Dialectical Behavior Therapy
What is Dialectical Behavioral Therapy?
Dialectical Behavioral Therapy (DBT) is a treatment that was developed by Marsha Linehan, Ph.D. It incorporates both acceptance based strategies and behavior change to decrease the misery and suffering in people’s lives. DBT is helpful for people who have difficulty with their emotions, which includes:
- Hypersensitivity to emotional experiences
- Painful emotions that seem unbearable
- Emotions that come on quickly and change rapidly
- Emotions that seem to control actions, or lead to impulsive or out-of-control behavior (such as self injurious behavior, drinking, eating disordered behavior, or verbal attacks)
- Intense self-hatred or shame
- Feelings of emptiness, loneliness, or numbness
- Feeling disconnected or detached
- Difficulties in relationships (sensitivity to criticism or disapproval, difficulties being left alone or feeling abandoned, high emotional conflict)
- Difficulties with extreme or rigid thinking
Overview of the four DBT skills modules:
Emotion regulation skills help people understand the value of their emotional responses, increase their capacity to handle emotionally evocative situations, and change painful emotions when the emotion is not working for them. When people can optimally regulate emotional arousal, they are in touch with their experience, they can consider a variety of viewpoints regarding the situation, and they can integrate rational and emotional components of decision-making.
When people are under threat, their attention narrows and they become preoccupied with protecting themselves and minimizing distress. The “fight or flight” response of the emotion-brain can be adaptive in some situations, but some people have difficulty lowering high emotional arousal once under threat. This can lead to behaving in ways that do not feel in control of actions. Alternately, people who have difficulty with under-regulation of emotional arousal feel disconnected, detached, numb, or “not present” with what is going on in the moment. To hear more about how emotions can be problematic – and how these skills help, watch the video below.
Instead of being “right” or “wrong” when in conflict with others, the interpersonal skills help people determine what they are wanting or needing depending on the context and situation. Effectiveness is about navigating difficult interpersonal conflicts while maintaining self-respect and paying attention to relationships. It is also about skillful self-advocacy. Participants are encouraged to act wisely, to consider the impact of their behavior on relationships, and to find ways to address difficult interpersonal situations with their integrity intact.
In many DBT skills groups, interpersonal learning may be focused on conflicts that group members have outside of group. However, because group dynamics influence learning, interpersonal improvements that occur inside the group can be powerful, immediate, and rewarding. During the interpersonal learning module clients are also encouraged to observe and describe behavior, generate potential hypotheses about intentions of behavior, identify the “unsaid” (including emotions), identify their own emotions and reactions in group (self-validation), and gently provide impressions on how group members influence each other. Having a wide range of perspectives and feedback about one’s individual situation can help increase awareness of how to handle personal problems, decrease loneliness, and give people a supportive “team” that is available to help solve personal problems.
Mindfulness is about increasing awareness of sensations, feelings, and experiences. It is also about regulating attention (which can help regulate emotional arousal), enhancing the capacity to calm a racing mind, getting in touch with one’s own inherent wisdom, and increasing one’s capacity for a connection with the universe at large. It is a core skill that is implemented in all the skills modules. With full awareness people can adequately address pain, reduce fear, and incorporate all information available to make wise decisions.
When in emotional distress, people often act in ways that are self-defeating in the long term but have immediate short term benefits. Distress tolerance is really about making painful life experiences more tolerable. In addition, distress tolerance is about learning how to problem solve distressing situations- Getting drunk, initiating a heated argument, engaging in self-destructive behavior, or restricting food intake doesn’t really solve the problem of emotional pain. This module is about finding ways to make one’s current life situation better when the reality one faces can not be changed and the immediate problem cannot be solved.
Does joining one of your groups mean that I am obtaining Dialectical Behavior Therapy?
No. DBT treatment was originally developed for chronic repeat suicide attempters with high treatment needs. Comprehensive DBT treatment includes individual therapy, pager coaching, team consultation, and skills groups with therapists who all have training in this very intense and complex treatment. This is often why it is difficult to find- and is mainly practiced in treatment settings where all of these resources are readily available (ie, prisons, community mental health centers, hospitals, and a very small number of group practices.) Much controversy exists today around whether or not clinicians with DBT training actually offer DBT in the way it was developed for research purposes- without losing the heart and compassion that is behind the treatment.
Joining one of my groups means that you will obtain the DBT skills. More specific information about what you will receive from working with me can be found on the DBT groups for adults page or the adolescent girls groups page.