Dialectical Behavioral Therapy
Dialectical Behavior Therapy (DBT) was originally developed by Dr. Marsha Linehan as a comprehensive treatment program to treat chronically suicidal individuals suffering from Borderline Personality Disorder (BPD). During the past two decades, DBT has been found to be especially effective for individuals with suicidal and other severely dysfunctional behaviors.
Before developing DBT, Dr. Linehan first attempted to apply standard Cognitive Behavior Therapy (CBT) to the problems of adult women with histories of chronic suicide attempts, suicidal ideation, urges to self-harm,
and self-mutilation. After recognizing that standard CBT was not effective with this group of patients, Dr. Linehan and her research team made significant modifications to their approach, incorporating acceptance-based interventions and a “dialectical world view”–recognizing that everything is connected to everything else, change is constant and inevitable, and opposite perspectives can be integrated to form a more accurate perception of reality.
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- It is known that patients with borderline personality disorder (BPD) show attention deficits and impulsivity. The main aim of this study was to explore the effects of Dialectical Behavioral Therapy-Mindfulness training (DBT-M), used as an adjunct to general psychiatric management (GPM), on attention variables in patients diagnosed with BPD.
- Psychotherapy, sometimes referred to as “ talk therapy, ” is a relationship in which the patient seeks professional help from a licensed provider to address difficult or troubling feelings, thoughts, attitudes and/or behaviors. In other words, the psychotherapist helps individuals make important changes in their lives.
Though DBT (dialectical behavior therapy) is known predomintately as a treatment for borderline personality disorder (BPD), its foundation is pretty simple. The concept of dialectics is used to simultaneously foster change and acceptance. This allows sufferers to accept the present while acknowledging that their future must involve change.
DBT is based on Dr. Linehan’s theory that the core problem in BPD is emotion dysregulation–a patient’s inability to effectively regulate intense emotional reactions. The focus of DBT is on helping patients learn and apply skills that will increase their ability to regulate intense emotion and decrease ineffective coping strategies. DBT typically includes a combination of individual psychotherapy and group skills training. Patients in DBT are asked to monitor their symptoms and utilize new skills on a daily basis. The four areas that are covered in DBT skills training include:
- Mindfulness–learning to observe, describe and participate in all experiences while maintaining a nonjudgmental approach, focusing on the present moment and being effective
- Interpersonal Effectiveness–learning to successfully assert your needs and to manage conflict in relationships
- Distress Tolerance–learning ways to accept and tolerate distress without resorting to behaviors that will make the distress worse in the long run
- Emotion Regulation–learning to identify and manage emotional reactions
Randomized controlled trials have demonstrated that DBT is more effective than other forms of psychotherapy in the treatment of BPD and BPD with co-occurring substance abuse. Among other results, these studies found that patients receiving DBT were significantly less likely to drop out of therapy, were significantly less likely to engage in suicidal behaviors, had less medically severe behaviors, were less likely to be hospitalized, and had higher scores on global and social adjustment. For patients with co-occurring substance abuse, DBT was more effective than standard treatment in reducing drug abuse. Other research has shown DBT to be effective in treating a variety of other disorders, including chronic depression, anxiety, eating disorders, and substance abuse.
Source: Cognitive-Behavioral Treatment of Borderline Personality Disorder by Marsha M. Linehan. Guilford Press, 1993.
What is mindfulness?
Mindfulness is paying attention on purpose to what is happening right now.
When you practice mindfulness, you focus your attention on your present experience; just noticing whatever is happening in each moment, not lost in the past or thinking about the future.
Mindfulness is the opposite of being on automatic pilot.
When you’re on automatic pilot, you’re doing things by rote, or out of habit.
An example of being on autopilot that many people can relate to is arriving at work but not really remembering the car ride there. You didn’t have to think, ok, first I open the car door, then I sit down, then I put the key in the ignition, etc. You just did all those things automatically and found yourself at work.
Doing things on autopilot can be quite useful; it helps save time and energy.
Problems arise, though, when you live most of your life on automatic pilot, acting out of habit and not really being present in the moment.
Why does mindfulness matter?
If you feel overwhelmed by your emotions, mindfulness is the magic ingredient that helps you take a step back from intense feelings.
When you can take a step back and just notice what is happening, you are much less likely to get caught up in out-of-control emotions.
If you struggle with an addiction or compulsion, mindfulness helps you stop the chain of habitual behaviors.
When you’re mindful, you pay attention to what is going on inside of you, noticing:
- Thoughts
- Feelings
- Sensations
- Impulses
And to what’s going on outside of you, noticing what you:
- See
- Hear
- Smell
- Feel
Mindfulness is powerful!
When you can control your attention through mindfulness, a whole world of choice opens up. You no longer have to act, and react, out of habit, fear, or rapidly changing emotions.
Research on the benefits of mindfulness has exploded in recent years. The regular practice of mindfulness has been shown to:
- Increase emotional regulation
- Decrease distraction and rumination
- Increase activity in the brain region associated with positive emotions
- Decrease anger and emotional irritability
- Decrease depression and anxiety
- Increase immune function
Mindfulness in DBT
What does mindfulness have to do with DBT?
Mindfulness is the backbone of DBT (Dialectical Behavior Therapy); it is the core skill that underlies all the other skill sets.
Mindfulness in DBT is the core skill that underlies all the other skill sets.
Mindfulness is the first skill taught in DBT. Because without mindfulness it’s nearly impossible to change long-standing patterns of feeling, thinking and acting.
Mindfulness is central to regulating emotions, getting through crisis without making things worse and successfully resolving interpersonal conflicts.
Mindfulness is also a key component to accessing your Wise Mind, another foundational DBT concept.
Wise Mind is the synthesis of Emotion Mind and Reasonable Mind. When you are able to find your Wise Mind, you are able to know what’s real or true for you and act accordingly.
Learning how to be mindful isn’t complicated, but it is a commitment.
Dialectical Behavioral Therapy Pdf
It’s saying yes to being fully present in the moment – over and over again.
For more on Mindfulness in DBT, read these posts:
Part 1 – The Observe skill in Mindfulness
Part 2 – The Describe skill in Mindfulness
Part 3 – The Participate skill in Mindfulness
More on Mindfulness in DBT
Want to learn more about how mindfulness and DBT can help you?
Call (415) 310-5142 for a free phone consultation.
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