The Theory
Basically, DBT maintains that some people, due to invalidating environments during upbringing
and due to biological factors as yet unknown, react abnormally to emotional stimulation. Their level of arousal goes up much
more quickly, peaks at a higher level, and takes more time to return to baseline. This explains why borderlines are known
for crisis-strewn lives and extreme emotional lability (emotions that shift rapidly). Because of their past invalidation,
they don't have any methods for coping with these sudden, intense surges of emotion. DBT is a method for teaching skills that
will help in this task. How it works
Dialectical Behavioral Therapy (DBT) consists of two parts: - Once-weekly
psychotherapy sessions in which a particular problematic behavior or event from the past week is explored in detail, beginning
with the chain of events leading up to it, going through alternative solutions that might have been used, and examining what
kept the client from using more adaptive solutions to the problem:
Both between and during sessions, the therapist actively teaches and reinforces adaptive behaviors, especially as they occur
within the therapeutic relationship. . . the emphasis is on teaching patients how to manage emotional trauma rather than reducing
or taking them out of crises. . . . Out of Therapy contact with the individual therapist between sessions is part of DBT procedures.
(Linehan, 1991)
DBT targets behaviors in a descending hierarchy:
- decreasing high-risk suicidal behaviors
- decreasing responses or behaviors (by either therapist or patient) that interfere with therapy
- decreasing behaviors that interfere with/reduce quality of life
- decreasing and dealing with post-traumatic stress responses
- enhancing
respect for self
- acquisition of the behavioral skills taught in group
- additional goals set by patient
- Weekly 2.5-hour group therapy sessions in which interpersonal effectiveness, distress tolerance/reality acceptance
skills, emotion regulation, and mindfulness skills are taught through worksheets
What Is Dialectical Behavior Therapy?
Dialectical behavior therapy
(DBT) is a type of cognitive behavioral therapy. Its main goal is to teach the patient skills to cope with stress, regulate emotions and improve relationships with others.
DBT is derived from a philosophical process called dialectics. Dialectics is based
upon the concept that everything is composed of opposites and that change occurs when one opposing force is stronger than
the other, or in more academic terms: thesis, antithesis and synthesis.
History
of Dialectical Behavior Therapy
DBT was developed in the late 1970s by
Dr. Marsha Linehan and colleagues when they discovered that cognitive behavioral therapy alone did not work as well as expected
in patients with borderline personality disorder. Dr. Linehan and her team added additional techniques and developed a treatment which would meet the unique needs of these
patients.
The Three Fundamentals of Dialectical Behavior Therapy
1. Cognitive Behavioral Therapy
Learning new behaviors -- which can be anything a person thinks, feels or does -- is a crucial part of DBT. There
are four main strategies that are used to change behavior: skills training, exposure therapy, cognitive therapy, and contingency
management.
- Skills Training - Attending skills groups, doing homework
assignments and role playing new ways of interacting with people.
- Exposure
Therapy - Exposing oneself to feelings, thoughts or situations which were previously feared and avoided.
- Cognitive Therapy - Recognizing and reassessing patterns of negative thoughts and replacing
them with positive thoughts that more closely reflect reality.
- Contingency
Management - Identifying how maladaptive behavior is rewarded and how adaptive behavior is punished and using this knowledge
to modify behavior in a positive way.
2. Validation
For patients with borderline personality disorder, the process of cognitive behavioral
therapy can cause a great deal of distress. The push for change feels to them as if it invalidates the emotional pain they
are feeling. Linehan and her team found that by offering validation along with the push for change, patients were more likely
to cooperate and less likely to suffer distress at the idea of change. The therapist validates that the person's actions
"make sense" within the context of his personal experiences without necessarily agreeing that they are the best
approach to solving the problem.
3. Dialectics
Dialectics makes three basic assumptions: (1) all things are interconnected (2) change is
constant and inevitable and (3) opposites can be integrated to form a closer approximation of the truth. In DBT, the patient
and therapist are working to resolve the seeming contradiction between self-acceptance and change in order to bring about
positive changes in the patient.
What Is Dialectical Behavior Therapy
Used For?
DBT is designed for use by people who have urges to harm themselves,
such as those who self-injure or who have suicidal thoughts and feelings. It was originally intended for people with borderline
personality disorder, but has since been adapted for other conditions where the patient exhibits self-destructive behavior,
such as eating disorders and substance abuse.
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