One of the biggest hurdles for people overcoming addictions and mental disorders is learning to manage through uncomfortable emotional states. Fortunately, Dialectical Behavioral Therapy, or, DBT, was designed to help with just that.
For many people who struggle with unhealthy behavioral patterns, these behaviors have been cultivated over a long period of time through a process of reinforcement and rewards. While many people are aware that unhealthy behaviors do not feel good for them, they usually offer a short-term solution to a long-term problem.
This is where Dialectical Behavioral Therapy steps in.
What is DBT?
Dialectical Behavioral Therapy was created in the 1980’s by psychologist Marsha Linehan as a method to primarily treat people with borderline personality disorder. It has since been discovered to be a beneficial tool for people who struggle with a wide range of mental and mood disorders, as well as people who struggle with addiction.
Dialectic means: when two things appear to be opposing, but can actually occur simultaneously. For example, everyone is trying their best, but they can always try harder!
Some of the most common targets and causes for people to enter into DBT therapy are
- suicidal thoughts
- restrictive eating, bingeing, purging
- abusing substances or alcohol
- risky behavior
- physical violence
- emotional turmoil or trauma
When DBT therapists speak about behaviors, what they mean is, “anything that can be reinforced or rewarded” and reinforced means, “anything that increases the likelihood that the behavior will happen again.”
This checks and balance system of behaviors and reinforcers often gets lost in translation throughout childhood, as many people find that they are reinforced (given attention) for bad behaviors more than for good ones, which leads to a continuation of unhealthy behavioral patterns.
What are the Goals of DBT Therapy?
The main goal of Dialectical Behavioral Therapy is for the individual to work with a team to build a life worth living. Through cultivating experiences and goals that are meaningful and important to the individual, it is believed that a framework for a healthier outlook on life can begin to develop.
DBT was not created to be only a substance abuse treatment modality, or a suicide prevention program, but it has been found to greatly improve the lives of people who struggle with issues such as these in their day to day lives.
Through learning to balance acceptance of the present, and a motivation for change, DBT helps reinforce the individual that while yes, this is what the present situation looks like, there is always an opportunity to change and improve it. The therapist will then help the individual create short-term and achievable goals to reach that point of change.
How Does DBT Work?
When a therapist first meets with a patient who is going to begin their DBT process, the individual often struggles with multiple diagnoses of concern. For this reason, the DBT therapist will use a hierarchy scale to address those behaviors which are deemed the most problematic, first.
The hierarchy is as follows:
- Life-Threatening Behaviors: behaviors that could lead to the client’s death (suicidal attempts, self-harm, suicidal ideation)
- Therapy-interfering Behaviors: anything that can affect the client from being present during the session, i.e., poor time management skills, being unwilling to move forward in the process, not being honest with a therapist.
- Quality of Life Behaviors: anything that interferes with day to day quality of life, such as risky behaviors (drug use, sexually harmful behaviors, isolation from family and friends, physical violence, etc.)
- Skills Acquisition: The level of the client’s ability to understand and incorporate healthy and effective behaviors over unhealthy and ineffective ones.
Dialectical Behavioral Therapy, in its truest form, consists of four modes of treatment:
- Structured Individual Therapy: focusing on behaviors and dialectics, therapists work closely with clients to track emotions and behaviors, identify the persons “target points” and create achievable, short-term goals.
- There is often an emphasis on family therapy for young adults and teenagers.
- Skills Group: a weekly meeting where the individual can learn more about specific behavioral tools for mindfulness, distress tolerance, interpersonal effectiveness, and emotion regulation.
- Mindfulness: the practice of remaining fully aware of the present moment and to stay in it
- Distress Tolerance: the practice of tolerating pain in difficult situations without needing to change them
- Interpersonal Effectiveness: how to set and abide by your own and other people’s boundaries – fostering self-respect and healthy relationships with others
- Emotion Regulation; how to change emotions that you want to change for the better
- Skills Coaching: the individual will have access to a DBT coach via telephone, 24 hours a day.
- This coach will help them identify their target behaviors, help incorporate a healthy behavioral tool, and to “talk them down” from using unhealthy target behaviors.
- Consultation Team: It is said that Dialectical Behavior Therapy is not itself if the therapist is not working as part of a team.
- By discussing options, treatment plans, and growth opportunities with the treatment team, the therapist is able to give a well rounded and multidimensional approach to healing.
- The Consultation Team ensures that DBT therapists are always motivated and on target with their own goals, and with the goals of their clients. They support each other, almost like a therapist for the therapists.
While it can sometimes be a pretty uncomfortable process, Dialectical Behavioral Therapists agree that the most caring thing a therapist can do is to help push their client towards reaching their long-term goal.
Through an emphasis on compassion and understanding, Dialectical Behavioral Therapists are well aware how hard change can be, but their main objective is to encourage their client to seek that change anyway.
The last main goal of Dialectical Behavioral Therapy is to allow the individual to remain present in their own life. While other treatment modalities require a person to be separated from their life for an extended period of time, DBT encourages people to go out and actively practice their new tools in their day to day activities.
When used inside of a treatment program, DBT can be a wonderful addition to a whole health treatment plan. It fosters long-term growth and the ability to analyze and accept who we are at the present moment and to continue wanting to be better.