What's DBT all about?

Dialectical behavior therapy (DBT) is a powerful form of psychotherapy that asks you to identify areas of conflict and resolve them differently than you may have in the past. DBT asks you to look at how you may have sacrificed values that are critically important to you and to include those values in your decisions, strategies, and emotional response styles.

DBT helps you to work with your emotions, your thoughts, and your behavior. It requires that you allow yourself to feel your experiences rather than run away from your feelings. DBT can thus at times be painful, because you allow yourself to experience feelings that you may have avoided in the past. However, the benefits of doing so are that you are able to accomplish your objectives better, see your situation more clearly, and develop plans more effectively.

There are 4 stages of treatment in DBT:

1. In stage 1 of the treatment, therapy is focused on getting behavioral control.  People who enter treatment at this stage are actively struggling with life threatening behaviors (e.g. cutting, suicide attempts, excessive drinking), treatment interfering behaviors (e.g dropping out of treatment, hostility towards therapist, skipping therapy) and major quality of life interfering behaviors (e.g. risk of losing housing, being expelled from school, losing marriage, custody of children).  The rationale for focusing on gaining behavioral control at this point is that it is assumed that a life lived out-of-control is excruciating.  Progress cannot be made on underlying emotional issues until you have the skill to manage emotion without engaging in dangerous behaviors and are committed to the process of therapy.

2. Stage 2 begins to focus on emotional experiencing.  For those with Post Traumatic Stress, this is the stage where past trauma is explored and maladaptive thoughts, beliefs and behaviors are identified.  The primary goal of stage 2 is to reduce traumatic stress.  This is achieved by remembering and accepting facts of earlier traumatic events, reducing stigmatization and self-blame, reducing the denial and intrusive response syndromes and resolving dialectical tensions regarding who to blame.  Stage 2 targets are worked on only when behavior is under control.

3. The goal of stage 3 is to solve the problems of everyday living and improve happiness and joy in life.  This stage of treatment focuses on owning your own behavior, building trust in yourself and learning to value yourself.

4. And finally, stage 4.  In this stage the focus is on achieving transcendence and building a capacity for joy.  Most people would feel they could benefit from work on this stage.

DBT has two major treatment components. The first is individual psychotherapy, where you meet with a DBT therapist and explore your individual feelings, situations, and goals. The second is psychoeducation, which is the teaching of more effective psychological coping skills. This second function may occur individually or within a group format.

What makes DBT different from more traditional forms of psychotherapy is that DBT focuses on feelings more than thoughts and long-term goals more than immediate ones. It breaks situations down into manageable steps so that it is clear what you are attempting to accomplish, and it focuses more on the here and now rather than what happened in the past. You may find this approach challenging, but it’s also productive.

In psychotherapy, as well as in the educational sessions, you will be asked to complete homework assignments between sessions. The purpose of these homework assignments is to better understand concepts, apply them to your individual situation, and promote faster emotional and behavioral changes than would be the case if you only paid attention to your sessions and had no between-session homework.

These are the six major components of the educational sessions:

Mindfulness Skills: Learning to be in the moment rather than always in your thoughts

Walking The Middle Path Skills: learning to shape your behavior, learning to validate a response, learning to balance you and your environment, and learning to think dialectically

Emotion Regulation Skills: Learning how to change emotions so that emotions that hurt you linger less and emotions that you like linger more

Distress Tolerance skills: Learning how to put up with emotions that hurt but can’t be changed

Interpersonal Effectiveness Skills: Learning how to break problem situations and interactions down into small, manageable steps that are capable of being accomplished.

Radical Openness Skills: Learning how to accept feedback, be open to new things and experiences, not be in extremes of 'digging your heels in' vs 'giving up'.

Is this approach to psychotherapy scientifically proven? While there is always more room for evidence and experimentation, this approach to therapy has been scientifically evaluated since 1993 and found effective for many people. It is not a “new fad” treatment.

It does however, require adherent application in order to keep things from getting worse.