What is Dialectical Behaviour Therapy?
Dialectical Behaviour Therapy (DBT) is a type of behavioural therapy designed to treat mood disorders, predominantly borderline personality disorder. It is also sometimes used in the treatment of PTSD, eating disorders and addiction.
*See links to DBT workbooks you can do from home at the end of the article.
This type of therapy helps the patient cope with stress, build healthy relationships and regulate their responses to emotional distress. It is a comprehensive program involving individual therapy, group therapy, and a therapist consultation team.
Developed in the 1980’s by Dr. Marsha Linehan, this therapy is evidence based with a high success rate in treating certain mood conditions. Borderline personality disorder, previously thought to be untreatable, responds very well to DBT.
Borderline personality disorder involves rapid and intense reactions to emotional situations. Those with BPD tend to see situations in “black and white” terms, lacking the ability to control extreme emotional swings.
How does DBT work?
The Four Main Models Of DBT
(1) Mindfulness: DBT teaches patients how to regulate their attention to the present moment, rather than theoretical futures or past trauma.
(2) Interpersonal Effectiveness: DBT teaches patients how to navigate interpersonal situations effectively.
(3) Distress Tolerance: DBT teaches patients how to survive distressing situations without making it worse.
(4) Emotional Regulation: DBT teaches patients how to regulate extreme emotions without adding to them.
See https://psychcentral.com/lib/an-overview-of-dialectical-behavior-therapy/ to read a more in depth explanation of these four models of Dialectical Behaviour Therapy.
The aim of DBT is to teach the patient how to manage extreme emotional responses. Those with borderline personality disorder are thought to have a very low threshold for emotional stimuli, along with a hard-wired disposition to emotional vulnerability.
Limitations of Dialectical Behaviour Therapy
(1) A DBT program can be extremely demanding, and time consuming. The program requires 1-hour long sessions of individual therapy, 2-hour long sessions of group skills training weekly and regular homework assignments over the course of one year or longer.
(2) An intensive DBT program requires a highly trained professional to orchestrate the therapy for the patient.
(3) Restructuring the patients environment can be challenging. For example, if the patients symptoms are aggravated by poverty, it can be difficult to change the financial situation.
(4) DBT is extremely time consuming and requires dedication and commitment. If the patient is severely ill they may not be able to keep up with the assignments or attend the weekly sessions.
(5) DBT can be very expensive.
Why do some people have such a low threshold for emotional stimuli?
It is thought that those with borderline personality disorder had a childhood environment that failed to validate their emotional responses. Oversimplification of the “ease” of coping or problem solving can also lead to the development of BPD later in life.
The dismissal or punishment of a child’s emotions can lead to an increase in emotional vulnerability. The child may grow to cope with emotions in self-destructive ways or become “emotion-phobic“.
Radical Acceptance in DBT
In the distress tolerance model in DBT, radical acceptance is an integral part of the therapy. Through radical acceptance, the patient learns how to accept the present moment for what it is wholeheartedly. This can have profound impacts on the quality of life of the patient over time.
Another component of this model involves acknowledging the validity of the patients experience, thoughts and emotional reactions. As much of the emotional patterns stem from the invalidation of the patients emotions in childhood, this may help rebuild these patterns in a healthy way.
Dialectical Behaviour Therapy Works – But Only If You Are Committed To The Program
Dialectical behaviour therapy works, but the patient must be committed to the program and willing to invest the energy and time.
If the patient does not attend the weekly group sessions or the individual therapy sessions, progress may not be obvious. This type of therapy is multifaceted, requiring ones patience, dedication and belief that they can get better.
Can’t Afford DBT? Here Are Some Options In The Meantime
It is most beneficial to undergo a DBT program under a trained professional in an office setting via sessions. That being said, many of us simply cannot afford the cost of therapy.
There are many resources for those who need a bit of help right away but cannot afford it. It is always best to work with a professional, but there are excellent workbooks you can use on your own that may help in the meantime.
DBT Exercise Books
*Never try to do DBT on your own from home if you are having suicidal thoughts or urges to self-harm.
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