Understanding Dialectical Behavioral Therapy

In a recent DiscoverU Podcast, Montare’s founder JD Kalmenson interviews Karen Clark, MFT to learn about the relatively new therapy called dialectical behavioral therapy. DBT has been shown to be effective with previously treatment resistant diagnoses like Borderline Personality Disorder and Suicidality, as well as other emotion regulation disorders. DBT is different from other behavioral therapies in its emphasis on mindfulness and related skills which therapists teach their patients. Mental health professionals use this evidence based treatment in a variety of ways to help patients overcome difficult diagnoses and work through their symptoms over the course of hour-long sessions.

Listen to Podcast Here https://www.buzzsprout.com/1590496/10756023

What is DBT?

DBT was originally developed by Marsha Linehan in the late 1980s to treat Borderline Personality Disorder which was often resistant to other therapies like Cognitive Behavioral Therapy. DBT differs from its predecessor CBT in the core skills it seeks to teach patients. While CBT offers targeted approaches to replacing unhealthy patterns of thought with new ones, DBT supplies a variety of techniques for understanding, accepting and changing internal monologues and feelings which are difficult to manage.

What does ‘dialectical’ in DBT mean?

The ‘dialectical’ in DBT describes a process: the patient will accept certain patterns of behavior, recognize how they themselves and others respond to these behaviors, and synthesize their reflections towards a renewed sense of self. In other words, as Keren Clark puts it in DiscoverU’s podcast: “Dialectics is the idea of that there can be two seemingly opposite things, both of which are true at the same time…[it is] how to both accept ourselves, right where we are in the moment and also work on change.” In DBT the patient works with therapists to first understand themselves and their patterns of behavior, thoughts and feelings. The dialectical aspect of the therapy processes these reflections in a way that allows patients to both accept and change, resulting in an altered internal well-being. For those suffering from disorders which result in extreme sensitivity to emotions, DBT can be effective in balancing an attention to and care for patients’ suffering while also teaching skills for change.

How does it work?

There are a few different modes of treatment for DBT. The most common form is individual psychotherapy, in which a therapist trained in this therapy will guide the patient over the course of weekly sessions. DBT can be used in conjunction with other ‘talk’ therapies depending on the patients’ needs. Psychotherapists trained in DBT will often use its core principles along with other modalities of treatment to offer the best plan of action for patients.

Therapists may also provide more pointed DBT skills training or in-the-moment phone coaching for acute crises.

What symptoms and diagnoses can it treat?

Dialectical Behavioral Therapy was originally designed to treat borderline personality disorder. DBT is also an evidence based treatment for a variety of other diagnoses such as: depression, bipolar disorder, eating disorders, substance abuse, and post-traumatic stress disorder.

The dialectical aspect of DBT means that it is targeted towards individuals with tendencies towards extreme emotional states which destabilize them in their everyday lives.

What are the expected outcomes of DBT?

As stated on Marsha Linehan’s organization Behavioral Tech’s website, the four skills taught in DBT are:

  • Mindfulness: the practice of being fully aware and present in this one moment
  • Distress Tolerance: how to tolerate pain in difficult situations, not change it
  • Interpersonal Effectiveness: how to ask for what you want and say no while maintaining self-respect and relationships with others
  • Emotion Regulation: how to change emotions that you want to change

Working with therapists trained in DBT helps patients to learn from and enact these four skills in their daily lives. Through the therapy, patients move towards both accepting themselves and changing destabilizing behaviors.






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