DBT Therapy in San Diego

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People suffering from addiction, mental health issues, or both are typically prescribed some form of therapy. While cognitive-behavioral therapy is the most common, dialectical behavior therapy (DBT) is also often prescribed.

Which form of therapy is best depends on their specific situation, symptoms, and personality. Some people respond better to one than to the other. So what it is and how it can benefit people struggling with mental health and substance use.

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What is Dialectical Behaviorial Therapy?

DBT was originally invented to treat one specific condition, namely borderline personality disorder (BPD). That does not mean that it can only be used to treat that or that it is always the best treatment for BPD.

DBT is essentially a series of learned skills that help people improve their ability to regulate emotions, tolerate distress, be present, and communicate more effectively with others.

Therefore, it works well for anyone who is having these issues and can be particularly useful for those whose mental health issues are affecting their relationships with others, ability to hold down a job, etc. DBT generally consists of both one-on-one therapy sessions and group sessions to work on and practice the skills with others.

Some physical signs include:

DBT vs CBT

Dialectical behavioral therapy is, in fact, a subset of cognitive-behavioral therapy. Both forms attempt to break negative patterns and instill more positive ways of thinking.

However, DBT deals specifically with balancing opposites. Dialectics in philosophy is a method of argument that involves the bringing together of opposing sides in dialogue, sometimes literally.

In this case, the opposites are “acceptance” and “change,” kind of like in the Serenity Prayer. The skills training involves learning to hold opposite perspectives at once.

Benefits of DBT Therapy

Some people benefit more from DBT than others. The people who tend to benefit the most are:

People who are chronically suicidal or engaging in self-harm or self-medication. Because of this, DBT is excellent therapy for people who have both a mental health problem and a substance use disorder. Some people resort to drugs or large quantities of alcohol to treat their mental health issues.
People who experience overwhelming emotions they are unable to regulate without help, which is common with borderline personality disorder and bipolar disorder.
People who’s mental health issues are affecting their ability to communicate and interact with others. If somebody’s marriage is in danger because of mental health issues, DBT can potentially help save it. It can also give people the skills they need to hold down a job.
People with binge-eating disorder.

DBT may be used on its own or in conjunction with medication and other types of therapy, such as art or music therapy.

What to Expect from DBT

Group Skills Training

This is not quite like the group therapy people typically envision, where people sit in a circle and talk about their problems. Instead, this is a class with a curriculum and homework. Typically, this is for a couple of hours a week for a fairly extended period of time. Briefer curricula might be used, or more intense ones designed for people in residential rehab. During these classes, clients are taught skills, encouraged to practice them with the group and then in everyday life.

Individual Therapy

In one-on-one therapy, the person is given personalized motivation and advice on how to apply the skills they are learning to their specific challenges.

Therapist Consultation

Because DBT is draining for therapists, they are typically required to consult with a team of therapists to discuss their client and also to give them the support they need.

The exact schedule will depend on the person’s needs and lifestyle. Once learned, DBT skills should become a lifelong practice and integrate into the person’s life. This is not quite the same thing as “coping mechanisms.”

What are DBT Skills You Learn?

So, what are these skills? They are split into four areas, two of which are “acceptance,” and two of which are “change.”

Acceptance

The two skills for acceptance are mindfulness and distress tolerance. Mindfulness is about being aware and present, which can reduce anxiety about the future. Distress tolerance is handling emotional pain without trying to "fix" the problem, which can only cause more distress if you are unable to "fix" it.

Change

The two skills for change are interpersonal effectiveness and emotion regulation. The former is asking for what you want and, importantly, learning how to say no. Saying no can help people with substance abuse set boundaries with people they can't avoid who are pressuring them into using again, and can also help people who are nervous and anxious in relationships.

The latter is learning to change unwanted and painful emotions. Which, of course, comes with knowing when you should change your emotions and when doing so is only going to cause more pain in the long term.

These skills alone can represent a promising long-term intervention across many populations and settings. However, they also work well as part of a comprehensive rehab and detox program.