As a clinician, you may use multiple types of modalities to address the needs of different patients. One type of therapy you have likely heard of but may want to learn more about is dialectical behavior therapy (DBT). DBT can be particularly useful for managing strong emotions. So, what is dialectical behavioral therapy?
What is Dialectical Behavior Therapy (DBT)?
Dialectical behavior therapy (DBT) is a modified version of cognitive behavioral therapy (CBT) developed in the 1980s to address deficiencies in CBT for the treatment of borderline personality disorder (BPD). However, it can also be used to treat other conditions, such as post-traumatic stress disorder (PTSD). DBT includes four treatment stages and several core techniques aimed at redirecting the patient away from self-destructive behaviors— promoting mindfulness, self-esteem, and good relationships with others—as well as helping patients move toward happiness and life goals.
Before we go on, it helps to know that the term “dialectical” refers to a synthesis of opposing forces. The origins of DBT go back to several unsuccessful attempts to use CBT for suicide prevention in the late 1970s. This led to DBT being developed and tested in the 1980s, principally by Dr. Marsha M. Linehan. Meta-analytic statistical research of numerous studies have supported DBT’s effectiveness for treating BPD, although it can additionally be used for other purposes.
At its core, DBT is an evidence-based type of psychotherapy, or “talk” therapy, that focuses on the therapist and patient working together for the patient to accept themselves while also embracing change. DBT includes a substantial time commitment both in terms of frequent therapy sessions and regular “homework” assignments to develop skills. It is often delivered in individual one-on-one sessions, but may also be delivered in a group setting with multiple patients.
What Does DBT Do?
DBT includes elements of analysis and behavioral change—techniques that include replacing deleterious behavior patterns with sensible and effective behaviors, of changing one’s cognitive thought patterns to be more positive and helpful, and of accepting oneself and one’s circumstances while making these changes. These goals are accomplished by emphasizing mindfulness skills to stay “in the moment” and cope with strong emotions, by developing mechanisms to cope with distress through repeated practice—such as distraction and self-soothing—by improving interpersonal communication and relationships, and more.
In DBT, the patient is frequently educated on metacognition—both what it is and how to implement it. Metacognition is the concept of deliberately and intentionally thinking about how one thinks and learns. For example, in DBT, therapists teach patients about the five states of change with respect to their psychological journey: pre-contemplation, contemplation, preparation, action, and maintenance. The first 3 stages involve the patient learning that they need therapy and seeking help. Then, within the action stage, and eventually the maintenance stage, the therapy itself occurs, which is often divided into 4 key subordinate stages:
- Treatment begins, with an emphasis on quickly addressing serious issues such as self-harm and suicidal behaviors.
- Now, therapy can move on to techniques to address the previously mentioned quality-of-life issues (distress tolerance, emotional regulation, interpersonal communication, etc.).
- The 3rd sub-stage focuses on acceptance and self-esteem (along with the dialectical balance of change and self-improvement), as well as on the development of healthy interpersonal relationships.
- The focus shifts to self-actualization issues such as life goals, lasting happiness, and strong long-term relationships. Assuming the patient continues with therapy, at this stage they are shifting from the action stage to the maintenance stage.
Overall, DBT’s focus on the patient’s development of emotional regulation techniques, long-term interpersonal relationships, and long-term planning distinguish it from CBT, which tends to be more focused on short-term skills and strategies.
What is DBT Effective At Treating?
DBT is particularly supported for the treatment of borderline personality disorder (BPD), as it helps patients build the tools to address symptoms including impulsivity, unstable moods, feelings of worthlessness, and dysfunctional social relationships. Beyond this, there is a good amount of support for DBT in the treatment of PTSD, including complex PTSD that may involved prolonged or “complex” trauma where the patient experienced trauma for a long time, often for years, with little or no hope of escape.
DBT is a flexible therapy method that can be adapted to specific patients and conditions. Some therapists have found success in using DBT to treat other conditions such as bipolar disorder, eating disorders, suicidal behavior, certain types of depression, and even attention-deficit/hyperactivity disorder (ADHD).
Dialectical behavior therapy has emerged as an important tool for treating patients with disorders that were previously thought to be intractable. Although DBT requires a larger commitment of time and resources than CBT, meta-analyses of numerous studies have supported its use for BPD, along with a smaller number of research studies for other disorders. If you are thinking about offering DBT or opening your DBT practice to accept insurance, the right EHR can make all the difference. Valant was born out of the first ever DBT practice, created by behavioral health professionals to be the best EHR for behavioral health. Book your free demo today!