Dialectical behavioral therapy (DBT) is a valuable treatment approach to your mental health and overall well-being. By understanding the principles and techniques of DBT, you can gain insight into your thoughts, emotions, and behaviors to manage difficult situations more effectively.

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Educating yourself about DBT can also be empowering, as it allows you to take an active role in your treatment. It can help you advocate for yourself and communicate more effectively with mental health professionals.

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What is Dialectical Behavioral Therapy?

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DBT is a psychotherapy initially developed in the late 1980s by Dr. Marsha Linehan to treat borderline personality disorder (BPD) and suicidal ideation. It operates as a type of cognitive-behavioral therapy specially adapted for those who experience intense emotions.

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Dr. Marsha Linehan's tireless efforts began as she attempted to create a treatment for women struggling with multiple problems and suicidal tendencies. In her search for effective psychosocial therapies for various disorders such as anxiety and depression, Linehan compiled several cognitive-behavioral interventions specifically targeting suicidal behavior.

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Before Linehan's work, initial interventions were too focused on changing patients' cognitions and behaviors. This led to many patients to feel misunderstood and criticized, often causing them to abandon treatment. Through a combination of science and practice, Linehan's clinical experiences with suicidal patients fueled further research and development of the treatment.

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Based on the principles of dialectical philosophy, DBT balances acceptance and change-oriented strategies. Linehan's creation of a comprehensive, evidence-based cognitive-behavioral treatment designed explicitly for BPD culminated in a breakthrough in the field of mental health.

Borderline Personality Disorder

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BPD is a disorder that leads to acute emotional distress. Patients may show intense bursts of anger and aggression, rapidly shifting moods, and extreme sensitivity to rejection. They tend to have difficulty regulating emotions, experiencing instability in:

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• Mood
• Behavior
• Self-image
• Thinking
• Relationships

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Impulsive behavior, such as substance abuse, risky sex, self-injury, and repeated life crises such as legal troubles and homelessness, are common in those with BPD.

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What Improvements Do BPD Patients Experience with DBT?

The American Psychiatric Association has endorsed DBT as effective in treating borderline personality disorder. Patients who undergo DBT have seen improvements such as:

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• Decreased rage and anger
• Improved social functioning
• Less frequent/severe suicidal behavior
• Shorter hospitalizations
• Smaller likelihood of dropping out of treatment

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However, research backs DBT's effectiveness in various other mental health conditions.

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What Other Mental Health Conditions Benefit From DBT?

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DBT focuses on high-risk, tough-to-treat patients. These patients often have multiple diagnoses. While initially designed to treat those with suicidal behaviors or BPD, psychologists have adapted DBT for other mental health problems threatening safety, relationships, work, or emotional well-being.

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DBT is effective in a wide range of mental health conditions, including:

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• Anxiety disorders
• Bipolar disorder
• Borderline personality disorder (BPD)
• Depression
• Eating disorders
• Post-traumatic stress disorder (PTSD)
• Self-harm
• Substance use disorders

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DBT can help individuals manage difficult emotions, reduce impulsivity, improve their interpersonal relationships, and increase their overall quality of life. Research has shown that DBT can significantly improve symptoms and functioning, even for individuals with complex mental health challenges.

The 4 Stages of DBT

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Dialectical Behavior Therapy (DBT) is a structured, comprehensive treatment divided into stages. Each stage builds upon the previous one and addresses different aspects of the individual's treatment needs.

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• Stage 1: This stage's primary focus is reducing and eliminating the most severe and life-threatening behaviors, such as suicidal or self-injurious behavior. It is also a time for developing skills to regulate intense emotions, cope with distressing situations, and improve mindfulness.
• Stage 2: During this stage, the individual develops skills for improving interpersonal relationships and overall quality of life. The focus is on learning emotional regulation skills and improving distress tolerance.
• Stage 3: The focus of stage 3 is on addressing issues related to self-esteem and interpersonal relationships, including assertiveness training and developing better communication skills.
• Stage 4: The final stage helps individuals achieve a sense of fulfillment and build a life worth living. This stage involves creating a vision for the future, developing a plan to achieve goals, building and maintaining healthy relationships, and enjoying greater happiness and contentment.

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The Stages of DBT Aren’t a Checklist.

Like all talk therapies, DBT requires time, dedication, and motivation. Change doesn't happen simply or quickly. Some additional points to keep in mind about the four stages of DBT include:

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• The length of each stage varies depending on the individual's progress and needs, and some people may spend more time in one than another.
• Each stage requires a certain level of mastery of the skills taught in the previous one.
• Progression through the stages is not always linear, and individuals may need to revisit earlier stages if they experience setbacks or challenges.
• DBT is a collaborative process between the therapist and the individual receiving treatment, and both parties work together to identify goals and develop strategies to achieve them.

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What Are the Principles of DBT?

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Before Linehan's work, initial interventions were too focused on changing patients' cognitions and behaviors. This led to many patients to feel misunderstood and criticized, often causing them to abandon treatment.

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The main goal of DBT therapists is to balance acceptance of who you are, your challenges, and the benefits of change. Your therapist will help you learn new skills to improve emotion regulation.

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The structure of dialectical behavior therapy can vary from therapist to therapist, but, in general, DBT is rooted in several principles.

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Dialectics

The concept of dialectics is central to DBT. Dialectics refers to the idea that two seemingly opposing views can simultaneously be true. For example, a person can both need help and want to be independent, or a person can both feel sad and have moments of happiness.

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DBT uses dialectics to help individuals see situations from multiple perspectives and find a balance between seemingly conflicting ideas.

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Mindfulness

DBT emphasizes the importance of mindfulness, which is the practice of being fully present and engaged in the current moment. Mindfulness can help individuals become more aware of their thoughts, feelings, and behaviors without judging themselves or their experiences. Mindfulness can also help individuals tolerate distressing emotions and reduce impulsive behavior.

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Acceptance

Another pillar of DBT is acceptance, which involves acknowledging and validating one's experiences without trying to change them. Acceptance can help individuals reduce their emotional suffering and increase their sense of self-worth.

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Change

While acceptance is essential, DBT also recognizes the need for change. DBT focuses on developing skills and strategies to help individuals change unhelpful thoughts, feelings, and behaviors.

Validation Components of DBT

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DBT is a powerful form of therapy that helps individuals resolve the apparent contradiction between self-acceptance and change, allowing them to achieve positive changes and growth.

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Validation is a crucial aspect of DBT, as it helps individuals feel understood and acknowledged, reducing their resistance to change. Therapists can help patients recognize that their thoughts, feelings, and behaviors are valid and understandable, given their unique experiences.

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Validation does not mean that the therapist agrees with every action the patient takes, but rather that they understand the reasoning behind the behavior. By acknowledging the patient's perspective, the therapist can guide them toward more effective problem-solving strategies and goal achievement.

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You can practice DBT in various settings, including individual psychotherapy, group skills training, and phone coaching. Each environment has a unique structure and goal, but all share the same underlying principles of validation and change. With the help of a skilled therapist, people can develop the tools they need to navigate life's challenges and achieve lasting growth and happiness. DBT typically consists of four main components:

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Individual Therapy

Individual therapy is the cornerstone of DBT. In individual therapy, a person works one-on-one with a trained therapist to develop skills and strategies to manage emotions, improve interpersonal relationships, and reduce impulsive behavior. The therapist and client work together to set goals, identify triggers, and develop strategies for managing distress.

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Group Skills Training

Group skills training is another vital component of DBT. In skills training, individuals with similar mental health challenges attend weekly sessions to learn and practice new skills. The skills taught in DBT include mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness. Skills training is typically structured, with a specific curriculum and homework assignments.

Phone Coaching

Phone coaching is a unique aspect of DBT. Clients are encouraged to contact their therapist outside regular therapy sessions if they are in crisis or need support. The therapist provides coaching and guidance over the phone to help the client manage their current distress.

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Consultation Team

Consultation team meetings regularly provide support and guidance to therapists implementing DBT. These meetings allow therapists to receive feedback on their work, discuss challenging cases, and receive additional training.

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Validation does not mean that the therapist agrees with every action the patient takes, but rather that they understand the reasoning behind the behavior.

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What Are the Challenges of DBT?

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DBT can be highly effective for many people, but there are some potential challenges that individuals may face when using this therapy.

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One of the main challenges is the significant commitment of time that DBT requires. In addition to regular therapy sessions, clients do "homework" to work on skills outside of individual, group, and phone counseling sessions. Homework can be difficult for those who struggle to keep up with assignments or have limited time due to work, school, or other obligations.

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Another challenge that some people may face is practicing the skills that DBT teaches. At different stages of treatment, people may explore traumatic experiences and emotional pain, which can be upsetting. Additionally, some of the skills taught in DBT, such as mindfulness and distress tolerance, may be difficult for some people to master.

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It's essential to remember that you can address these challenges with the help of a qualified DBT therapist who is there to support and guide you through the treatment process.

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Can You Perform DBT on Yourself?

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The main goal of DBT therapists is to balance acceptance of who you are, your challenges, and the benefits of change.

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Professionals generally recommend you avoid attempting any therapy on your own without the guidance of a trained therapist. DBT is a complex therapy that involves various techniques and skills, and it's essential to have someone trained to help guide you through the process.

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That said, there are some things you can do on your own to develop new coping skills. Mindfulness, breathing exercises, and progressive muscle relaxation are all techniques you can learn and practice on your own to improve your ability to tolerate distress.

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However, it's essential to remember that self-practice should not replace professional help. If you're struggling with a mental health condition, it's always best to seek out a qualified mental health professional. They can help you navigate the complexities of DBT and ensure that you're receiving the most effective treatment possible.

Get Started with DBT

Talking to a trained professional is crucial if you or someone you know could benefit from DBT. They'll assess your symptoms, treatment history, and therapy goals to see if DBT suits you. However, we recognize that finding a qualified DBT therapist can be difficult.

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At Sequoia Behavioral Health, we have trained professionals who specialize in DBT and can offer personalized treatment plans. We understand the first step is always the hardest, but we'll be with you every step after. Don't hesitate to start your journey towards a healthier, more fulfilling life.

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