What is Dialectical Behavior Therapy (DBT)?
Dialectical Behavior Therapy (DBT) helps people address strong emotions, thought patterns and behaviors that they want to change or that in the past may have led to increased distress or chaos. DBT helps people find the difficult balance between accepting the things they cannot change and learning the skills to be able to change life patterns, habits and choices in order to reduce unrelenting crisis and suffering. DBT offers skills and strategies to regulate emotions, make effective behavior choices, reduce suffering and increase happiness. The difficulties the world brings can sometimes be unfair and harsh. And, at times, the only thing we can control is the way we handle it. That often makes the difference between misery and joy. DBT combines cognitive-behavioral therapy and mindfulness approaches to help people better meet their goals.
DBT may be of benefit to you if you experience any of the following. Do YOU:
DBT has been shown in numerous studies to:
"This program is for people who want to take control of the emotions, thoughts and related behaviors that are making their lives or relationships more difficult. How well we are able to regulate or adjust our emotions at will is directly related to our success in sustaining healthy relationships with our families, friends and in the workplace." Patricia Gieselman, MFT - DBT Therapist
Emotions serve a number of important functions for survival, communication and for social connection. Our emotions and associated behaviors impact the relationship with ourselves and with others. Do you ever get depressed about being depressed? Or angry or ashamed about getting angry? Sometimes our emotions about our emotions are actually more painful than what we felt originally! Maybe you think, "This is just how I am" or "This is how things will always be". When people have difficulty managing their emotions, they may develop behaviors that make them feel better in the moment but are harmful in the long run. Some examples include:
Whether someone is passionate by nature or has just become reactive to life, they can learn to regulate emotions when they want to or when it is important for them to do so - at work, at home, in school and other social settings. The answer is in gaining skills that can be practiced until they become natural to use when feeling overwhelmed or out of control. Until we learn new skills, our actions are often based on what "feels" right in the moment - only later do we realize that these actions can be harmful to ourselves or to important relationships.
What would a DBT program include for me?
Developed by Dr. Marsha Linehan, PhD, at the University of Washington, DBT is a combination of individual therapy, skills training and coaching. When needed, family therapy is also included to help integrate new skills into current relationships and get coaching to practice in real world settings.
For DBT to be successful, the treatment has to do two things effectively:
(1) Teach skills that you need in order to move closer toward your life goals; and
(2) Help your cultivate an ability to work those skills into your daily lives.
The skills are taught through our DBT Skills groups. A standard DBT program for adults is a one (1) year program and includes participation in Individual Therapy and DBT Skills Group weekly, as well as telephone coaching to assist you in integrating the new skills when difficult situations arise. We generally ask clients to make a commitment to the entire one (1) year program. However, an integral part of the evaluation is to determine what is needed for each individual. Some people are already working with a therapist and seek to enroll only in the DBT Skills group. Outside therapists are asked to participate in ongoing case management and consultation activities to best serve each client. Commitment to your treatment is required of both the participant and the therapist and is a critical component for your success.
Individual DBT psychotherapy and DBT Skills groups are two ways of developing and sharpening the ability to apply new skills in real life. Individual DBT therapy is personalized and based on specific goals determined in partnership with your therapist. DBT Skills groups offers you social support and the opportunity to see how others incorporate DBT skills into their lives.
DBT clients usually meet individually with their therapist one to two times per week for 45-minute sessions. It is in these sessions that therapists work with you to discover behaviors and emotions that you want to change. With the help of the therapist, you can discuss current situations in your life. Together, you will problem solve and practice choosing and applying effective skills and strategies.
The DBT Skills group is usually made up of 4-8 group members who meet together once a week for about 2 hours. The Skills Group is run very much like a class or a seminar. Participants are provided with notebooks that go along with the skills being taught in group. Homework corresponding with the skills topics is routinely assigned and reviewed. Groups take place in continuous 6-month cycles, incorporating four (4) learning modules. New members can join at the beginning of each module throughout the cycle.
These skills groups teach you the strategies you need in order to reach your goals and provide regular opportunities to practice using those skills in your daily life. The skills modules include:
(1) Mindfulness - This is the core skill of DBT. Mindfulness is being present in the moment, learning how to effectively participate and respond rather than just react. Mindfulness is useful in helping you stay in the moment instead of focusing on the pain of the past or trying to prevent pain in the future;
(2) Interpersonal Effectiveness - Learning how to ask for what you want and say "no" effectively;
(3) Distress Tolerance - Living through difficult situations without making them worse; and
(4) Emotion Regulation - Reducing suffering and increasing happiness by managing the intensity and reactivity of emotions.
For adolescents, a fifth skills module has been added and is often presented in a Multi-Family Skills Group or Family Therapy format:
(5) Walking the Middle Path - Finding new ways for parents and teens to deal with the struggles of adolescence without engaging in power struggles.
Skills Coaching
Dialectical Behavior Therapy is all about learning new skills to use when things get tough. Sometimes, though, when a situation arises, you may have trouble knowing which skills to use in order to keep the situation or your emotions from getting out of hand. For those times, you can call your therapist for coaching. The therapist will help you identify and practice an appropriate skill in the moment to be effective.
The goal of DBT is to help individuals and their families create "lives worth living". You finally have the means to get off the emotional rollercoaster and reclaim control of your own life. DBT teaches specific strategies to help you get "unstuck" from your way of thinking, while at the same time validating where you are and affirming your feelings while leading you to change. This therapy approach is most successful when you are willing to commit to agreed upon goals and take an active role in partnership with the therapist toward your own recovery.
For further information, you can refer to:
TIME Magazine BPD Article w/Linehan and DBT
BTECH website
BRTC website