Dialectical Behavior Therapy (DBT)

Dialectical Behavior Therapy (DBT) is an evidence-based practice developed by Marsha Linehan as a therapeutic intervention formerly for borderline personality disorder. Research studies portray that the dialectical behaviour approach is effective post 8 sessions of administration, each session lasting one hour approximately. This approach revolves around four key concepts namely.

Concepts in DBT

Core Mindfulness:

It involves a practice that focuses on the present moment via techniques like the observation of internal and external cues to gain awareness about oneself and the surroundings, thought defusion where one differentiates between their irrational and unproductive cognitions and feelings from themselves. Perception of one’s environment via the senses and staying mindful of the present prevent impulsive behaviour and automatic negative thought patterns. 

Distress Tolerance:

Grounding techniques, box-breathing, progressive muscle relaxation and other relaxation techniques are adopted during emotional crises. Individuals often engage in activities that are aimed at distracting them from the uncertainty and the stressors. They are encouraged to practice self-soothing activities in times of crisis.

Moreover, one needs to learn to recognize the cues to detect the crisis that is yet to occur. DBT (Dialectical Behavior Therapy) involves radical acceptance of situations or crises that arise and tackling the unproductive emotions that accompany the same. Moreover, a cost-effect analysis of the crisis helps individuals gain insight and perspective on distress tolerance. 

Interpersonal Effectiveness:

Effective communication strategies involve active listening and assertiveness to build healthy relationships fostering trust and resilience. Resolving conflicts and setting boundaries help individuals attain their respective goals in personal, professional and social contexts. Validation and clarification ensure that an individual effectively comprehends the perspective and accurately understands the message of another individual.

Emotion Regulation:

Emotional regulation is a key aspect of Dialectical Behavior Therapy (DBT) in the pursuit of interpreting and controlling one’s emotions as well as others. Encouraging comfort with negative emotions can help people encounter and process difficult feelings without fear or avoidance, thereby individuals can reduce their instinct to shy away from challenges or uncomfortable experiences. This emotional resilience allows for personal growth, healthier coping mechanisms, and a deeper understanding of oneself.

Functions of DBT:

Improving Skill-set:

Individuals taking DBT (Dialectical Behavior Therapy) sessions are made aware of mindful practices, tolerating distress, improving interpersonal relationships and regulating emotions. 

Generalization:

The individuals are taught certain practices in the course of the DBT (Dialectical Behavior Therapy) sessions which need to be implied in their daily lives in terms of personal, professional and social contexts. The clinician or the therapist ensures that the progress of the client and the rational cognitions and behaviours acquired during the therapeutic process are reinforced and replaced by the maladaptive ones. 

Motivation and prioritization:

The individual once figure out their problematic maladaptive behaviours, are told to determine which problems need prior intervention based on their impact and urgency. Thus, it is required to identify the most pressing concerns needing immediate attention and interventions. This evaluation is made based on the severity of the issue – behaviours that are a threat to the individual’s life like suicidal ideation or self-harm need former attention, followed by destructive behaviours that cause impairment to the individual’s social, interpersonal and occupational lives. 

CBT vs DBT:

CBT (Cognitive Behavior Therapy) is an approach that focuses on altering irrational thoughts and maladaptive behaviours into rational and positive ones. This approach considers thoughts to be distortions that need to be transformed into rational acceptable ones. Whereas, DBT’s (Dialectical Behavior Therapy) focus lies on a dialectical approach where one accepts and acknowledges their present situation while adopting effective strategies to foster positive change. 

DBT (Dialectical Behavior Therapy) incorporates four practices namely – improving the skills of an individual via mindfulness techniques, elevating their distress tolerance, fostering interpersonal relationships and effective regulation of emotions. It involves providing psychotherapy to the affected individual to identify the problematic behaviours and maladaptive thought patterns and help them cope with their everyday stressors with efficient strategies. Moreover, telephonic consultations are offered to the individuals where clinicians guide the clients and aid in gaining insight into the present issues. Additionally, the therapist consultation team caters to the motivation and well-being of the therapists conducting DBT sessions as the same can be stressful and challenging. 

Borderline Personality Disorder (BPD):

Borderline personality disorder (BPD) is characterized by a pervasive pattern of instability of interpersonal relationships, affect and self-image. Affected individuals have marked impulsivity in at least two areas of self-damaging behaviours namely – sex, substance abuse, and spending money. Moreover, they exhibit recurrent patterns of suicidal and self-mutilating behaviours. Due to temperamental factors, genetic predisposition, and impairment of the amygdala, hippocampus and prefrontal cortex, individuals having borderline personality disorder (BPD) face emotional dysregulation.

Additionally, environmental factors like trauma, abuse, neglect, and social isolation during childhood along with inconsistent and neglectful parenting styles lead to their distorted sense of self. Thus, they resort to ineffective coping styles like suicidal ideation, paranoid behaviour, distorted self-perception, and black-and-white thought patterns. Dialectical Behavior Therapy (DBT) helps these individuals address and identify their emotions, regulate the various emotional states and discriminate within the same.

Treatment

Dialectical Behavior Therapy (DBT) is effectively used in the treatment of various disorders like:

• ADHD (attention-deficit hyperactivity disorder): Impulsivity is one of the key aspects of ADHD and DBT therapy sessions help individuals gain self-control over their impulsive and maladaptive behaviours.
• Bipolar disorder: DBT aids in the pervasive and recurrent episodes of mania and depression as this therapeutic approach focuses on emotional regulation and mindfulness techniques. 
• Eating disorders: DBT helps individuals having anorexia nervosa, binge eating disorder and bulimia nervosa control their social and physical environment to alter the maladaptive binging or purging episodes. Moreover, it helps them accept and validate their problematic behaviours and stay mindful of their surroundings and food habits.
• Suicidal ideation: Research studies have portrayed that DBT is an effective treatment approach for self-mutilating behaviours and suicidal ideation which reduces the risk of attempting suicide. DBT approach offers telephonic consultations to clients which caters to their present needs. Moreover, therapists and clinicians might feel stressed due to the challenging issues, thus, DBT also involves a therapist consultation team that caters to the motivation and well-being of the therapists.
• OCD (Obsessive-compulsive disorder): Clients with Obsessive-Compulsive Disorder (OCD) experience intrusive, irrational thoughts (obsessions) that lead to compulsive behaviours aimed at reducing their distress. These compulsions often become repetitive and ritualistic, as individuals feel an overwhelming urge to perform certain actions to relieve the anxiety caused by their obsessive thoughts. Distress tolerance skills are one of the core aspects of DBT which aids these individuals to address and tackle these repetitive and unrealistic cognitions and alleviate the stress caused by the same.
• PTSD (Post-traumatic stress disorder): DBT helps individuals develop effective skills to reduce distress stemming from traumatic events, addressing behavioural, emotional, and physical aspects. Moreover, mindfulness practices help individuals remain aware of the present moment while grounding techniques assist in staying anchored in the present, effectively managing flashbacks.
• Substance use disorders: DBT approaches prevent relapse and support individuals in maintaining long-term recovery. Interpersonal effectiveness and distress tolerance skills address the social and environmental factors that initially led the individual to start using psychoactive substances.
• Major depressive disorder: Dialectical Behavior Therapy (DBT) is a therapeutic intervention aimed at promoting healthier emotional functioning by cultivating skills in emotional awareness, expression, regulation, tolerance, and acceptance. Through DBT, individuals learn to become more mindful of their emotions, recognize and articulate them effectively, manage emotional intensity, tolerate distress without resorting to harmful behaviours, and ultimately accept their emotions as part of the human experience.
• Generalized anxiety disorder: Individuals having GAD worry incessantly in all domains of their life namely social, interpersonal and occupational contexts. Distress tolerance techniques help them alleviate stress and anxiety. Additionally, the dialectical approach in the regulation of emotions aids in effective discrimination and validation of emotions along with efficient strategies to manage and counter the same.

In conclusion, Dialectical Behavior Therapy (DBT) is an effective therapeutic approach for managing emotional and behavioral challenges, particularly in borderline personality disorder and related disorders. By emphasizing mindfulness, distress tolerance, interpersonal effectiveness, and emotion regulation, DBT equips individuals with the skills needed to enhance emotional resilience, build healthier relationships, and improve their overall quality of life. Its versatility makes DBT a valuable intervention for various psychological disorders, supporting individuals in their journey toward better mental health.