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IMPORTANT INFORMATION.
By reading this site, the reader acknowledges their personal responsibility in choices for mental health for themselves and their children, and agrees that the AYCNP or anyone associated with this site, bears no responsibility for one's personal decisions in choices for mental health. Anyone coming off medication should do so gradually rather than abruptly, and under a doctor's supervision. Anyone experiencing thoughts of suicide should seek support.
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| Page last updated: June 26, 2009 |
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Dialectical behavior therapy
(DBT) is a psychological method developed by Marsha M. Linehan, a psychology researcher at the University of Washington, to treat persons with borderline personality disorder (BPD). DBT combines standard cognitive-behavioral techniques for emotion regulation and reality-testing with concepts of mindful awareness, distress tolerance, and acceptance largely derived from Buddhist meditative practice. DBT is the first therapy that has been experimentally demonstrated to be effective for treating BPD. Research indicates that DBT is also effective in treating patients who represent varied symptoms and behaviors associated with spectrum mood disorders, including self-injury.
Linehan created DBT in response to her observation of therapist burnout after repudiating patients' motivation to cooperate in successful treatment. Her first core insight was to recognize that the chronically (para)suicidal patients she studied had been raised in profoundly invalidating environments and required a climate of unconditional acceptance (not Carl Rogers' humanistically "positive" version, but Thich Nhat Hanh's metaphysically neutral one) in which to develop a successful therapeutic alliance. Her second insight concerned the need for a commensurate commitment from patients to (be willing to) change -- subject to their skillfulness in the present moment--based on 'radical acceptance' of their dire level of emotional dysfunction.
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Elements of Easter religion and Buddhism are incoporated into Dialectical Behavioral Therapy
Photo: Buddhist monk. Tevaprapas Makklay
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Linehan united commitment to the core conditions of acceptance and change through the Hegelian principle of dialectical progress, in which thesis + antithesis - synthesis, and proceeded to assemble a modular array of skills for emotional self-regulation, drawn from Western (e.g., CBT and an interpersonal variant, "assertiveness training") and Eastern (e.g., Buddhist mindfulness meditation) psychological traditions. Arguably her signal contribution was to elide the adversarial paradigm implicit in the hierarchical modernist therapeutic alliance, using the deconstructive spirit of Hegel and the Buddha to substitute a postmodern alliance based on intersubjective tough love.
All DBT involves two components:
1. An individual component in which the therapist and patient discuss issues that come up during the week, recorded on diary cards and follow a treatment target hierarchy. Self-injurious and suicidal behaviors take first priority, followed by therapy interfering behaviors. Then there are quality of life issues and finally working towards improving one's life generally. During the individual therapy, the therapist and patient work towards improving skill use. Often, skills group is discussed and obstacles to acting skillfully are addressed.
2. The group, which ordinarily meets once weekly for two to two-and-a-half hours, learns to use specific skills that are broken down into four modules: core mindfulness skills, interpersonal effectiveness skills, emotion regulation skills, and distress tolerance skills.
Neither component is used by itself; the individual component is considered necessary to keep suicidal urges or uncontrolled emotional issues from disrupting group sessions, while the group sessions teach the skills unique to DBT, and also provide practice with regulating emotions and behavior in a social context.
Mindfulness
Mindfulness is one of the core concepts behind all elements of DBT. Mindfulness is the capacity to pay attention, nonjudgmentally, to the present moment. Mindfulness is all about living in the moment, experiencing one's emotions and senses fully, yet with perspective. It is considered a foundation for the other skills taught in DBT, because it helps individuals accept and tolerate the powerful emotions they may feel when challenging their habits or exposing themselves to upsetting situations. The concept of mindfulness and the meditative exercises used to teach it are derived from traditional Buddhist practice, though the version taught in DBT does not involve any religious or metaphysical concepts.
Interpersonal effectiveness
Interpersonal response patterns taught in DBT skills training are very similar to those taught in many assertiveness and interpersonal problem-solving classes. They include effective strategies for asking for what one needs, saying no, and coping with interpersonal conflict.
Individuals with borderline personality disorder frequently possess good interpersonal skills in a general sense. The problems arise in the application of these skills to specific situations. An individual may be able to describe effective behavioral sequences when discussing another person encountering a problematic situation, but may be completely incapable of generating or carrying out a similar behavioral sequence when analyzing his or her own situation.
The interpersonal effectiveness module focuses on situations where the objective is to change something (e.g., requesting that someone do something) or to resist changes someone else is trying to make (e.g., saying no). The skills taught are intended to maximize the chances that a person's goals in a specific situation will be met, while at the same time not damaging either the relationship or the person's self-respect.
Emotion regulation
Individuals with borderline personality disorder and suicidal individuals are frequently emotionally intense and labile. They can be angry, intensely frustrated, depressed, or anxious. This suggests that these clients might benefit from help in learning to regulate their emotions. Dialectical behavior therapy skills for emotion regulation include:
Identifying and labeling emotions
Identifying obstacles to changing emotions
Reducing vulnerability to emotion mind
Increasing positive emotional events
Increasing mindfulness to current emotions
Taking opposite action
Applying distress tolerance techniques
Distress tolerance
Many current approaches to mental health treatment focus on changing distressing events and circumstances. They have paid little attention to accepting, finding meaning for, and tolerating distress. This task has generally been tackled by psychodynamic, psychoanalytic, gestalt, or narrative therapies, along with religious and spiritual communities and leaders. Dialectical behavior therapy emphasizes learning to bear pain skillfully.
Distress tolerance skills constitute a natural development from mindfulness skills. They have to do with the ability to accept, in a non-evaluative and nonjudgmental fashion, both oneself and the current situation. Although the stance advocated here is a nonjudgmental one, this does not mean that it is one of approval or resignation. The goal is to become capable of calmly recognizing negative situations and their impact, rather than becoming overwhelmed or hiding from them. This allows individuals to make wise decisions about whether and how to take action, rather than falling into the intense, desperate, and often destructive emotional reactions that are part of borderline personality disorder.
Distress tolerance behaviors are concerned with tolerating and surviving crises and with accepting life as it is in the moment. Four sets of crisis survival strategies are taught: distracting, self-soothing, improving the moment, and thinking of pros and cons. Acceptance skills include radical acceptance, turning the mind toward acceptance, and willingness (working within one's present situation) versus willfulness (trying to impose one's will regardless of reality).
end of article
Dialectical Behavioral Therapy Source Adapted From:
Wikipedia.com
http://en.wikipedia.org/wiki/Dialectical_behavioral_therapy
Please Note:
This site does not recommend or endorse DBT because of its emphasis on philosophies derived from Buddhism and Eastern religion. However, some of the principles of DBT, less those of Eastern religions, can be of value. (In public schools there is a separation of religion and education. Some might consider DBT as teaching the practice of a form of religion, insomuch as Buddhist philosophies and meditation form a part of the treatment. Teaching religion on an academic level, however, is accepted in public schools). However, it has been noted, that DBT has been effective for many, more effective than standard treatments, probably in large part, because of the specific training of
therapists, and the intensity, specific and regularity of the treatment schedule.
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