Dialectical Behaviour Therapy

Dialectical Behaviour Therapy

We all suffer from some emotional distress at some point in our lives. For some people, this phase is short-term, and the person moves on with their life on their own. But for other peoples, it is really difficult to cope. And they keep struggling in their lives.

Talk therapy is significantly important for those people along with traditional treatment. Dialectal behavior therapy is a type of talk therapy that targets maladaptive behaviors and increases patient acceptance of such behavior. 

If you’re considering DBT as a treatment option, this article will surely help you with understanding the basics of DBT. 

What is Dialectical Behaviour Therapy?

Dialectical Behaviour Therapy or DBT is a subtype of cognitive-behavioral therapy originally developed to treat borderline personality disorder (BPD). It is an approach therapy that helps you learn essential skills to cope with your condition.

DBT focuses on accepting the patient’s experiences and thoughts and positively changing these thoughts with different skills.

Indication for DBT

DBT is considered one of the most effective treatments for borderline personality disorder (BPD) and persistent thoughts of suicide. But it can also help in certain mental health conditions like 

  • Attention-deficit/hyperactivity disorder (ADHD)
  • Bipolar disorder
  • Eating disorders including anorexia, binge eating, and bulimia
  • Generalized anxiety disorder (GAD)
  • Major depressive disorder such as treatment-resistant major depression and chronic depression
  • Obsessive-compulsive disorder(OCD)
  • Post-traumatic stress disorder (PTSD)
  • Substance use disorder

DBT is an intense therapy program that focuses on positively changing your behavior. Although DBT provides the best results, it might not be the best choice in every case. The effectiveness of DBT increases if:

  • You are ready to make positive changes in yourself
  • You want to try your best to accomplish tasks and follow therapy
  • You are ready to address your past traumas

Targets of DBT

Individuals with multiple mental health problems require treatment with DBT. DBT is a structured therapy that allows the practitioner to prioritize the problems in an organized way. The treatment targets are

  1. Life-threatening behaviors. Such as major depressive disorder or suicidal thoughts. These problems must be the priority to avoid suicidal or non-suicidal injuries.
  2. Therapy-interfering behaviors. These types of behaviors reduce the effectiveness of the treatment plan. This includes non-cooperative with the therapist, coming late, or even canceling therapy sessions.
  3. Quality of life behaviors. Relationship problems, social or financial issues, and other medical illnesses can interfere with the therapy. Such issues are addressed to ensure that client is receiving effective treatment.
  4. Learning new skills to cope with the environment. We face new challenges every day. So, proper skills are needed to cope with the stress of life. This therapy helps you to identify triggers and how to handle them.

Dialectical Behaviour Therapy – basics components

DBT is specially designed to systematically and comprehensively treat the patient’s condition. There are two main components of the DBT training program 

  1. Weekly individual therapy sessions:

During individual therapy sessions, the therapist and patient work together to learn many new social skills and apply these skills to specific events in their lives. These sessions are held once weekly, and the duration is 60 to 90 minutes.

Individual goals are set for the patient for each week. And the patient’s problem-solving behavior of the previous week is discussed. The priority is suicidal behavior and then the behaviors that may interfere with therapy. These sessions help patients to build their self-respect and self-image.

  1. Weekly group therapy sessions

Weekly group therapy sessions are run under the supervision of a trained therapist. Each session consists of 2 and a half hours. Individuals learn acceptance-oriented and change-oriented skills from these therapy sessions.

Also, group members provide moral support to each other and provide positive criticism. These sessions are the perfect opportunity to improve one’s communication and social skills.

Some other components of DBT are:

  1. Phone coaching

Phone coaching is used to provide in-the-moment support. The therapist makes brief phones to check on patients during a week. 

The therapist will coach an individual through a stressful event and provide guidelines to cope with stress. The goal is to ease the person back in their lives.

  1. Case management strategies

The therapist teaches individuals how to control their lives and be their case manager. 

  1. DBT consultation teams

DBT consultation team helps therapy providers keep motivated and focused on providing the best treatment to patients. Knowledge is shared among team members, and support is provided. 

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Goals of DBT

The treatment goals of DBT are:

  • Developing new skills and techniques to cope with stress
  • Keep the patient motivated to continue treatment
  • Help patient accepting their condition. Not all mental health problems are curable. However, with the right treatment intervention, the symptoms can be managed,
  • Improve one’s functionality and quality of life
  • Modifying maladaptive behaviors
  • Improving communication and relationship with friends and family
  • Improving self-awareness and self-respect

How will DBT benefit you?

DBT will benefit you in more than one way, which includes

  • Reduction in self-destructive and suicidal behaviors
  • Reduction in mental health symptoms such as anxiety, depression, post-traumatic stress disorder (PTSD), and many others.
  • Improve tolerance and regulate emotions
  • Learn skills to improve quality of life
  • Improves one’s belief about themselves and their environment
  • Decreasing maladaptive behaviors that affects life quality and relationships
  • Improves self-respect and self-recognition

Length of a Dialectical Behaviour Therapy program

A full course of DBT typically runs for 24-weeks or 6 months, often recommended twice a year. Patients are recommended to take 6-month long courses on each module; distress tolerance, emotion regulation, and interpersonal effectiveness. In between each module, a 2 weeks practice of mindfulness is provided.

A typical DBT program is a one-year commitment. But shorter DBT programs are also available; take 12 weeks to complete. These programs often called “DBT-informed programs,” use some methods of standard DBT programs and can be very beneficial for patients.

Also, there may be some versions of DBT without telephone coaching. The duration for DBT can be tapered according to patient’s needs and the severity of their condition.

Cost of DBT

DBT generally comprises a weekly individual therapy session, weekly group therapy sessions, and phone calls throughout the week to check on the patient. The DBT program costs $150-$300 per week.

There are public centers available. But their waiting list is so long that they cannot be feasible. Insurance is the far most common way to pay for group and individual therapy sessions. But you must take each therapy session on different days.

How to find a DBT treatment?

Many people get confused about how to access a DBT treatment. Only a certified practitioner with proper knowledge and skills can provide DBT services. Finding such a person is difficult because there is no official register of DBT practitioners in the UK.

You can seek DBT through

  1. NHS or public sector; but the waiting might be very long 
  2. Private sector; these are expensive

Private health insurance can cover your expenses, but not everyone has insurance. So, what to do? If you don’t have insurance, you can apply for National Disability Insurance Scheme (NDIS). NIDS can help you to relocate funds to pay for DBT.

Your psychiatric can refer you to enter these services according to your need.

Four modules of DBT

Dialectical means’ working with opposites.’ DBT provides an opportunity to develop existing skills required for capability enhancement. 

It works through the strategies of “Acceptance and Change.” This set consists of four core skills or modules to cope with your situation. These skills are; mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness.

Let us look into the detail of these skills

  1. Acceptance oriented skills

Mindfulness

Mindfulness is the practice of fully aware and be present in the current moment. It also allows you to acknowledge your feelings, behaviors, and thoughts as they are, without any manipulation. 

Mindfulness helps you to learn “what” and “how” skills. For example, “what” skills teach you what you are focusing on, and “hoe” skills teach you how to be more mindful. 

Distress tolerance

Distress tolerance is a set of skills that help in coping with uncomfortable emotions and crises. You will learn how to keep control when you cannot change the situation.

There are many sample exercises to help manage the crisis and distract yourself from distressing emotions; one such exercise is ACCEPTS. This includes:

  • Activities – indulge yourself in activities that will distract you from negative thoughts.
  • Contributing – do something that shifts your focus on another person
  • Comparison – compare your situation with something more saddening
  • Emotions – do some activity that will alter your emotions. 
  • Pushing away – for example, push away harmful urges for half an hour. If the urge persists, try for another half hour.
  • Thoughts – use a mental strategy to shift your attention
  • Sensation – allow your body to feel safe physical sensations to change your focus.
  1. Change oriented skills

Emotional regulation

Managing your emotions is very difficult. Mostly we are driven by our feelings and make impulse choices, which can result in wrong decisions. So, always try to keep your emotions in control. 

Emotion regulation strategies help you to manage your intense emotions that are the cause of trouble. But how can you do it? Here are few tips that may help you

  • Try to express yourself by writing
  • Meditation or yoga exercises
  • Getting proper diet and adequate sleep
  • Talking with family and friends
  • Focusing on negative thoughts that occur before or after strong emotions

Interpersonal effectiveness

Do you struggle in a relationship? You find it difficult to properly express yourself? Well, Interpersonal effectiveness helps you to learn all the assertive strategies you might need. You will learn 

  • how to appropriately ask for what you want, 
  • how to say ‘no,’ 
  • communicate more effectively,
  • deal with challenging situations
  • and how to manage interpersonal conflicts while keeping the relationship positive and healthy.

There are many exercises available to learn all such things. For example, a sample exercise, GIVE, can help you. What is GIVE? It means

  1. be gentle, 
  2. show interest, 
  3. validate other person’s thoughts, 
  4. and keep an easy attitude.

Stages of DBT 

DBT is divided into four stages. The therapist sets goals for each stage, keeping in mind the patient’s condition and the severity of the patient’s behavior. The stages are

Stage 1 – Behaviour Stabilization

People in therapy may be dealing with self-destructive and suicidal thoughts. They often experience feelings of worthlessness and helplessness. This stage is focused on safety and crisis intervention. The goal is to gain control over problematic behaviors. 

Stage 2 – Emotional Stabilization

Although the patient’s behavior is stable, now mental health problems persist. Emotional pain and desperation become more apparent often because of past trauma. 

The goal of this stage is to accept their emotional pain instead of denying it. At the end of this stage, the client moves from a desperate state to full emotional experiencing.  

Stage 3 – Enhancing quality of life

After behavior and emotional control, the focus shifts toward enhancing the quality of life; by defining life goals, build self-respect, improving self-awareness, and promoting happiness and success. 

Stage 4 – Returning to previous lives

The therapist will provide support to the patient to help him fit back in his life; this stage aims to improve his capacity for happiness and stability. The individual moves from the stage of incompleteness to finding meaning in life. This stage is often for individual who fail to find fulfillment or connectedness

Is DBT effective?

DBT is an effective treatment for treating BDP and suicidal thoughts. According to American Psychiatric Association, treatment with DBT improves the patient’s condition, i.e., decreases the frequency and severity of the disease. 

However, the clinical trials held on small sample sizes. Hence more data is needed. Experts are looking for the after-treatment effectiveness of DBT for BDP.

Limitations of DBT:

Do DBT work 100%? Although DBT is effective most of the time, that is not the case for everyone. DBT has certain potential limits and risks. This criticism is because

  • DBT requires a significant time duration to work
  • A person is obliged to attend and complete the assigned tasks; not everyone can do so.
  • DBT is an intense, well-organized, and logistic therapy and the free-spirited people find it difficult to cope, which reduces the effectiveness of the treatment plan.
  • Only certified practitioners and therapists can provide the right treatment to patients.
  • There is limited research on post-treatment follow-ups. It is not known for how long DBT can be effective.

Dialectical Behaviour Therapy vs. cognitive behavioral therapy

Although DBT is a subtype of CBT, DBT is slightly different from CBT. DBT is more intense than CBT. DBT targets emotions and interpersonal relationships, while CBT targets individual’s maladaptive beliefs. 

DBT was originally used for patients with borderline personality disorder who struggle with building healthy relationships with others. But both CBT and DBT are a type of talk therapy that helps you address your maladaptive thoughts and behaviors.

Can you do DBT on your own?

A common question related to DBT is, “can I learn DBT techniques myself?” On the outside, it seems very easy. 

Just change your attitude, and you can achieve your goals. But that is the most difficult part. That’s why doing it yourself doesn’t work, and attending the therapy session supervised by a trained DBT therapist. The session can help you in

  • Staying motivated throughout the course
  • Learn skills to apply in certain situations
  • Maintaining positive attitude
  • Feeling supported

There is much material available on the internet, including dairy cards, exercises, and worksheets. They will help you to maintain recovery during or after completing the treatment course. 

Alternate therapies – What to do if DBT fails?

Mental health problems and substance use disorder require a personalized treatment plan that varies from patient to patient. You can apply the same formula to everyone. So, there might not be a chance that DBT is not as effective for you as it is for some other patient. 

Then, what should you do? Psychotherapy for mental health illnesses is of a wide range. There are different types of therapies available to meet every patient’s needs. Some of these therapies are:

  • Cognitive-behaviour therapy –CBT helps you learn skills to get rid of self-destructive behaviors and learn about stressors. 
  • Family therapy –provides an opportunity for the patient and his family to resolve their differences and repair their relationship.
  • Humanistic therapies –these therapies help shift individual’s view to become more positive and increase their self-awareness
  • Interpersonal therapy (IPT) –IPT focus on improving interpersonal problems that are affecting one’s quality of life and relationships
  • Psychodynamic therapy –this therapy targets the person’s unconscious processes to improves self-awareness and self-respect. It also helps to identify the past-related issues that are affecting their present.

DBT is used to reduce symptoms of BDP, but it can treat other conditions as well. If you are dealing with emotional distress and want to learn new coping skills, DBT is your way to go!

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