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Dialectical Behavioral Therapy (DBT)

Do you find that you get upset easily? Does your mood change quickly and become intense? Do you find you’re always in a fight with someone you care about?

Dialectical Behavior Therapy is a robust model that teaches people:
 

  • how to cope with being overwhelmed
  • process emotions
  • communicate well with others to decrease fighting with those you care about most

What is DBT?

The “D” stands for dialectical. A dialectic is a synthesis or integration of opposites. In DBT, dialectical strategies help both the therapist and the client get unstuck from extreme positions.

Our lives are full of dialectics—which is a fancy word to convey that in order to get unstuck from pain, we often have to find a balance between two opposite truths. For example, DBT’s most essential tenets are acceptance and change. DBT encourages us to accept that we are doing the best we can with our current tools, coping skills, and circumstances. At the same time, if we aren’t truly content, we have to embrace the opposite of acceptance, which is change. We have to try something different to get the life we want. Carl Rogers nailed it when he so eloquently said:

“The curious paradox is that when I accept myself just as I am, then I can change.”

~Carl Rogers

We often can feel both relieved and scared, or happy and sad, or angry and sad all at the same time. These opposing feelings often contribute to depression, anxiety, self-harm, and discontent. For example, a person struggling with depression might want to go for a walk outside in hopes of increasing their energy, but due to depression, doesn’t have the energy necessary to get out the door.

The “B” stands for behavior, which means that in DBT counseling there is an emphasis on what we are actually doing, the choices we are making, and the motivations behind those choices.

The “T” stands for therapy. While discussing your feelings and your past is important, DBT focuses on teaching skills that will help clients deal with all that life throws at them. This is why DBT is sometimes referred to as a “doing” therapy rather than a “talking” therapy.

DBT is different than other models of therapy because of its main goal of building a life worth living.

To do this, DBT is jam-packed with tools to help you:

  • cope with emotions
  • cultivate mindfulness
  • thrive in relationships
  • handle anything life throws at you

DBT is used to effectively address problem behaviors such as:

  • Ongoing conflicts in relationships
  • Intense and rapid mood changes
  • Inability to relax
  • Substance abuse
  • Holding in your anger, then “blowing up” at others
  • Impulsive or reactive decisions you often regret
  • Overeating
  • Eating Disorders
  • Spending too much
  • Trouble recognizing choice
  • Feeling overwhelmed
  • Avoiding responsibilities, people, or events
  • “Numbing out” in response to fear, anger, etc.
  • Risky Behaviors
  • Impulsivity
  • Self-harm
  • Suicidal Thoughts

DBT is Effective in Treating:

  • Mood disorders, including Depression
  • Anxiety Disorders
  • Self-esteem issues
  • Emotional Dysregulation
  • Borderline Personality Disorder

 

How DBT Helps

DBT is a skills-based model, meaning that in counseling, you will learn:

  • how to have hard conversations
  • adaptive ways to cope with stress
  • how to solve problems without freaking out
  • how to regulate your emotions

To do this, you’ll need to learn four different sets of skills:

Mindfulness

Mindfulness encourages you to:

  • Increase your ability to observe, describe and participate in life
  • Live your life in the current moment — accept reality — and yourself — without judgment

Every skill taught in DBT depends on mindfulness. Mindfulness can seem like a difficult concept, but it is simply the ability to stay present. With every phone notification, our running unfinished to-do list, and our brain’s tendency to stay distracted, many people spend very little time mindfully engaged in the present moment.

Why is this important?

The present moment defines your actual experience and how you respond to others. These small moments add up to define your day, and therefore your life. When you are distracted from the present moment by your thoughts, judgements, or opinions about what you’re doing or experiencing, you’re training your brain to engage in your thoughts, which aren’t always true, rather than in reality.

For example, if you’re in a social situation and are alone for a moment, your mindful brain would simply notice without judgment, that you aren’t currently talking to anyone. But if your emotional brain is engaged instead, your thoughts might spiral into unhelpful—and probably untrue—cognitions about your likability and friendships. These thoughts can lead to difficult feelings that may be unwarranted. And this is all a result of your thoughts and judgment. When we tune out our present experience, it is easy to lose sight of what is actually happening, and therefore we lose sight of how best to handle what is happening.

Distress Tolerance

DBT teaches skills that help us

  • tolerate and survive a crisis
  • accept life as it is in the moment
  • meet pain head on to actually reduce suffering

Problems, uncomfortable feelings, and difficult conversations are inevitable. With DBT, we can mindfully and skillfully respond to what life throws at us in a way that reduces our own suffering.

Emotion Regulation

Many people are intimidated by their strong emotions, or don’t know how to handle uncomfortable emotions. This is usually met with unhelpful coping skills, such as numbing out with social media, alcohol, drugs, or busyness…all in an attempt to not feel uncomfortable emotions. However, Brene Brown points out that we can’t only numb the difficult emotions—if we numb the negative emotions, we are also numbing the positive emotions.

DBT helps us learn how to process through all emotions by teaching skills that help:
identify and label emotions, thus increasing your “emotional vocabulary”

  • Identify obstacles to changing your emotions
  • Reduce vulnerability to negative emotions
    enhance positive emotional events
Interpersonal Effectiveness

Our brains are built for connection. At our core, we are here to love and be loved. But if we don’t know how to have hard conversations or deal with people that we disagree with, this impedes our connection to others and doesn’t feel good.

DBT teaches us:

  • Say “no”
  • Resist pressure
  • Maintain a position or point of view
  • How to ask for things
  • How to initiate a discussion
  • Effective conflict resolution
  • Balancing your priorities with the demands in your life

These skills are intended to increase your ability to meet your goals, while enhancing relationships and increasing your self-respect.

Evidence-Based Treatment

DBT is backed by a lot of research on its effectiveness in helping people overcome the issues mentioned above.

The National Institute of Mental Health (NIMH) and the National Institute of Drug Abuse (NIDA) provided funding for two of the very first studies conducted that proved DBT to be an effective form of treatment for Borderline Personality disorder and co-occurring substance abuse problems. The results of these two reputably funded studies proved that DBT helps reduce hospitalization in individuals struggling with psychological issues and addiction, as well as helps them integrate into social settings with greater ease.

Additional studies on DBT and its effectiveness on Borderline Personality Disorder highlighted the following results:

  • DBT reduces emotional distress, such as depression, anger, suicidal thoughts, and self-esteem issues
  • DBT reduces the likelihood of an individual engaging in self-harmful practices
  • DBT helps keep individuals with Borderline Personality Disorder tuned into treatment, meaning that very few leave treatment
  • DBT helps reduce the symptoms of Borderline Personality Disorder, as well as numerous other psychological disorders

In addition to the many studies conducted on DBT and Borderline Personality Disorder, studies have also been conducted on how well DBT helps treat other psychological issues. The results of these studies have concluded the following:

  • DBT reduces binging and purging behaviors in individuals with eating disorders
  • DBT decreases drug use in individuals struggling with opiate addiction
  • DBT reduces symptoms of depression
  • DBT helps develop stronger coping skills

In short, DBT is a highly effective form of treatment for people battling a variety of mental health disorders. It is also a powerful form of therapy for teens.