DIALECTICAL BEHAVIOR THERAPY

Dialectical behavior therapy (DBT) was established with the goal of helping suicidal individuals embrace that life is worth living through a standardized framework of treatment that centered around radical acceptance.

Dialectical behavior therapy is unique in the sense that it focuses first on helping clients strive for acceptance through emotional regulation and an acknowledgement of past and current behaviors without judgment.

The name comes from the dialectic approach that therapists use to achieve this, and an emphasis on a tit-for-tat, flow-based therapeutic process. Dialectical behavior therapy is also well-known for being one of the first psychotherapy programs to adopt mindfulness-based lessons into its framework.

What is Dialectical Behavior Therapy (DBT)?

Broadly speaking, dialectical behavior therapy can be considered a form of cognitive behavior therapy (CBT), and it follows many of the same principles. Under dialectical behavior therapy, clients will learn to identify their maladaptive coping mechanisms, unhelpful or self-destructive behaviors, and negative preconceptions.

While gathering evidence for the first draft of a treatment manual through a randomized controlled trial in 1991, researchers discovered that to receive federal funding, they would have to limit the scope of their framework to focus on the treatment of a single diagnosable condition, rather than a qualifying symptom (such as suicidality).

Researchers focused on borderline personality disorder, a mental health condition known for a high rate of self-harm and suicide. While DBT was first categorized as a treatment plan for borderline personality disorder as a result, its scope has since grown to help treat many other mental health conditions.

Rather than push solely for change from the get-go, the emphasis in DBT is on a dialectical exchange that strives to help clients achieve peace and acceptance first.

How is Dialectical Behavior Therapy Different from Other Therapies?

Dialectical behavior therapy was developed out of a need for a therapeutic framework that does not force change, but centers around acceptance of what was and what is, while developing the skills to tolerance distress.

The reason this was important at the time was that many other treatments were liable to push away clients facing suicidal ideation and co-occurring mental health issues, such as anxiety and depression.

They were more likely to avoid appointments, struggle to adhere to mental health treatment plans, or had a hard time with other rigid treatment protocols due to poor time management skills. DBT reprioritized acceptance without judgment or change as a first-step approach to helping clients with imminent life-interfering behaviors (self-harm, suicide) and treatment-interfering behaviors (treatment nonadherence, irritability, refusal to cooperate).

This was an entirely novel idea at the time, meant to address the problems therapists were facing when treating suicidal individuals who would lash out against change-based treatments, but also struggled heavily with other acceptance-based treatments.

Dialectical behavior therapy was also one of the first psychotherapy frameworks to adopt Eastern Zen philosophy and translate meditative exercises into the concepts of mindfulness to help clients benefit from contemplative practices without the potentially alienating qualities of the spiritual or religious overtones. As a result, dialectical behavior therapy combined the three concepts:

• Behavioral psychology, which centers on the concepts of conditioning and learned behavior.
• Dialectics, or the process of converging opposing beliefs and concepts through rational thinking.
• Mindfulness, as per Eastern Zen philosophy.

How Does Dialectical Behavior Therapy Work?

Dialectical Behavior Therapy is broken down into four key stages of treatment. These stages of treatment are based on the client’s needs.

1. Stage 1 is focused on behavioral control and stabilization. In stage 1 treatment, the key of the therapeutic process is to decrease suicidality, improve treatment adherence, address factors such as substance use or unemployment, and replace dysfunctional behaviors with healthy coping skills.
2. Stage 2 is focused on experiencing the full range of emotions. In this stage, clients with past trauma also go through treatment for their trauma-related stress.
3. Stage 3 is focused on ordinary problems, and problem-solving. Once stages 1 and 2 are overcome, stage 3 aims to help clients address the individual factors that continue to contribute to their mental health symptoms.
4. Stage 4 focuses on emotional and personal fulfilment, both through change, and through mindfulness-based acceptance (gratitude). Fulfilment is not always a concrete goal, but rather a practicable state of mind.

One of the core concepts of DBT is skills training. Clients undergoing DBT will learn to develop skills in the following four categories:

• Mindfulness-based skills – living in the moment.
• Emotional regulation skills – controlling your emotions.
• Interpersonal effectiveness skills – improving your day-to-day interactions with other people.
• Distress tolerance skills – learning to react less to irritating or distressing triggers.

Who Benefits from Dialectical Behavior Therapy?

The researchers that developed the framework for dialectical behavior therapy always intended for it to be used to treat individuals with complicated, high-risk, multi-diagnostic disorders, with co-occurring conditions such as anxiety, depression, and trauma.

Common mental health disorders that DBT can help with include personality disorders, emotional regulation disorders (conduct disorder), self-destructive behaviors (suicidal ideation, severe depression, eating disorders, substance use disorders), and post-traumatic stress disorder.

DBT was also designed to intersect with other treatment plans and be used as part of a multimodal approach. As such, it was often utilized alongside other treatment modalities such as exposure therapy (for trauma or phobia conditions) and addiction treatments.

THE VERVE DIFFERENCE

The Verve offers dialectical behavior therapy in Washington DC as one of many therapy modalities. We partner clients with a peer professional, guiding them through their own treatment process, and addressing session-to-session changes through a flexible treatment plan.

We also place great importance on the value of community, and the role of interpersonal relationships in long-term mental health treatment and recovery. More than just your immediate peers, we help clients develop bonds within the greater community, and find their place in life.

CONTACT US

Want to learn more about dialectical behavior therapy in Washington DC and other treatment modalities at The Verve?

Get in touch with us today to schedule an appointment, talk to a treatment professional, or find out more about mental health resources in the area. Get started today by calling (202) 816-6006 or sending us a message via our contact form.