when you’re in the midst of emotional pain, mindfulness can help you focus on what’s important. The strategy will also enable you to remain calm and stray away from automatic negative thought patterns or impulsive behavior that could lead to drug or alcohol use. 

Distress Tolerance

Distress tolerance is another skill used in dialectical behavior therapy that helps you accept yourself and the current situation. During DBT, you’ll learn several techniques that help you during a crisis, including the following:

• Learning how to improve in the moment
• Distracting yourself
• Self-soothing
• Learning how to think of the pros and cons of not tolerating distress

Distress tolerance techniques prepare you for intense emotions or situations you might encounter. It’ll empower you to cope with these circumstances positively in the long term.

Interpersonal Effectiveness

The primary objective of interpersonal effectiveness will enable you to become more assertive in a relationship. For example, some people don’t know how to say no, causing extreme discomfort. Interpersonal effectiveness will teach you how to say no in these moments while maintaining a positive and healthy relationship. You’ll learn how to communicate and listen more effectively, respect yourself and others, and deal with difficult people. 

Emotion Regulation

When it comes to emotion regulation, you’ll learn how to navigate your powerful feelings effectively. It’s easy to have a bad day and find an excuse to use drugs or alcohol. “It’s been a bad day, I’ve earned this drink.” Unfortunately, that’s not a healthy way to cope or manage your emotions. Emotion regulation provides you with the skills to help you learn, name, and change your emotions. Recognizing and dealing with intense negative emotions like anger or sadness will reduce your emotional vulnerability and enable you to have more positive emotional experiences without turning to drugs, alcohol, or other potentially dangerous ways to cope.

Benefits of Dialectical Behavior Therapy

During dialectical behavior therapy, the therapist and patient work to resolve the contradiction between self-acceptance and change. The objective is to bring positive changes during the treatment. Part of the process involves validation, which helps individuals become more likely to engage in change and be less resistant.

The therapist will validate an individual’s actions so long as they make sense within the context of their personal experiences. It doesn’t always mean the actions are the best approach to solving an issue. Each therapeutic setting will come with its own goals and structure, but the characteristics of DBT are all the same, including individual psychotherapy, group skills training, and phone coaching.

The following are what you can expect during DBT:

• Behavioral: A therapist will work with you to learn how to analyze problems and destructive behavior patterns. You’ll then learn how to replace it with more effective and healthy ones. 
• Acceptance and change: The therapist will help you learn strategies that enable you to accept and tolerate your emotions, life circumstances, and, most importantly, yourself. You’ll also develop skills that help you make positive changes in your interactions with others.
• Cognitive: DBT will help you focus on changing beliefs and thoughts that aren’t helpful or effective.
• Skill sets: DBT will teach you new skills that enhance your current capabilities. 
• Support: DBT will encourage you to recognize your positive attributes and strengths, pushing you to develop and use them more often.
• Collaboration: During DBT, your therapist will help you communicate effectively and teach you how to work with others on a team. 

Dialectical Behavior Therapy for Substance Use

You’ll be hard-pressed to find conclusive evidence that dialectical behavior therapy treats stand-alone substance use disorder. However, there is proof that DBT is a valuable component in a comprehensive treatment plan for someone with a co-occurring disorder, which is a substance use disorder and mental health condition, such as borderline personality disorder or depression.

A study with 10 women with borderline personality disorder and a substance use disorder who received dialectical behavior therapy showed a reduction in substance misuse in the first year of treatment and during their four-month follow-up. The study also showed there were fewer dropouts from treatment when DB was involved than those who didn’t receive dialectical behavior therapy as part of their treatment plan.

Getting Help for Your Addiction

If you’re struggling with addiction, it’s vital that you reach out for help. When you’re ready to get help and want to take an addiction-focused approach to DBT, you can benefit from the treatment in the following ways:

• Your substance use will decrease dramatically.
• You’ll notice a decrease in the physical discomfort that withdrawal symptoms cause.
• There will be a noticeable decrease in your impulsivity, cravings, and temptations for drugs or alcohol.
• Dialectical behavior therapy will help you create and enforce boundaries crucial for long-term abstinence.
• Therapy will help you avoid triggers and other events that could cause you to relapse.
• DBT reduces problematic behaviors that lead to substance use.
• Another important benefit is how DBT helps you increase healthy interpersonal relationships through the community, which supports your individual success.

As you’re ready to stop using drugs or alcohol, consider this approach. However, if you are seeking help with managing your mental health, dialectical behavior therapy could be beneficial. 

Dialectical Behavior Therapy for Mental Health

Those struggling with their mental health will have trouble with their coping skills. However, dialectical behavior therapy’s approach allows people to develop effective ways to manage and express these strong emotions. Researchers have also found that the therapy is effective no matter the person’s sex, age, gender identity, race/ethnicity, or sexual orientation. In short, it can help anyone who adopts its principles. 

How to Get Help with Dialectical Behavior Therapy

It’s hard to deny the benefits of DBT and what it can do for those with mental health or substance abuse challenges. If you’re ready to get help and want to learn more about DBT, reach out to your physician or contact our staff today.