Beginner's Guide To Dialectical Behavior Therapy

Dialectical behavior therapy is a form of counseling used to treat a range of mental health issues, particularly borderline personality disorder and eating disorders. The therapy combines methods used in both cognitive behavioral therapy and behavioral therapy to help patients improve their mindset and wellbeing. Specifically, dialectical behavior therapy aims to give patients healthy coping mechanisms and other tools that will help them convert negative thinking patterns and destructive behavior into something with a positive, healthy outcome.

This form of psychotherapy was first developed in the 1980s by a team of cognitive behavioral psychologists. Led by Dr. Marsha Linehan, these psychologists were struggling to achieve positive outcomes in patients with borderline personality disorder solely with cognitive behavioral therapy methods, and this led them to create the new therapeutic approach that became known as dialectical behavior therapy.

Basic Definition Of The Therapy

Dialectical behavior therapy is founded on the principles of a philosophy known as dialectics and incorporates three central values. These are that all things are connected, change is inevitable and constant, and opposing things can be woven together to create a more accurate estimation of the truth in a situation. Dialectical behavior therapists help their patients arrive at a resolution of self-acceptance and change, which are perceived opposites.

In contrast to other therapies, this form of therapy incorporates the idea of validation, which has been shown to enable patients to experience less stress and distress from the therapy process, and also increases patient compliance with a therapist's suggestions. To use validation, the therapist validates the patient's thoughts or actions make sense in the context of the patient's personal experience, although the therapist may not necessarily agree with the patient's thoughts or actions as a healthy, effective way to approach or solve a given situation. Validation helps build a closer rapport between the therapist and patient.

Four Dialectical Behavior Therapy Models

There are four dialectical behavior therapy models therapists routinely use. The first of these is mindfulness, which can take many forms, and all of them involve learning to be present in the current moment without thinking about the past or the future. For example, a patient struggling with an eating disorder might focus on the sensations associated with eating a bite of food. They might try to focus on how the texture of the food feels or observe the sweetness of a piece of fruit.

The second model used in dialectical therapy is known as distress tolerance. This uses the tools of distraction, self-soothing, weighing the pros and cons, and improving the moment to help patients cope with moments of crisis by accepting themselves and the present situation. Interpersonal effectiveness, the third dialectical model, teaches patients to assert themselves and express their needs in a relationship. This technique helps patients to build healthy and positive relationships. The fourth and final dialectical behavior model is emotional regulation, which is a tool that teaches patients to recognize anger, sadness, and other negative emotions. They are then taught coping methods to handle these emotions in a manner that increases their positive emotions and reduces the amount of emotional vulnerability they may experience.

When It Is Used

Traditionally, the first patients to undergo dialectical behavior therapy were individuals with borderline personality disorder. Over the last three decades, the therapy has evolved, and it is now successfully used in the treatment of eating disorders such as anorexia nervosa and several other mental health issues. In particular, dialectical behavior therapy may be especially suited to patients experiencing post-traumatic stress disorder. Additionally, the therapy is beneficial when it is used for patients exhibiting signs of any mental health issues involving self-destructive behavior. For example, patients struggling with alcohol or substance abuse or other addictions may wish to try this form of therapy. It may also help patients who struggle with self-harm, smoking, binge eating disorder, or suicidal thoughts.

What Patients Can Expect

Generally, what patients can expect when undergoing dialectical behavior therapy is to participate in a combination of classroom and individual therapy sessions. During classroom sessions, patients role-play various scenarios to learn healthy methods of interacting with others. Homework assignments and worksheets are also used to help patients learn new behavior patterns. Individual therapy sessions are private sessions with a patient and a professional therapist. These sessions help the patient reinforce the healthy behaviors they learn in group sessions by providing personalized advice on how they might adapt and apply these healthy behaviors to their unique life challenges.

Patients involved in this form of therapy also have access to coaching over the phone. They can call their therapist if they are experiencing a particularly difficult day or crisis moment, and the therapist will provide advice on how to handle that and support the patient through the experience. For patients who have particularly complex situations, the individual therapist may consult with other therapists who form part of a consultation team for suggestions on how to effectively help the patient.

Effectiveness As A Therapy

Due to its combination of several psychotherapy approaches, dialectical behavior therapy has shown particular effectiveness as a therapy. The unique approach has helped many patients with serious conditions that could not be effectively treated with other approaches. The therapy is particularly effective in helping patients curb or eliminate serious self-destructive behaviors that can result in injury, including self-harm, suicidal thoughts or actions, and addiction to and misuse of prescription and recreational drugs, alcohol, and tobacco.

Patients with several types of eating disorders such as anorexia nervosa, bulimia, binge eating disorder, and other non-specified eating disorders generally have some form of dialectical behavior therapy in both outpatient care and residential treatment facilities. The therapy is also used in residential treatment centers for those struggling with addiction.