Dialectical Behavior Therapy

Psychotherapy, or talk therapy, is one of the primary techniques used for mental health treatment. Depending on your specific circumstances or needs, different types of therapy may be recommended. Cognitive Behavioral Therapy (CBT) helps to identify emotional, environmental, and social stressors or triggers that may lead to self-destructive behaviors, including negative visions of self-worth and substance abuse. CBT teaches life skills and coping mechanisms in order to reverse these negative behavior and thought patterns and turn them into more positive ones.

Psychologist Marsha Linehan took CBT a step farther and modified it to create Dialectical Behavior Therapy, or DBT. It was initially formed as a treatment for suicidal patients and those suffering from bipolar disorder (BP). Today Behavioral Tech, created by Linehan, reports that DBT is successfully used to treat many mental health disorders, including:

  • Post-traumatic stress disorder (PTSD)
  • Depression
  • Substance abuse disorder (SUD) and dependency
  • Eating disorders

When more than one disorder occurs in the same person at the same time, they are considered co-occurring disorders, and DBT may prove an effective treatment method for co-occurring disorders as well.

Dialectical Behavior Therapy Skills

The word “dialectical” refers to the integration of both change and acceptance when used in treatment models. DBT, therefore, is inherently accepting, validating people as they are, while also helping to facilitate some level of necessary change in order to promote recovery. One of the main premises of DBT is accepting thoughts and behaviors that may be uncomfortable instead of fighting against them. This allows you to realize that change is possible and can gradually be realized.

DBT encompasses four main modules or behavioral skills, as published by PyschCentral:

  • Mindfulness
  • Emotional regulation
  • Distress tolerance
  • Interpersonal effectiveness

The concept of mindfulness most likely stems from Eastern practices of meditation and yoga, and it focuses on recognizing bodily sensations and becoming more in tune with your physical self in order to become fully aware, centered, and present in the moment at hand. In strengthening the connection between mind and body and channeling your energies in a positive way, yoga can actually decrease stress levels. A German study published by Harvard Health Publications reported a decrease in depression by 50 percent and anxiety by 30 percent for those studied who regularly practiced yoga for three months. Mindfulness can help curb self-destructive urges and reduce self-criticism, while encouraging better choices and less impulsive actions. Learning how to regulate your emotions and make positive changes is an important behavioral skill learned during DBT.

Stress is a part of everyday life, and everyone copes with it differently. Chronic stress leads to chemical changes in the brain. Researchers at the University of California, Berkley found that a connection exists between levels of stress and the potential for mood or anxiety disorders in the future. Learning how to cope with and manage stress effectively can help repair brain functions and aid recovery. DBT requires that some levels of stress be accepted and pain should be tolerated instead of trying to change all distressing events. This is different than many models of therapy, as most call for the change of stressful circumstances instead of the toleration of them.

Methods Used During DBT

dbtDialectical Behavior Therapy has four main components in its standard form: group skills coaching, individual therapy sessions, phone sessions, and therapy for the therapist. The group skills portion of DBT teaches behavioral skills, typically in a classroom format, once a week for 2.5 hours. Homework is often distributed to be completed outside of the group before the next session.

Individual therapy sessions likely occur once a week and focus on individual motivations and coping with personal challenges and specific circumstances. The phone sessions are often optional and provide patients with an open line to their therapist anytime they may need help between sessions.

Therapists generally work together, and a therapist consultation team may meet once a week to further discuss treatment options and modify or enhance methods in order to ensure therapy is successful and relevant. This is essentially therapy for the therapist and helps keep medical professionals motivated and current with the most current methods and treatment options.

DBT utilizes a hierarchy in order to determine the most effective path of treatment. First, any and all self-injurious or life-threatening behaviors are addressed and redirected. DBT’s primary function is to reduce suicidal thoughts, tendencies, and behaviors. Next, DBT focuses on any behaviors that may get in the way or interfere with its effectiveness, such as missing sessions or showing up late. Collaboration is vital during DBT, and all parties need to be on the same page.

Check out more on how society currently views mental health illness and how we hope to shift this perspective in the future. Sam Webb shares his thoughts on Recovery Unscripted.

Behaviors that interfere with general quality of life are dealt with next during DBT and include mental health concerns, substance abuse, and other matters, such as relationship, employment, or housing status. Finally, DBT teaches new life skills and behaviors to replace old and ineffective ones in order to achieve positive goals. DBT starts with the behaviors that may be the most detrimental to one’s health and interrupt possible treatment. Standard DBT treatment models last at least 24 weeks, although depending on specific and individual factors and circumstances, treatment may be extended up to a year or be shortened.

Benefits and Effectiveness of DBT

benefits of dbtBipolar disorder (BD) affects around 1.6 percent of the American adult population in a given year, as reported by the National Institute of Mental Health (NIMH). Bipolar disorder is characterized by intense mood swings, difficulties with interpersonal relationships, and suicidal thoughts and behaviors. Around 80 percent of BD sufferers exhibit suicidal behaviors, and four to nine percent of these attempts will be successful, according to NIMH. DBT can help control these self-destructive behaviors and regulate moods.

The Journal of the American Medical Association (JAMA) Psychiatry reports that suicide attempts by those with BD were cut in half in a study where DBT was employed as the primary treatment method. Suicidal thoughts leading to hospitalization and medical risk in general were also lowered with DBT.

Approximately one-half of those suffering from a severe mental illness, including bipolar disorder, will also abuse substances, just as one-third of alcohol abusers and over half of all drug abusers also suffer from mental illness, according to the National Alliance on Mental Illness (NAMI). Co-occurring disorders are common, therefore, and they may stem from an attempt to self-medicate or provide temporary relief from mental health symptoms. Substance abuse is likely to produce the opposite effect, however, and instead exacerbate mental illness symptoms as well as interfere with the treatment of mental health disorders and any necessary prescription medications. Mental illness also may complicate substance abuse and increase the risk factors and side effects associated with illicit drugs and/or alcohol abuse and dependency.

Co-occurring disorders can be complex and require specialized, simultaneous, comprehensive, and integrated care models wherein teams of medical professionals work together to treat both disorders. Studies published in Addiction Science and Clinical Practice indicate that DBT can reduce substance abuse in those suffering from BD and may also be effective in treating other co-occurring serious mental health disorders and substance abuse disorders. Substance abuse is inherently a self-destructive behavior that may be a response to stress or trauma and utilized as a coping mechanism. DBT can retrain negative impulses and promote healthier alternatives.

DBT can provide you with the necessary tools to build a successful and healthy life. The Oaks at La Paloma understands the complexities surrounding co-occurring disorders, mental health disorders and substance abuse. Individualized treatment plans are tailored to each person’s specific needs and teams of medical professionals work together in an integrated fashion to provide evidence-based treatment models employing the most current research and scientific methods as well as years of clinical expertise. Our admission coordinators can guide you through a confidential assessment and answer any questions you may have. Contact us today.