Dialectical behavior therapy (DBT) was originally developed to treat chronically suicidal individuals with borderline personality disorder (BPD). Over time, DBT has been adapted to treat people with multiple different mental illnesses, but most people who are treated with DBT have BPD as a primary diagnosis. DBT is heavily based on CBT with one big exception: it emphasizes validation, or accepting uncomfortable thoughts, feelings and behaviors instead of struggling with them. By having an individual come to terms with the troubling thoughts, emotions or behaviors that they struggle with, change no longer appears impossible and they can work with their therapist to create a gradual plan for recovery. The therapist's role in DBT is to help the person find a balance between acceptance and change. They also help the person develop new skills, like coping methods and mindfulness practices, so that the person has the power to improve unhealthy thoughts and behaviors. Similar to CBT, individuals undergoing DBT are usually instructed to practice these new methods of thinking and behaving as homework between sessions. Improving coping strategies is an essential aspect of successful DBT treatment. Studies have shown DBT to be effective at producing significant and long-lasting improvement for people experiencing a mental illness. It helps decrease the frequency and severity of dangerous behaviors, uses positive reinforcement to motivate change, emphasizes the individual’s strengths and helps translate the things learned in therapy to the person’s everyday life.
Dialectical behavior therapy (DBT) treatment is a type of psychotherapy — or talk therapy — that utilizes a cognitive-behavioral approach. DBT emphasizes the psychosocial aspects of treatment.
The theory behind the approach is that some people are prone to react in a more intense and out-of-the-ordinary manner toward certain emotional situations, primarily those found in romantic, family and friend relationships. DBT theory suggests that some people’s arousal levels in such situations can increase far more quickly than the average person’s, attain a higher level of emotional stimulation, and take a significant amount of time to return to baseline arousal levels.
While the majority of research to date has focused on the effectiveness of DBT for people with borderline personality disorder who struggle with thoughts of suicide and self-harm. DBT has also been used in the treatment of a variety of mental health conditions including:
Mindfulness which is perhaps the most important strategy in DBT, teaches you to focus on the present or “live in the moment.” By doing so, you can learn to pay attention to what's going on inside of you (thoughts, feelings, sensations, impulses) as well as what's outside of you (what you see, hear, smell, and touch) in non-judgemental ways. These skills will help you to slow down so you can focus on healthy coping skills in the midst of emotional pain. Mindfulness can help you to stay calm and avoid engaging in automatic negative thought patterns and impulsive behavior. Skills include: “What” skills of DBT - Observe, Describe, and Participate. Reasonable Mind, Emotion Mind, Wise Mind, "How" skills of DBT - Non- judgementally, One-Mindfully, Conscious Breathing, Doing One Thing at a Time, A Day of Mindfulness, Effectively.
Distress Tolerance teaches you to accept yourself and the current situation. More specifically, you learn how to tolerate or survive crises using four techniques: distraction, self-soothing, improving the moment, and thinking of pros and cons of not tolerating distress. By learning distress tolerance techniques, you'll be able to prepare in advance for any intense emotions and cope with them with a more positive long-term outlook. Skills include: Accepts, Self-Soothe, Improve, Pros & Cons, Accepting Reality, Observing your Breathe, Half-Smile, Awareness, Willingness, Turning the Mind, Radical Acceptance.
Interpersonal Effectiveness helps you to become more assertive in a relationship (for example, expressing needs and saying "no") while still keeping that relationship positive and healthy. This happens by learning to listen and communicate effectively, deal with difficult people, and respect yourself and others. Skills include: Dear Man, Give, Fast, Myths about Interpersonal Effectiveness, Cheerleading Statements, High Intensity Options, Situations, Factors.
Emotion Regulation provides a set of skills that helps one more effectively navigate powerful feelings. It teaches you to identify, name, and change your emotions. By recognizing and coping with intense negative emotions (for example, anger), you can reduce your emotional vulnerability and have more positive emotional experiences. Skills include: Please, Identifying Emotions, Describing Emotions, Myths about Emotions, Function of Emotions, Validation, Self Care, Build Mastery, Opposite Action, Letting Go, Riding the Wave.
We agree to accept a dialectical philosophy. When caught between two conflicting opinions, we agree to look for the truth in both positions and to search for a synthesis by asking questions such as, “What is being left out?”
We agree that the primary goal of this group is to improve out own skills as DBT therapists, and not serve as a go-between for patients to each other. We agree not to treat patients or each other as fragile. We agree to treat other group members with the belief that others can speak on their own behalf.
Because change is a natural life occurrence, we agree to accept diversity and change as they naturally come about. This means that we do not have to agree with each others’ positions about how to respond to specific patients nor do we have to tailor out own behavior to be consistent with everyone else’s.
We agree to observe our own limits. As therapists and group members, we agree not to judge or criticize other members for having different limits from our own (e.g., too broad, too narrow, just right).
All things being equal, we agree to search for non-pejorative or phenomenologically empathic interpretations of our patients’ our own, and other members’ behavior. We agree to assume we and our patients are trying our best, and want to improve. We agree to strive to see the world through our patients’ eyes and through one another’s eyes. We agree to practice a non-judgmental stance with our patients and one another.
We agree ahead of time that we are each fallible and make mistakes. We agree that we have probably either done whatever problematic things we’re being accused of, or some part of it, so that we can let go of assuming a defensive stance to prove our virtue or competence. Because we are fallible, it is agreed that we will inevitably violate all of these agreements, and when this is done, we will rely on each other to point out the polarity and move to a synthesis.
We all agree that we will strive to stretch our limits when working with our patients and with each other.
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