What is Dialectical Behavior Therapy ?
DBT is an evidence-based treatment modality originally developed by Dr. Marsha Linehan to treat individuals with borderline personality disorder and chronically suicidal behaviours. However, it has since been found helpful for clients with other conditions such as depression, anxiety, eating disorders, bipolar disorders, posttraumatic stress disorder, and relationship difficulties. The overall goal of DBT is to help clients learn healthy ways of coping with stress, regulate their emotions, and improve their interpersonal relationships.
What does Dialectical Behavior Therapy mean?
The theoretical underpinnings of DBT include the following three theories: the theory of Dialectics, behaviour therapy, and biosocial theory. Thinking dialectically means looking at both perspectives in a situation; acknowledging that we must practice acceptance while simultaneously continuing to work toward positive change. A dialectical worldview on the nature of reality and personality development has three distinctive features:
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The principle of interrelatedness and wholeness: assumes that a system must be analyzed as a whole and that all individuals are intimately related to and are influenced by their mutual interactions and experiences that comprise their social environments.
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The principle of polarity: posits that reality is not static, but comprises of internal opposing forces. A dialectical perspective, therefore, suggests that within dysfunctions, there is also function; that within destruction you can find construction; and that within distortion there is accuracy.
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The principle of continuous change: suggests that the fundamental nature of reality is change and process rather than content or structure. This also implies that both the individual and the environment are undergoing continuous transition. Thus, DBT doesn’t focus on maintaining a stable, consistent environment, but rather aims to help the client become more comfortable with change.
The biosocial theory posits that emotion dysregulation stems from the combined effects of a biological predisposition toward emotional vulnerability and an invalidating environment. DBT strategies are designed to help with treatment engagement through balancing acceptance/validation with change.
What are DBT skills?
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Mindfulness skills to develop self-awareness and for living in the present moment.
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Emotional regulation skills to help clients better understand and cope with their intense emotions.
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Distress tolerance skills to help individuals build resilience by adopting acceptance and a non-judgmental stance when going through difficult situations or intense emotions.
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Interpersonal effectiveness skills help clients become more skilled during interpersonal interactions, especially those involving conflict.
What does DBT Treatment look like?
Standard DBT treatment includes a pre-treatment phase and four treatment stages. In the pre-treatment phase, the counsellor and client collaboratively determine their treatment goals.
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Stage 1 wherein the target is to reduce problem behaviours, life-threatening behaviours and therapy-interfering behaviours and increasing skills-based practice.
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Stage 2 focuses on reducing any trauma-related symptoms and involves trauma processing.
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Stage 3 focuses on enhancing quality of life through maintenance of progress and reasonable goal- setting.
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Stage 4 the focus is on achieving transcendence and building a capacity for joy. It is important to understand that these stages are not chronological and one may move back and forth several times before reaching the final goal and that there is no timeline for moving through the stages.