An Overview of Dialectical Behavior Therapy
Diseases bring with them much discomfort and inconvenience. They alter your normal way of life and require urgent treatment.
There are cases however, where some conditions are not purely treatable and may need to be just managed. Living with these conditions can be challenging, but it’s still possible.
One category of such conditions are those affecting the mind.
Mental conditions are not always treatable. This reality can be difficult to embrace but once you acknowledge the situation, you start managing it.
And just as there are many conditions, so are there different ways of dealing with them.
One such psychotherapy technique is called Dialectical Behavior Therapy.
This is what we’ll look at in this article.
Dialectical Behavior Therapy is a common and well documented therapy type.
And as you will see, it’s also easy to learn. You can learn how to use it to help someone or even to manage your own condition.
THE DIALECTICAL BEHAVIOR THERAPY
The Dialectical Behavior Therapy is a type of Cognitive Behavior Therapy (CBT). Cognitive Behavior Therapy is therapy which focuses on the mind to either provide treatment or provide relief for the patient.
Since the target of CBT is the mind and the functions around it, Dialectical Behavior Therapy (DBT) follows the same path. It looks at the thoughts, emotions and perceptions of the patient and helps him make the changes necessary for a better life.
It’s responsible for the kind of views held by people with anxiety and depression. It causes them to think in extremes.
If you have an all-or-nothing thinking pattern, you’ll only see and consider the extremes. Everything will be either black or white. You won’t be able to see the logic of the area between the two extremes.
DBT was developed by Marsha M. Linehan, a psychology researcher at University of Washington in the late 1980s. At the time of development, the therapy was aimed at helping people suffering from Borderline Personality Disorder.
The name of the therapy comes from the word “Dialectic.” This is the practice of arriving at the truth through the exchange of logical arguments. Logical arguments are used to critically look into assumptions and perceptions and challenge their validity.
Thus, DBT helps look at situations differently. And although DBT does not aim at solving the problem, it helps you deal with the crisis which is caused by the problem.
Going through DBT will make you become open-minded in how you look at situations.
This helps you realize that there are other possible reasons why things have happened the way they have.
It then becomes easy for you to change your behavior and act more logically.
Dialectical Behavior Therapy is hailed for its ability to build a strong relationship between the therapist and the patient.
This relationship is based on compassion as the therapists’ desire is to help break the behavior cycles which trap those with negative thinking.
Who is DBT meant for?
Dialectical Behavior Therapy was first meant for Borderline Personality Disorder patients. But its success in BPD prompted its use in handling other conditions.
Over the years, DBT was put to the test in managing many other mental conditions and the results were outstanding. This led to its adoption for patients with:
- Self-destructive behavior
- Substance abuse
- Binge eating
- Bipolar disorder
- Post-Traumatic Stress Disorder (PTSD)
These are neither rare nor simple conditions. People with these conditions suffer a lot from the interference with daily life. Life can become difficult and stressful enough to make someone consider suicide.
These conditions have some similarities even as they differ. At the core, they are really about mental perceptions.
Although these conditions can be complicated—sometimes with suicidal thoughts and acts—DBT usually works. The strategies used work well to guarantee results.
We’ll look at the strategies below and show you how you can apply this knowledge and get some relief for any condition you or a friend may have.
But first, let’s look at some of the assumptions DBT makes in order for the therapy to succeed.
In the practice of Dialectical Behavior Therapy, there are some assumptions which are made. Being assumptions doesn’t mean they are acts or moments of ignorance. These are more like principles.
In fact, these assumptions are realities derived from actual facts seen from the practice of DBT.
The assumptions are mainly used to lay a foundation for the therapy to take place. Just the same way you have to prepare the environment for a meeting, these assumptions help ensure the therapy is successful.
As you read through the three assumptions below, you’ll realize that they help shape the mindset of the therapist towards the patient.
They help the therapist see the patient in the best light. It also helps him practice the much-needed compassion.
1. Patients suffer from difficulties regulating their emotions.
Being a mental disorder treatment, DBT deals a lot with emotions. From the above list of conditions which can be managed through DBT, you may have noticed that they’re all connected with emotions.
Emotions are pretty powerful and unless you have trained your mind well, you most likely make more emotional decisions than logical ones.
In fact, it’s said that most people make emotional decisions then justify them logically.
Emotions are at the root of most mental conditions. When you manage to deal with them well, then you’re guaranteed to get relief.
In making this assumption, therapists are actually using a fact to help them see the patient in the best light. Understanding that patients are suffering due to the struggle to control their emotions is a key part of the therapy.
This motivates the therapist to be compassionate and seek to help the patient.
2. Patients may not have caused all their problems, but it’s up to them to solve them.
Having mentioned compassion in the first assumption, this second one may sound a bit harsh.
You probably don’t see any compassion in this statement. It’s as though the therapist is now leaving the patient to work out a solution on his own.
But that is not the case.
First of all, it’s almost impossible to solve someone’s emotional problems.
You cannot take away their current emotions and thinking patterns and give them new ones. It is the same way you cannot develop new or bigger muscles for someone else.
If you want bigger muscles, you simply have to eat well and exercise. Just getting great advice online won’t help until you put in the effort to exercise.
Similarly, when you have emotional problems, you get advice and deal with the challenge. You get support from the therapist or friends and family but you’re still the one to deal with the issue.
Secondly, this is a very wise assumption to make and stick to. If someone solves your problems for you without your involvement in working towards the solution, how do you deal with the same problem if it recurs?
The essence of solving your emotional problem is for you to develop the strength to deal with that issue any time it comes up. This gives you the freedom and ability to live life confidently. You don’t have to be afraid of being far away from the therapist. Or losing contact with him.
This second reason for the assumption helps make the therapy very focused. The focus of DBT is on building skills and abilities which will empower you to live a better life.
3. Patients are to work towards the goals they define.
This is a crucial assumption which every therapist must keep in mind. Related to the second assumption, this emphasizes the need for your active participation in the therapy being provided.
The therapist does not define goals for you. You’re the one who defines your own goals. The therapist’s work is to help you work towards them.
The importance of this is clearly seen in the difference between the two attitudes you can manifest. These are willingness and willfulness.
- Willingness – this is when you are open to learning new and different ways of looking at situations. It therefore becomes easier for you to see things differently and embrace a new way of thinking.
- Willfulness – this is an unwillingness to change your way of thinking. You hold firmly to your opinion and believe it to be right. This creates a lot of difficulty in relating with the therapist and can make the therapy unsuccessful.
COMPONENTS OF DBT
The Dialectical Behavior Therapy has four components. These four are what make up a DBT therapy.
Three of these are interactions between you and the therapist while the fourth is between the therapist and other consultants.
The individual session is where you talk with the therapist in private. You tell him about your situation and maintain a willingness to be helped deal with the challenge at hand.
Once therapy starts, individual sessions will usually be a review of the past week’s behavior. The challenges or problems faced are recorded on diary cards which you then go through with your therapist.
The challenges are not necessarily handled in the order in which they occurred. Some are given a higher priority. These include any self-injurious and suicidal behaviors.
Once these are dealt with, behaviors which can potentially interfere with the therapy are addressed. This helps improve the success rates of the therapy. From here, issues to do with quality of life are looked into.
Group sessions are usually held in a class setting. You meet other patients with challenges similar to yours. You will learn the DBT skills as a group and provide mutual support for one another.
Together with providing mutual support, you will also be sharing experiences. These two activities i.e. providing support and sharing experiences play a significant role in the therapy.
Different patients will usually be at different levels in their struggles with the mental condition they have. As such, one can help another better understand the condition and even help them see that it’s possible to manage it.
Furthermore, someone struggling with any of the conditions treatable by DBT is best placed to understand someone else struggling with the same.
And with the understanding of the difficulty they have faced in dealing with situations, patients are naturally empathetic towards one another.
This is very helpful for patients since it’s easier to take advice from someone you know “feels” your pain.
The other way the therapy is done is through phone coaching. This is where you call your therapist and speak with him or her over the phone. Phone coaching sessions are not always planned for as the individual and group sessions are.
Phone coaching happens almost randomly in between the individual and group sessions. It provides an opportunity for you as the patient to call the therapist and get advice on a particular situation.
A situation may arise where the advice required has not yet been covered in class. In this case, the advice will still be given and you’ll be told that you’ll learn more about it later.
The primary goal of having a phone coaching session is to help you get a solution to the situation you’re currently in.
Therapist Consultation Team (Therapy for the therapist)
This is a slightly different session in that it doesn’t involve you. At least not directly.
Every time there is a DBT therapy going on, there has to be a team of individuals who provide the therapist with support.
If left alone, the therapist can easily get sucked into the situation and become too stressed to offer any meaningful help. There is also the possibility of burnout considering that therapists handle patients at high risk of suicide.
If you have ever heard that counselors go through counseling, then this is why there is a therapist consultation team.
The process of providing DBT treatment is intensive and very involving. One of the most important abilities a therapist must have is the ability to show empathy.
When you’re empathetic and are showing compassion, you get fully involved.
The therapist is also supposed to help you see things differently and think differently. This won’t happen unless there is a connection.
This whole process of creating a connection and understanding the patient can take a toll on therapists. They therefore need to “offload” the emotional and psychological burden they have taken from the patients.
A bit more indirectly, the therapist consultation team helps the patient by helping the therapist stay motivated and focused on the task at hand. Once they have offloaded the weight they carry, it becomes easier to help you achieve your goal.
The therapist consultation team sessions usually run concurrently with the other DBT sessions. This is because the therapist may require the team at any time in the course of the therapy.
DIALECTICAL BEHAVIOR THERAPY SKILLS
Dialectical Behavior Therapy teaches you the skills you require to successfully handle life. When these skills are learned and used, you gain more control over your emotions and are better able to have more fruitful relationships with friends and family.
With the end goal of DBT being to help patients enjoy a better life, these skills are therefore the main aspect of the therapy.
There are four skills you’ll learn through DBT. These are mindfulness, distress tolerance, emotion regulation and interpersonal effectiveness.
Below is a brief discussion on these skills.
Mindfulness is the core skill taught in DBT. The skill itself is borrowed from the meditation practices used for spiritual benefits. For DBT purposes however, there are no spiritual aspects to the training at all.
Mindfulness in DBT is centered on training you how to live in the moment. This means focusing on what’s going on inside you and what’s happening in your immediate surroundings.
What happens on the inside refers to your thoughts, impulses and feelings. Your external surroundings refer to the smells, sights, voices etc, which are around you.
Practicing mindfulness is summarized into two skill sets: the “What” and “How” skills. The “What” skills tell you what to do while the “How” skills tell you how to practice the “What” skills.
The “What” skills are meant to help you observe, describe or participate in what is happening at the moment.
You can observe and describe anything you see, hear, taste, feel or smell. In participating, you get involved in doing something which gets your mind from the crisis situation you’re in.
The “How” skills tell you to act non-judgmentally, effectively and one-mindfully.
This means that you make observations without judging whether what you observe is good or bad. You act effectively by seeking progress and one-mindfully by letting go of distractions.
The biggest challenge DBT patients have is in controlling their emotions and reactions to situations.
Therefore, mindfulness is used to teach them how to temporarily ignore the situation so as to calm themselves down. This prevents emotional outbursts.
Learning mindfulness will help you notice when your emotions are going up because of a situation. You will then opt to focus on other things instead of allowing those emotions to drive you towards reactions.
Sample Mindfulness Exercise
You’re seated in a restaurant with your friend. He says something you did not expect of him. Your emotions are getting aroused and you’re getting angry. Before you react, here’s a simple mindfulness exercise you can do while still seated opposite him.
Using the “What” skills, you can look at your plate. Picking your fork and knife, observe how cutting the slice of bacon is happening. Be slow and deliberate, looking for the smallest changes in the bacon and taking note of the process.
Observe how the bacon gets pressed when you push the fork into it. Don’t wonder whether you pushed the fork softly or forcefully; just observe. Notice how the fork itself goes into the bacon. Look at the progress of cutting the snack as you move the knife forward and backwards.
As you raise the fork and put the bacon into your mouth, think of the taste. Can you describe it?
2. Distress Tolerance
It’s said that sometimes pain can’t be avoided, but many times suffering can.
This means that life can deal you a painful blow, and it may be unavoidable. But you can either choose to keep thinking about the pain for as long as possible or learn from the situation and quickly move on.
Focusing on the pain too much produces unnecessary suffering.
This is why Distress Tolerance is also known as Reality Acceptance.
The reasoning behind distress tolerance is that some things don’t require resisting. Not every battle is to be fought.
And in the case of struggles with emotional and psychological conditions, accepting a situation can provide relief as opposed to trying to fight it.
This line of thinking is very different from the popular advice of fighting till you win.
In view of such teachings which define strength as the ability to always fight and win, distress tolerance can seem like a show of weakness.
But it’s not.
Since controlling your emotions is itself a struggle and thus a cause of pain, accepting the situation becomes a wise alternative. In embracing this skill, you learn to live through painful or unwanted situations instead of fighting and possibly making it worse.
In accepting the reality, it does not mean that you agree with it. It also does not mean that you will not feel the normal emotions of anger, sadness etc. You will still have these feelings but choose not to act on them. In other words, you won’t act instinctively or impulsively.
In gaining this control over your emotions, you get to avoid things like substance abuse and self-harm activities. These usually come into mind as quick ways to get relief. They however only make things worse.
For example, a bad situation may lead you into substance abuse as a way of getting a solution. After taking the drug, your judgment gets impaired. You drive home and cause an accident and end up jailed for murder due to driving under the influence of a drug.
There are various skills taught in distress tolerance. A popular one is called TIPP.
TIPP stands for Temperature, Intense exercise, Paced breathing and Paired muscle relaxation. Here is how it works.
- Temperature – emotional highs tend to increase the body temperature. This is what leads to reactions. To avoid this, you can splash cold water on your face or hold an ice cube. This will cool you down both physically and emotionally.
- Intense exercise – doing an intense workout will increase the flow of oxygen into your body and brain. This reduces the stress level heightened by an intense emotion such as anger.
- Paced breathing – this is another way of cooling yourself down and avoiding emotional responses and reactions. When you do any breathing exercise, you’ll end up calm. Watch the below video and learn different breathing exercises.
- Paired muscle relaxation – it has been observed that when you tighten a muscle then relax it and give it time to rest, it actually relaxes more than it previously was. This is the trick in paired muscle relaxation.
You can easily do this by tightening both your biceps and triceps then letting them relax. This way, they end up requiring less oxygen, thus relaxing you and calming you down.
Other skills include ACCEPTS (Activities Contributing Comparisons Emotions Push away Thoughts Sensatins) and IMPROVE (Imagery Meaning Prayer Relaxation One thing in the moment Vacation Encouragement).
3. Emotion Regulation (Confirm the Content in this Section, esp. the Points)
Emotions are important for everyday life. They help us communicate and even act.
One challenge when dealing with emotions is the decision made when the emotion is triggered.
Is the path from emotion to action automatic or do you have control over the action?
In DBT, emotion regulation helps you learn how to manage negative emotions. And to counter them, you also learn how to stay in control and increase positive experiences.
The skills you learn from emotion regulation enable you to:
- Identify and label emotions – when emotions run your life, it’s easy to become confused. You may not know what exactly is wrong. You may feel angry one moment then happiness the next, as is the case with manic depression.
The first step towards regulating your emotions is to identify and correctly label them. This is important because different emotions require different responses. For example, the way you deal with anger is different from how you deal with sadness.
- Identify obstacles to changing emotions – having identified the emotion causing you discomfort, you need to work on changing it. But that is not easy. However, when you apply mindfulness techniques, you are able to recognize the obstacles standing in your way.
Once you identify the obstacle, it then becomes easy to remove it then proceed to changing the emotion.
- Reduce vulnerability to “emotional mind” – there are generally three states of the mind. The logical, emotional and what many refer to as wise mind. The logical mind is driven by logic. This is where reason and sense rule your decision-making and thinking processes.
Emotional mind is where emotions rule your mind. The wise mind is the balance between the two states of logic and emotion. This is the sweet spot of the mind and when you get it, your decisions will be wise—balancing both logic and emotion.
Having learned how to regulate your emotions, you’ll be able to engage logic without shutting down emotions.
You’ll thus be able to avoid the control of emotions and balance it off with logic. This reduces your vulnerability to emotions and results in wise mind.
- Increase positive emotional events – one way you can change your state of mind is by coming up with an emotional event. For example, did you know that you can make yourself happy by just laughing? Even when you don’t feel like it?
You can build the ability to make your mind think along certain lines. This way, when for instance you feel angry, you can immediately decide to feel happy and your mind will respond accordingly. The more you train your mind in this, the easier it becomes.
- Taking opposite action – everything on emotion regulation leads to doing the opposite of what your emotions want you to do. If not opposite, at least the better option as opposed to what your emotions are pushing for.
In taking opposite action, you essentially do something which will force your emotions to change. For instance, when you get angry, instead of thinking of what has been done, you can decide to walk up the stairs, taking two steps at a time.
This action is not what your emotions expect.
However, your emotions have little control over physical activities which are already happening.
In this case, as your heart starts pumping and your breathing rate increases, the anger emotion will subside.
4. Interpersonal Effectiveness
In interpersonal effectiveness, the focus is on the relationship and confidence-building skill called assertiveness. Assertiveness is a skill which many need to learn.
Interpersonal effectiveness will help you improve your current relationships, build new ones and terminate the toxic ones.
As you learn the skills taught in this part of the therapy, you’ll be empowered to experience a better life. Here are at least three things you will learn:
- Learn to say “No” – saying “No” is not easy for many people. The most challenging part is the feeling which comes afterwards making you feel guilty. If you struggle with emotions, you’re likely to be unable to say “No.” This is partly because you have thoughts of low self-worth.
When you feel like you’re not important, you then try to make yourself loved by others. This makes you susceptible to manipulation. You can end up saying “Yes” to everyone and everything in an attempt to feel important. This only leads to frustrations and further hurting.
- Learn to express your needs – expressing your needs is important, otherwise no-one will know what you want or need. Being too afraid to ask, you will hope that someone somehow realizes your needs and fulfills them.
When this doesn’t happen, you start blaming yourself for not speaking up. As you struggle sorting yourself out, your emotions will be taking you on a guilt trip whose end could only be worse than where you started.
- Learn how to resolve conflict – conflict resolution is another important skills you learn in DBT’s interpersonal effectiveness. Conflicts are unavoidable in any kind of relationship. From work relationship to family, there will always be a clash of opinions and ideas.
You will learn how to address differences in opinion and how to settle on a middle-ground solution.
Resolving conflict may at times require just allowing the situation to continue as it is while saving your energies for future negotiations.
Dialectical Behavior Therapy is a tried and tested means of managing negative emotions.
Though the emotions themselves are not bad, if left unchecked, they can drive you towards the wrong actions.
With documented proof that DBT is good for major mental conditions like depression, you will want to learn the skills.
You can implement them in your own life or help someone else in their journey to emotional stability.
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