Dialectical Behavioral Therapy for Mental Health
Unlike traditional psychotherapy, cognitive-behavioral therapy (CBT) focuses on a person’s behaviors, thoughts and feelings, and setting goals. One significant form of CBT is dialectical behavior therapy (DBT), developed in the 1980s by psychologist Marsha M. Linehan. In successful cases, DBT improves how people interact with others and helps them express their emotions healthily and positively. DBT is known to treat many mental health disorders. In many cases, mental illnesses and behavioral disorders go hand in hand, making DBT an even more effective therapy for people with co-occurring disorders. Learn more about dialectical behavior therapy, and see if this talk therapy is the right kind of mental health treatment for you.
What is Dialectical Behavioral Therapy (DBT)?
Dialectical behavioral therapy is a method of cognitive-behavioral therapy that focuses primarily on changing unhealthy behaviors, teaching coping skills, and improving social interactions. In philosophy, the theory of dialectics means “balancing opposites.” By bringing together two opposite ideas (change and acceptance) in therapy, DBT counselors hope to improve a patient’s reactions to all kinds of situations. DBT establishes three beliefs: that opposites can be brought together to achieve greater results, that change is constant and inevitable, and that everything in life is interconnected. Although change and acceptance seem like opposite ideas, DBT practitioners believe that these two produce positive results when brought together.
The Four Strategies of Dialectical Behavioral Therapy
DBT teaches people to change their behaviors through four strategies, or modules:
Stage 1: Interpersonal Effectiveness
Interpersonal effectiveness refers to how well you interact in relationships, both professional and personal. Through interpersonal effectiveness, you learn how to be more assertive, listen, and communicate better, and handle conflict while still keeping healthy and positive relationships. Some skills learned through this strategy include saying “no” and standing up for yourself, as well as dealing with difficult people.
Stage 2: Distress Tolerance
Distress tolerance is an important skill to learn in DBT. People with borderline personality disorder and depression can find it difficult to tolerate intense emotional situations like death, career changes, divorce, and loss. When you learn distress tolerance, you can cope with long-term distressing situations through self-soothing and distraction.
Stage 3: Emotion Regulation
Emotion regulation makes up a large part of DBT. Learning how to properly control your feelings will help you improve your relationships with family, friends, and coworkers. Emotion regulation teaches you how to identify and cope with your negative emotions and pinpoint obstacles that keep you from changing your emotions.
Stage. 4: Mindfulness
Mindfulness teaches us to be at peace with ourselves, accept reality as it is, and embrace change. People who are mindful are more aware of themselves in the present moment. Mindfulness in DBT teaches “what” and “how” skills. The “what” skills (observe, participate, describe) are what you do to practice mindfulness, and the “how” skills (one-mindfully, effectively, and nonjudgmentally) are how you practice mindfulness. By learning these four strategies, DBT patients can learn how to be better people and have better relationships, which will improve self-esteem and behaviors.
What Does Dialectical Behavioral Therapy Treat?
DBT is especially helpful in treating borderline personality disorder, which makes it difficult for people to regulate emotions. Those with borderline personality disorder also react intensely to different situations, and DBT can help with this as well. DBT can also treat people who frequently experience suicidal thoughts. Dialectical behavioral therapy is best for people with high-risk conditions and behaviors. DBT patients are prone to self-harm, engaging in risky sex, financial problems, and running into legal problems. People with troubled thinking, relationships, self-image, and moods are good candidates for this method of mental health treatment. In addition to borderline personality disorder, dialectical behavioral therapy is also effective in treating the following conditions:
- Post-Traumatic Stress Disorder (PTSD)
- Bipolar Disorder
- Eating disorders
Dialectical-Behavioral Therapy (DBT) and Mental Illness
People recovering from mental illness can benefit greatly from Dialectical-Behavioral Therapy (DBT). Since DBT teaches coping mechanisms and lets you live your life as efficiently as possible, it can also help people with mental health issues have a more productive life. It does this by emphasizing acceptance and change, which can be difficult for people with mental illness to comprehend.
Mental illness is fueled by destructive behavior. Those suffering from mental health issues tend to experience low self-esteem, and mental and emotional instability, leading to poor relationships and trouble dealing with conflict. Through emotion regulation and mindfulness taught in DBT, people can learn how to handle triggers that can lead to relapse, as well as control cravings and urges.
Goal setting in DBT can also be a positive experience for mental illness sufferers, giving them something to look forward to. Patients can focus on their recovery goals and look toward the future. In mental health treatment, DBT can be offered in both inpatient and outpatient settings. The therapist and the patient must be willing to collaborate for DBT to be effective. Montare Behavioral Health offers DBT for people suffering from mental disorders, and we can educate you on how it works.
What to Expect During Dialectical Behavioral Therapy
If you participate in DBT, you’ll usually have two sessions per week. DBT sessions are held in three different ways, each of which has a different positive effect on the patient:
- Group therapy sessions: DBT therapists will hold weekly group therapy sessions in which everyone can have a chance to speak out and voice their feelings. During each session, which lasts about two and a half hours, patients will practice role-playing and complete homework assignments that help them apply their new skills toward real-world situations.
- Individual therapy sessions: As important as group DBT sessions are, individual therapy is crucial, and focuses on the person as a separate entity. Therapists work with individual patients on the behavioral skills they’ve learned in group sessions and apply them to their own personal situations. Therapists will help teach the patient how to deal with difficult people in their lives.
- Phone coaching: In times when patients are in a crisis in between sessions, DBT therapists can offer phone coaching to guide them through a troubling situation.
Dialectical behavioral therapy will work in four stages:
- Stage 1: Treat the most destructive behavior first (i.e. self-harm and suicide attempts
- Stage 2: Address quality-of-life skills, like interpersonal effectiveness, mindfulness, and emotion regulation
- Stage 3: Focus on improving self-image and relationships
- Stage 4: Promote connection and joy in relationships
During each session, therapists will also accept a patient’s thoughts or feelings as making sense, even if that’s not what they actually think. They want patients to feel that these thoughts are correct based on their own experiences. This practice is called validation. By feeling validated, patients feel heard and listened to, and they’re more accepting of the idea of change.
During group DBT sessions, patients will practice exercises for each of the four strategies. One exercise you might practice for interpersonal effectiveness is using the acronym GIVE to improve relationships:
- Gentle: Don’t threaten or attack someone.
- Interest: Don’t interrupt someone to speak; listen with interest
- Validate: Acknowledge the person’s feelings
- Easy: Smile and have an easy attitude; stay lighthearted
For emotional regulation, you might practice “opposite reaction”: doing the opposite of what you feel. For example, if you feel like staying inside, go outside. If you feel like isolating yourself, surround yourself with family and loved ones. While learning about mindfulness, people may try to be observant of their bodies. An example of one exercise is paying attention to breathing and observing the rise and fall of the belly. Patients will become aware of how they inhale and exhale.
Characteristics of Dialectical Behavioral Therapy
The following characteristics of DBT can be seen through all types of sessions, including group, individual, and phone coaching:
- Cognitive-based: As mentioned previously, DBT is based on cognition, which is the process of learning new things and acknowledging feelings and thoughts. DBT centers on changing thoughts that have hindered your health and well-being in the past.
- Supportive: DBT provides unending support. While in your group and individual sessions, your therapist and peers will encourage you to use your newfound skills and identify your positive strengths. This way, you can utilize them in everyday situations.
- Collaborative: DBT requires constant collaboration between patients and therapists.
- Skill sets: You’ll learn numerous skills in DBT, such as improved listening and communication, coping mechanisms, and emotion regulation.
- Change and acceptance: These two opposite ideas are brought together in DBT, and you’ll learn how to tolerate and accept your life while in therapy. You’ll also learn how to positively deal with change and learn healthier reactions to difficult situations.
Even though each DBT session may have different structures and goals, the above characteristics can be seen in most meetings.
Benefits of Dialectical Behavioral Therapy
Patients who complete DBT notice improvements in their moods, social interactions, and everyday behaviors. People experience fewer hospitalizations, less anger, and less severe suicidal behaviors. Relationships are also known to dramatically improve. DBT also helps patients to accept reality, makes them realize that change is inevitable, and helps them to be less judgmental. It also forces people to move forward with their lives despite any negative events that might be happening.
Experience Dialectical Behavioral Therapy at Montare Behavioral Health
Dialectical behavioral therapy is one of many talk therapy treatments we offer at Montare Behavioral Health.