Dialectical Behavior Therapy (DBT)
Marsha M. Linehan, a psychologist at the University of Washington with a focus on borderline personality disorder (BPD), created Dialectical Behavior Therapy (DBT) in the late 1990s as a means of doing so.
Mindfulness, stress tolerance, and acceptance are important tenets of Buddhist meditation practice that are integrated into DBT alongside established cognitive-behavioral approaches for emotion control and reality-checking.
Private DBT therapy is the first proven effective therapy for the treatment of Borderline Personality Disorder (BDP). Based on the experimental successes and the similarity between the behavioral modalities of individuals with borderline personality style and people with bipolar disorder, DBT is now used in several clinical contexts also for the treatment of bipolar disorder.
Linehan created DBT to treat therapist burnout, as therapists experience stress in response to some patients’ lack of motivation, and in response to their difficulty in cooperating for effective treatment.
His first insight came from the observation of patients who had repeatedly attempted suicide (parasuicide), who had grown up in deeply disabling environments and needed an atmosphere of unconditional acceptance in which to develop a constructive therapeutic alliance.
His second insight concerned the need for an adequate commitment to change on the part of the patient based on radical acceptance of his very serious level of emotional dysfunction and on the acquisition of appropriate skills to live in the present moment.
Marsha Linehan assembled a skill set for emotional self-regulation by drawing on both the Western psychological tradition (cognitive behavioral therapy with its interpersonal variant of assertiveness practice) and the Eastern one (Buddhist meditation based on awareness). Her most original contribution was to foster a therapeutic alliance based on solid mutual affection.
All dialectical-behavioral therapies are based on two components:
1. an individual therapy modality, in which therapist and patient discuss issues raised during the week, is recorded in a special diary and follows a hierarchy of behavioral goals.
Suicidal and self-injurious behaviors come first, and behaviors that interfere with therapy come second. Then, we move on to quality of life issues to finally work for the overall improvement of the patient’s life. During individual therapy, therapist and patient work to enhance the use of skills.
2. A group modality, which generally meets once a week for about two to two and a half hours, and in which you learn to use specific skills divided into four modules: mindfulness key skills, interpersonal effectiveness skills, emotional regulation skills, and stress tolerance skills.
Neither therapeutic component is used without the other: the individual component is deemed necessary to ensure that suicidal impulses or other emotional problems do not destructively interfere with group sessions, while the latter teaches the characteristic skills of DBT and they are a proving ground for practising emotion and behavior regulation in a social context.
The four modules.
Mindfulness is the ability to nonjudgmentally focus attention on the present moment. Mindfulness allows you to live in the present moment, fully experiencing your emotions and sensations, it helps people accept and tolerate disturbing emotions, put their habits into question and face difficult situations.
The skills taught in DBT are very similar to those covered in many assertiveness and problem-solving courses. They include effective strategies for expressing yourself according to your needs, knowing how to say no, and being able to manage interpersonal conflicts. The skills taught intend to maximize the chances that in a given situation the individual will achieve his or her goals, without harming the other or giving up self-respect.
People with borderline personality functioning, like people with bipolar disorder and those with suicidal ideation, are often mentally labile and tend to experience intense emotions. They can be easily angry, frustrated, depressed or anxious. Thus, these individuals may benefit from therapy that helps them regulate their emotions. Skills taught in DBT for emotion regulation include: identifying and naming emotions, identifying barriers to emotion modification, narrowing vulnerability to the emotional sphere of the mind, increasing events that bring positive emotions, increasing awareness of emotions you feel,
Tolerance of negative situations.
Many modern psychological treatments focus on trying to change stressful events and circumstances. Little attention is given to tolerating negative situations. Dialectical behavior therapy emphasizes the importance of learning to cope with pain with the appropriate skills, these stress tolerance skills are a natural development of mindfulness skills. They have to do with the ability to accept, non-judgmentally, both yourself and your current situation. Although we speak of non-judgmental mode, this does not mean that we have to approve everything or that we have to resign. The goal is to acquire the ability to calmly acknowledge negative situations and their impact, rather than being overwhelmed or running away from them.