Dialectical Behavior Therapy
What is Dialectical Behavior Therapy?
Dialectical behavior therapy (DBT) is a form of Cognitive Behavioral Therapy treatment that intends to instill new positive coping skills to regulate adverse emotions and help provide better conflict resolution skills in their relationships. Psychologist Marsha M. Linehan developed this evidence-based therapy during the late 1980s to treat borderline personality disorder.
DBT has applicable merit as a therapy in treating several other kinds of mental health disorders. DBT is comprised of therapeutic skills in four key areas that establish a better sense of self, which is why it is highly effective in treating borderline personality disorder and disruptive mood dysregulation disorder.
Dialectical behavior therapy for substance abusers is a commonly used form of psychotherapy that has proven to be effective for substance abuse recovery. The common goal of DBT is to stabilize one’s self and control of their emotions regardless of their mental health disorder or substance use disorder.
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Understanding Dialectical Behavior Therapy
A cognitive-behavioral approach is utilized in dialectical behavior therapy. Cognitive Behavioral Therapy is considered talk therapy that focuses on altering the thought process and how you view things, and by doing so, you will change your behavior to match your altered state of thought. DBT specifically focuses on psychosocial factors of treatment.
For example, individuals may tend to respond more intensely and outwardly to certain situations, some of which are not appropriate to the situation they are facing. These may be known as triggers, which means that certain stimuli or environment will provoke the individual to respond in a manner not appropriate to the situation. Many of these outbursts are found in family and friend relationships and especially romantic situations.
This is common in people with a borderline personality disorder. Individuals who are treated with DBT are observed to have arousal levels to situations at a much quicker rate than those who do not have emotional dysregulation. Their level of emotional stimulation is significantly increased and takes longer to return to emotional homeostasis than other individuals.
These symptoms can be attributed to a variety of mental health disorders; however, borderline personality disorder is the most common disorder associated with these symptoms and is treated with DBT. People with borderline personality disorder tend to experience unexpected mood swings and usually only see the events of the world in “black-and-white.” There are no shades of “gray” or middle ground, most of the time.
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Where Does Dialectical Behavior Take Place?
Many recovery centers and psychiatric facilities have therapists who provide DBT. The empirical psychotherapy treatment is used to treat many mental health disorders, including substance abuse. There are three therapeutic settings where dialectical behavior therapy for substance abusers are conducted:
- Group settings: Individuals interact with each other by doing exercises, such as roleplaying and assignments to build interaction skills.
- Individual therapy: Therapists provide DBT to individuals on a one-on-one basis. The individual learns skills to practice outside of therapy.
- Phone coaching/teleconference: This is a method of DBT that is used by the therapist and individual communicating via telephone or the internet.
The Main Components of Dialectical Behavior Therapy
The main components of dialectical behavior therapy assist in regulating their emotions and thoughts through various techniques. This works for both mental health disorders and substance use disorders. The main components include:
- Cognitive-based: Talking through problems will help identify the beliefs, thoughts, and perceptions that make the individual’s life more difficult than necessary. It eradicates the negative thoughts and replaces them with rational and positive thoughts. This helps the individual regulate their emotion more regularly than before.
- Support-oriented: This portion of DBT is about identifying an individual’s strengths and focusing on them so that they can live a more productive life. The idea is for the individual to strengthen their natural capabilities so that they have healthier self-esteem and self-identity.
- Collaborative: This is an essential component of DBT. The individual and the staff are in constant communication to provide treatment. This includes working out issues they may have with their therapist, and the therapist will do the same as they do. It is a way to work on healthy coming to resolutions that work for both parties involved. Individuals are also asked to do assignments that relate to what skills they have learned and how they will apply them in real-life situations and relationships. Roleplay is also including as a means to learn to healthily interact with other individuals in various situations and events. This also includes using coping skills when the individual may become bothered. It is the treatment in action.
These exercises from DBT are crucial to progress. Therapy takes place typically every week, with new lectures, reviewing assignments from last sessions, and learning new coping mechanisms to replace the negative ones.
The 4 Modules of Dialectical Behavior Therapy
- Mindfulness: The core mindfulness skills are a significant part of the modules because it helps the individual ask themselves what to do. This means they will think more deliberately before they decide to act. The core mindfulness is to observe, describe, and participate.
- Interpersonal Effectiveness: This module of DBT improves your interpersonal emotional reactions to stimuli and interactions with other individuals and personal relationships. It teaches assertiveness without aggression or negativity. It is a new pattern of being able to relate appropriately with others. Especially with interpersonal conflict. Individuals typically display optimal interpersonal skills with others with the exception that certain situations arise where they feel emotionally attacked or violated. That is where the escalation of emotion and behavior collide. They are not rational when they are in their heightened emotional state, but they know how to interact when they do not experience the intensity of emotions. The purpose of this module is to evoke change in interactions regarding positivity and how to firmly say no in certain situations. The goal is to enhance relationships while gaining self-confidence in their ability to interact with others.
- Distress Tolerance: Dialectical behavior therapy does not teach individuals to fear pain but rather to bear it with healthy coping skills. Denying pain will only lead to a worsening mental state. Distress tolerance develops from mindfulness skills because they both accept without contempt or judgment of oneself or painful stimuli or situations. It is important to note that acceptance is not approval. It simply means to tolerate the reality of the distress in a way that healthily regulates your emotions. This is a module designed for individuals to be able to tolerate and cope with crises. Acceptance is a major theme in distress tolerance. Acceptance is a learned skill that an individual grows emotionally.
- Emotional Regulation: Individuals who undergo dialectical behavior therapy are typically emotionally fragile. They may have a borderline personality disorder, major depressive disorder, or anxiety. They can even be suicidal. Therefore, emotional regulation is an important part of the four modules. Skills to help regulate emotion include:
- Identifying and categorizing emotions.
- Identifying obstacles to changing emotions.
- Reducing vulnerability to “emotion mind.”
- Increasing positive emotional events
- Increasing mindfulness to current emotions
- Taking the opposite action
- Applying distress tolerance techniques
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