Dialectical Behavioral Therapy for Mental Health
What is Dialectical Behavior Therapy (DBT)?
At URP Behavioral Health, comprehensive DBT and skills training is a core aspect of our treatment methodology for different mental health conditions. Besides treating borderline personality disorder, it’s highly effective at building distress tolerance skills useful in several situations. Let’s discuss what this evidence-based therapy includes and its different applications.
Based on CBT, dialectical behavior therapy is a psychotherapy that’s formulated for people who struggle with overwhelming and intense emotions. It helps you understand, accept, and manage unpleasant feelings while working to introduce positive life changes.
Throughout your DBT sessions, you’ll build the following skills:
This involves observing and participating in the present moment without worrying about the future. Through mindfulness, you learn to experience emotions without judging or labeling them as good or bad.
With this skill, you build up healthy coping skills and mechanisms to deal with emotional pain and suffering. One of them includes radical acceptance, which helps you accept situations beyond your control and eventually move on.
This means gaining control over your emotions instead of being controlled by your emotions. For instance, your therapist may suggest doing the opposite of what your emotions make you do. So when your emotions make you isolate yourself, you can regain control by going outside and meeting your friends.
Through interpersonal effectiveness skills training, you’ll know how you fulfil your needs in a healthy way, improve your relationships, and set healthy boundaries. Most importantly, you build self-respect.
DBT Treatment Stages
According to Linehan, there are four stages of dialectical behavioral treatment, each of which corresponds to a specific level of disordered behavior.
Before the stages, you go through a pretreatment phase. This is when your therapist uses strategies to help you commit to the process. They’ll also inform you about the goals of the individual therapy, as a way to increase treatment compliance.
The purpose of the first stage is to reduce the risk of life-threatening behaviors and other actions that could interfere with the treatment. Some examples include suicide attempts other mental health conditions and substance abuse.
In the second stage, your therapist will address underlying issues that cause your emotional dysregulation. They’ll work with you to reduce traumatic stress symptoms and emotional avoidance.
Ordinary Happiness and Unhappiness
In the third stage, you’ll be more emotionally stable and learn to cope with the happiness and unhappiness that comes with a normal life.
Capacity for Sustained Joy
Upon reaching the fourth stage, you’ll learn to find meaning in existence. This develops a capacity for experiencing greater happiness and joy.
What Conditions Does DBT Treat?
When you’re diagnosed with an anxiety disorder, such as generalized anxiety disorder, it can lead to persistent worry that disturbs your ability to function. These can lead to unpleasant emotions that worsen your symptoms. During DBT sessions, your therapist will teach you to focus on now instead of anticipating future catastrophes. Using emotion regulation techniques, you’ll learn to ride out the wave of negative emotions that manifest when you’re anxious.
In bipolar disorder, you go through episodes of depression and mania that affect daily functioning and relationships. During episodes of mania, you feel irritated or distracted easily. You may have increased energy and confidence, which can lead to risk-taking behavior.
Meanwhile, depressive episodes can lead to feelings like hopelessness and guilt. With DBT, you build an awareness of where these feelings come from. So, the next time you experience these feelings, you tolerate them instead of engaging in negative coping behaviors.
Disorders like major depression can lead to persistent low mood and lack of interest in things you previously enjoyed. Through regular DBT sessions, your therapist will guide you on ways to tolerate low mood.
As you become more mindful of how your mood irregularities affect you, you try to stay in control. You can learn how to resolve conflicts and build healthy relationships with others despite experiencing low moods.
Post Traumatic Stress Disorder
PTSD develops due to exposure to a single traumatic event or prolonged exposure to complex trauma. As a result of the condition, you avoid places, events, and people associated with that trauma, which can prevent you from functioning.
Through using mindfulness skills, you ground yourself in the present instead of thinking about the event. You’ll also implement distress tolerance techniques that stop intrusive thoughts from worsening. Most importantly, interpersonal effectiveness is used to interact with other people without being fearful or hypervigilant.
Because schizophrenic disorders include hallucinations and/or delusions, most treatment plans include a combination of therapy and medication. Mental health practitioners may recommend DBT as a way to manage intense emotions during psychosis.
In these sessions, you build emotional awareness and understand the connection between your symptoms and how you feel. By doing so, you start to accept the feelings and work on adaptive responses to hallucinations and delusions. This effectively prevents harmful behaviors.
Treatment for OCD requires a method that addresses both components: obsessive thoughts and compulsive behaviors. Therapists usually rely on CBT as a way to change your thought process and resulting behaviors. However, they also recommend DBT to help you practice acceptance when you fail or encounter disturbing thoughts.
For instance, your therapist will teach you skills for distress tolerance so you experience intrusive thoughts without engaging in compulsive behavior. There’s also emotion regulation skills too, which helps you realize that anxious feelings eventually subside without the need for compulsive behavior.
When you have a diagnosis of panic disorder, you’re constantly worried about encountering situations in which you may experience a panic attack. During a panic attack, your body experiences physical sensations like increased temperature and heart rate. With DBT sessions, you’ll learn to target those sensations to activate your parasympathetic nervous system (for example, through paced breathing and muscle relaxation) and relieve anxiety as a result.
Whether you have a nonsuicidal self-harm disorder or any other mental illness, you may have experienced the urge to self-harm as a way to cope with overwhelming emotions. Your therapist will use DBT to teach you distraction techniques that take your mind away from distressing thoughts.
Borderline Personality Disorder
DBT is a major component in the treatment of borderline personality disorder. That’s because BPD is marked by impulsive behaviors, unstable relationships, and mood swings. In DBT sessions, you’ll build skills that help you cope with strong emotions while sustaining healthy relationships with others. Moreover, you’ll become more accepting of the pain you experience and understand that it’s a part of life. Gradually, you’ll start to show more control over your emotions, which can prevent dysfunctional behaviors.
Depending on which dissociative disorder you have, you may experience lapses in memory, issues in perception, and problems with your sense of self, identity, and personality. Usually, these disorders occur because of trauma, so you’ll need therapy to re-process the trauma and reduce the intensity of symptoms.
However, keep in mind that symptoms like forgetting important personal information and feeling uncertain about who you are can be quite upsetting. Here, your therapist will suggest DBT skills as a way to tackle distress in situations and manage overwhelming emotions.
What is the Science behind DBT?
Dialectical behavior therapy was developed as a result of applying standard behavioral interventions for the treatment of suicidal patients. It’s based on the concepts of behavior therapy, which focuses on changing unhelpful behaviors, as well as acceptance, which is a core principle of Eastern mindfulness.
Marsha Linehan, the founder of DBT, states in her biosocial theory that some people are biologically more vulnerable to increased emotional reactivity. This makes them more likely to develop borderline personality disorder. In fact, research shows that BPD is associated with abnormalities in areas of the brain, such as the hippocampus, anterior cingulate cortex, and amygdala. Studies that compared brain activity before and after DBT show that therapy leads to reduced activity in the inferior frontal gyrus when exposed to arousing stimulus.
FAQs about Dialectical Behavioral Therapy
Here are some of the most commonly asked questions about DBT and its applications in mental health treatment.
The four modules of DBT are mindfulness, distress tolerance, interpersonal effectiveness, and using emotional regulation skills. Mindfulness refers to consciously focusing on the current moment and doing so in a nonjudgmental way, while distress tolerance involves managing difficult events and crisis situations to prevent impulsive actions. Through interpersonal effectiveness, you understand your needs in a relationship and work on healthy ways to meet those needs. Lastly, emotional regulation teaches you to experience emotions without acting on them.
According to the founder of DBT, Marsha Linehan, the term ‘dialectical’ refers to the synthesis of opposites. You can think of it as the simultaneous existence of opposing truths. It’s how, in DBT, you learn to practice acceptance but work towards change at the same time. For instance, accepting your flaws but acknowledging that you need to change to achieve certain goals.
Even if your teen doesn’t have a diagnosis of a disorder, the hormonal changes associated with puberty have an effect on their emotional responses. This makes them likely to decide based on emotions. Pair these changes with exposure to violence, abuse, or poverty, and it increases the risk of developing a mental disorder. DBT is designed for people who experience intense emotions, so it can help teenagers think logically and be more accepting. They’ll start blaming other events or people less and focus on coming up with solutions.
All three therapies serve the same purpose of reducing negative and unwanted behaviors. Neuro-linguistic programming does this by focusing on language and how we perceive it, while CBT emphasizes thoughts, beliefs, and attitudes. Meanwhile, DBT therapy involves understanding and accepting your feelings.
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