What is Dialectical Behavior Therapy (DBT)?
DBT is a model of therapy developed by Marsha M. Lineham for the treatment of Borderline Personality Disorder. The use of DBT has expanded to include many additional diagnoses and symptoms.
Dialectical refers to dialogue between the client and therapist where opposing viewpoints are discussed and both parties eventually come to an agreement. (This is the opposite of debate where two parties come together and argue until one party is proven incorrect.) Dialectics is also a perspective from which one attempts to understand the
nature of reality.
The nature of the relationship between the client and therapist is collaborative and helping. A client’s feelings are validated. Empathy and respect are integral characteristics to the treatment process. The treatment environment is receptive to dialogue and emotionally safe while setting clear healthy boundaries.
DBT holds that all behavior patterns are interrelated and we are always in a state of change and transition. This can be unsettling to those who do not have a perception of control in their lives and who need skills for resilience and adapting to one’s environment.
As Western culture is developing an understanding and appreciation for Eastern philosophies and practices, such as, yoga; psychology is exploring treatments that expand the traditional knowledge base to include meditation, acceptance, and mindfulness.
DBT is a combination of Cognitive Behavior Therapy (CBT), specific skills training, and Buddhist philosophy.
DBT concepts do not require a specific belief system, religion, or spirituality for it to be an effective treatment and will not conflict with a client’s religious beliefs.
The emphasis on
acceptance and mindfulness
as mechanisms for coping with a highly stressful situation, rather than merely emotionally reacting to stimuli, is a major tenet of DBT and is borrowed from traditional Eastern philosophy, namely, Zen.
In DBT acceptance is acknowledging the situation and your feelings in the situation as they are and taking an “it is what it is,” frame of mind. Another way of framing an acceptance statement is, “I am doing the best I can at this moment in my life right now.”
The concept of acceptance does not mean that one submits to problems and is a helpless victim of their circumstances. Instead, one uses acceptance to understand and gain insight into behaviors (without negative judgments) and from a new perspective an individual can make a clear assessment of what needs to change and how to achieve his or her goal.
There are many ways to describe mindfulness. According to Germer, Siegel, and Fulton (2005), mindfulness is awareness of the current moment with acceptance. Kabat-Zinn (1994) defines mindfulness as purposely paying attention, in the present moment and without judgment.
Mindfulness is paying attention to one’s life with intent and purpose to live fully in the moment, in the present, and without judgment about the situation or one’s feelings in regards to the situation.
Mindfulness is a form of meditation and requires active concentration as we go through our daily activities.
Mindfulness is helpful because we are less likely to be hyper-emotional if we are consciously aware of the moment, analyze the situation, and develop a proportional reaction to our feelings and environment. (To try your first mindfulness exercise see below.)
DBT is helpful to people who feel emotionally overwhelmed easily and may need assistance developing stress tolerance. DBT can assist those with volatile mood swings, hyper-sensitivity to their environment, and self-harm behaviors. It is also for those seeking increased peace of mind through improving coping skills.
Concentrate on an object. Notice all of the qualities of the object. Take a mental inventory of each characteristic of that object paying attention to each detail. Do this for as long as you can. How long does it take for your mind to drift into another subject?
- When you showered this morning how often did you take notice of the water on your skin? Or did you ignore it? Were you lost in your thoughts preparing for your day?
- While driving how long do you actually concentrate on what you are doing? How many times in the past few days have you arrived at your destination only to realize that you do not recall the previous intersections? Do you recall the car in front of you as you drove?
- Try these exercises out and see how long it takes for your mind to drift and you lose yourself to your thoughts. The more we walk through our day as a passive observer the more we are allowing our environment to rule our emotions and behaviors through our “unawareness”.
The Dialectical Behavior therapy Skills Workbook for Bipolar Disorder by Sheri Van Dijk, MSW (2009)
The Dialectical Behavior therapy Skills Workbook for Bulimia by Ellen Astrachan-Fletcher, PhD and Michael Maslar, PsyD (2009)
Skills Training Manual for treatment Borderline Personality Disorder by Marsha Lineham (1993)