Dialectical Behavioral Therapy (DBT)

Published on 20th July, 2021

Dialectical  Behavioral Therapy (DBT)

Dialectical Behavioral Therapy

Dialectical Behavioral Therapy(DBT) is a form of cognitive-behavioral treatment approach. DBT was employed originally in treating women with suicidal ideation. Further research and trials led to it being proven as an effective, evidence-based treatment for individuals with Borderline Personality Disorder (BPD).

The biosocial theory of BPD suggests that individuals with BPD are born with a disposition toward emotional vulnerability (i.e., a low threshold for responding emotional stimuli with difficulty returning to normal levels of arousal). When the environment that this individual grows up in invalidates their emotional responses, it increases the risk of the individual developing BPD. The individual fails to develop emotional regulation skills, becomes afraid of their own emotions and may often resort to quick but maladaptive coping strategies (i.e., self-harm behaviors).

Hence DBT focuses on reducing actions associated with dysregulated emotions by teaching clients the necessary skills and validating their emotional responses. Studies over the years has shown its effectiveness in helping individuals who have suicidal intentions, substance use disorders, eating disorders and depression.

What does “Dialectical” mean?

Dialectic refers to discussion and reasoning through dialogue. The philosophy that reality consists of opposing forces and that these forces are continually balanced, is what differentiates DBT from other types of cognitive-behavioral approaches.

In DBT, the therapist seeks to maintain this balance by acknowledging that both acceptance and change are required for clients to achieve a meaningful and fulfilling life. Dialectical thinking allows the therapist to focus on ways to integrate their opinions with that of the patient, rather than insisting on the “correct” one. Hence giving way to discuss when they have differences with their clients. When suggesting solutions or skills, the therapist often proposes both acceptance-based and change-based solutions.

What are the other fundamental principles in DBT?

  1. Mindfulness

Mindfulness helps clients to be in the moment. Mindfulness skills is taught to the client as part of skills training. It allows the individual to view their current experience non-judgmentally, describing the facts of the situation and experiencing the present. At the same time, they are encourage to attend to one thing at a time and focus on effective, skillful behavior.

  1. Acceptance and Validation

Clients are taught to accept the experience of the present moment without trying to change or resist it. These acceptance skills are taught as part of skills training. Another way in which acceptance intervention is delivered by validating the individual’s experience, emotional reactions, thoughts or opinions. This is based on the belief that most individuals feel criticized or invalidated by those around them (i.e., their issues are ignored, dismissed or minimized. By conveying acceptance of their thoughts and feelings and then suggesting alternative perspectives to them, therapists would ensure the balance as mentioned in the philosophy of DBT.

What is skills training in DBT?

DBT aims to improve certain life skills that clients are assumed to lack or need. Through teaching these skills, DBT intends to enhance the individual’s capabilities to cope effectively. The four essential skills DBT focuses on are:

1) Mindfulness: paying attention to experience of the moment and regulating attention

2) Interpersonal Effectiveness: navigating interpersonal relationship with focus on assertiveness

3) Emotion Regulation: recognizing and managing maladaptive behaviors while correcting maladaptive coping strategies

4) Distress Tolerance: focusing on acceptance and to survive crises without making situations worse

How is DBT delivered?

A standard, comprehensive DBT has four parts:

1) Individual therapy: in which the focus is on improving client’s motivation to change and reduce ineffective behaviors and to help them apply their newly learnt skills in their life.

2) Group skills training: in which the four essential skills are taught through didactics, active practice, discussion and tasks for clients to practice skills between sessions.

3) Phone coaching: if needed for crises between sessions where they will be guided to apply the skills they have learnt.

4) Consultation team meeting for therapists: in which the aim is to maintain the motivation and enhance the skills of therapists who employ DBT.