What is Dialectal Behavior Therapy?
Dialectical Behavior Therapy (DBT): a highly specialized form of Cognitive Behavioral Therapy (CBT) designed to help people with difficulty with emotion regulation. They may struggle in five areas of dysregulation:
- Emotional dysregulation: emotions may feel overwhelming, moods may change rapidly and feel out of control, and a person may feel very angry, sad or fearful and have emotional outbursts.
- Behavioral dysregulation: as a response to emotional suffering, a person may have strong urges to self-harm. They may engage in various impulsive behaviours such as drugs, alcohol, spending, gambling, eating binges, unsafe driving or unsafe sex.
- Interpersonal dysregulation: a person may go back and forth between love and hate in close relationships. Relationships may be stormy. There may be deep fear of abandonment and frantic efforts to avoid losing connection.
- Cognitive dysregulation: in stressful situations, a person may become hyper-vigilant or dissociate. They may feel that others are deliberately mean to them or out to hurt them them. At other times they may feel spaced out or emotionally numb as if watching things from a distance.
- Dysregulation or fragmentation in one’s sense of self: a person may feel empty inside, unsure of who they are, or questioning if they even have an identity. They may feel that they change all the time according to the people they are with. They may feel like they don’t even exist.
Many therapists incorporate DBT into their treatment, however, only a handful in the area are intensively trained and provide DBT effectively. DBT skills is a small portion of the treatment, which incorporates very specific techniques to help our clients build a life they embrace.
We pride ourselves on adherence and fidelity to the model. Adherence is the accuracy of the therapists’ delivery of DBT which includes factors such as movement, speed and flow; balancing acceptance and change. Fidelity is the extent to which different components (modes) of treatment are being delivered in a manner consistent with the principles of the treatment.
DBT asserts that pervasive difficulties in managing emotions arise in part from skills deficits. Accordingly, part of DBT is a weekly skills training group designed to remedy those deficits. In group, clients learn skills for better management of emotions, relationships, distress and focusing on the present moment. In conjunction with the group, clients in DBT attend once weekly individual therapy that is focused on applying the skills to their particular problems and goals. If a client has an existing individual therapist, the client would continue with their existing therapist, and we would collaborate on the skills.
CBT and DBT therapists believe that some clients can not be helped by insightful discussions alone. Although insight can be helpful at times, learning new behaviors is critical in DBT. “Behavior” refers to anything a person thinks, feels, or does. Dialectical behavioral therapy uses a wide variety of techniques to help people change behaviors and build a “tool box” of skills.
In DBT a combination of validation and collaboration leads to change. Clients will also focus on acceptance of those things in their lives that cannot be changed. DBT teaches skills enabling clients to walk through instead of reacting or running away from difficult situations.
Dialectics are one of the important unifying concepts that reflect how the mind fundamentally understands and perceives most core concepts and ideas. The field of psychology contains an abundance of such concepts, including self esteem, trust, courage, honesty, rage, passivity, withdrawal, impulsivity, inhibition, blame, worthiness, guilt, risk taking, and on and on. Dialectics are based in part on the fact that we cannot fully understand any of these abstract concepts without appreciating that they consist of bipolar opposites with a higher level of integration somewhere in between them.
Often individuals may see a different “truth” to the same problem, and therefore become polarized taking opposite positions on the subject. In DBT we learn to understand the various truths that are possible, and that it is likely that the real “truth” is not a pure polarized position, but rather some shade of grey between the two viewpoints.
“Dialectics” is a complex concept with roots in philosophy and science.
It involves several assumptions about the nature of reality. Everything is connected to everything else; Change is constant and inevitable; and opposites can be integrated to form a closer approximation to the truth (which is always evolving).
DBT Theory and Background
Dr. Marsha Linehan, the creator of DBT, studied a group of chronically depressed patients struggling with suicidal ideation who were unresponsive to existing cognitive behavior therapies (CBT) were frequently emotionally dysregulated. By this she meant that they became intensely emotional and had great difficulty returning to baseline.
She reviewed the existing Behavior Therapy (BT) literature to see what techniques had already been proven to effectively modulate intense emotional states like anger, anxiety, depression, and fear. CBT techniques that worked for those emotional issues were a good starting point to test on the emotionally dysregulated population she wanted to help. She also identified how mindfulness skills developed by practices such as meditation, often seen in religious or spiritual practices, may benefit these clients. Applying these skills in the context of DBT is not dependent on any particular religious or spiritual belief. Mindfulness skills are utilized for many reasons. These DBT Skills enable group members to become more proficient at slowing down and observing, describing, and labeling their emotional experiences, thoughts, and other internal experiences. With practice those skills also help them to participate more in the present moment and become more effective in decision making and problem solving, precluding impulsive actions that might make situations worse, and exacerbate or prolong emotional distress.
Although she imported a variety of tools, she was able to group them in a well organized treatment package. And given that many of the skills are effective on their own for treating particular problems, it makes sense that group members learning how to utilize many of them together increase the probability they can address many different kinds of intrapersonal and interpersonal challenges.
DBT at The Counseling Center of MarylandTM
The Counseling Center of MarylandTM offers an adherent DBT Program which includes the four components of DBT: skills training group, individual treatment, DBT phone coaching, and consultation team.
- DBT skills training group is focused on enhancing clients’ capabilities by teaching skills.
- DBT individual therapy is focused on helping clients to apply the skills to specific challenges and events in their lives. In the standard DBT model, individual therapy takes place once a week for as long as the client is in therapy and runs concurrently with skills groups.
- DBT phone coaching is focused on providing clients with in-the-moment coaching on how to use skills to effectively cope with difficult situations that arise in their everyday lives. Clients can call their individual therapist between sessions to receive coaching at the times when they need help the most.
- DBT therapist consultation team is intended to be therapy for the therapists and to support DBT providers in their work so they can provide the best treatment possible.
As its name suggests, DBT emphasizes dialectics — the reconciliation of opposites in a continual process of synthesis. DBT emphasizes the dialectic of acceptance and change in improving the quality of participants’ lives.
Dialectical Behavior Therapy (DBT) is a highly specialized form of CBT designed to help people with pervasive difficulties managing their emotions. These difficulties may be apparent in a variety of ways including self-destructive or self injurious behavior, anger management problems, binge eating, ongoing relationship conflicts, and self-hatred. DBT is a mindfulness-based therapy that balances the use of change strategies from cognitive behavioral therapy along with acceptance strategies.
“Participate more in the present moment and become more effective in decision making.”