Dialectical behavior therapy
Overview
Dialectical behavior therapy (DBT) is a type of cognitive-behavioral therapy that was originally developed by psychologist Marsha Linehan in the late 1980s. It is primarily used to treat individuals with borderline personality disorder (BPD), but has since been adapted for other mental health disorders that involve emotion dysregulation, such as bipolar disorder, post-traumatic stress disorder (PTSD), and depression.
Theoretical Background
DBT is grounded in the principles of behaviorism, while incorporating elements of Buddhist meditative practice. The term "dialectical" refers to the process of finding the truth through the exchange of logical arguments, and in the context of DBT, it involves the integration of opposites, particularly change and acceptance.
Core Components
DBT includes four core components: individual therapy, group skills training, phone coaching, and consultation team. Each component serves a specific function and is considered equally important in treating clients.
Individual Therapy
In individual therapy, the therapist and client work one-on-one to apply the skills learned in group sessions to specific challenges and events in the client’s life.
Group Skills Training
Group skills training involves a therapist teaching skills related to mindfulness, distress tolerance, interpersonal effectiveness, and emotion regulation in a group setting.
Phone Coaching
Phone coaching provides clients with in-the-moment support to help them apply skills to real life situations as they occur.
Consultation Team
The consultation team is a support group for the therapist, designed to help therapists stay motivated and competent.
Treatment Stages
DBT treatment typically occurs in four stages, with each stage having its own goals, tasks, and targets.
Stage 1: Stabilization
The goal of this stage is to achieve behavioral control.
Stage 2: Emotional Experience
This stage focuses on experiencing emotions fully.
Stage 3: Ordinary Life
The goal of this stage is to learn to live: to define life goals, build self-respect, and find peace and happiness.
Stage 4: Capacity for Joy
This stage is about moving from a sense of incompleteness towards a life that involves an ongoing capacity for experiences of joy and freedom.
Efficacy
Multiple studies have shown DBT to be effective in reducing suicidal behavior, non-suicidal self-injury, psychiatric hospitalization, treatment dropout, substance use, anger, and depression and improving social and global functioning.
Criticisms and Limitations
Despite its effectiveness, DBT has been criticized for its complexity and the extensive training required to implement it effectively. It has also been suggested that DBT may not be as effective in treating PTSD.