What is DBT?
Dialectical Behavior Therapy (DBT) is a well researched and comprehensive
treatment approach designed to help people who have difficulty
in regulating their emotions. This often results in a high
degree of impulsive reactivity, self-destructive behaviors,
and volatile relationships with others in their lives. DBT works
by teaching participants to become more aware of their particular
sensitivity to negative emotions such as anger and anxiety.
At the same time, it provides the skills necessary to tolerate
these feeling and then begin to regulate them. DBT also teaches
assertiveness skills to enable participants to effectively begin
asking for what they want from others and saying no to things
they don't want.
Who can benefit from DBT?
Developed by Marsha Linehan, Ph.D. at the University of
Washington in the early 1990's, DBT was originally designed as
an innovative and integrative treatment for suicidal and actively
self-harming patients with a history of multiple psychiatric hospitalizations
who met criteria for Borderline Personality Disorder (BPD). Because
of its success in treating this patient population, DBT has gained
in popularity and has been used to treat a broader range patients
who present with many of the characteristics listed below.
- a tendency towards impulsivity and self-destructive behaviors
- an unstable sense of self, including chronic feelings of
emptiness
- high emotional reactivity requiring a long time to calm
down
- a tendency to see others and the world in black and white
terms
- extremely sensitive and can lash out in anger over the
slightest miscue
- unstable relationships, especially those involving intimacy
- a pronounced fear of being abandoned
- rapid mood changes with mixed anxiety and depression
How does DBT work?
DBT separates skills training from individual psychotherapy,
requiring participants to attend weekly skills training groups
in addition to being in ongoing and weekly psychotherapy. As
a unique and powerful way to further reinforce the skills taught
in the skills groups, telephone coaching with a trained DBT
therapist is available between group sessions. One of the key
assumptions of DBT is that while we may not have caused all
of our problems, we are the only ones capable and responsible
for fixing them. This requires a continual willingness on the
part of DBT participants to put in the hard work necessary for
making the changes they want in order to create lives worth
living. Because of the personal dedication, sacrifice and effort
required to successfully complete our DBT program, applicants
are required to complete a DBT Orientation and Commitment class
before being eligible for admission into a DBT skills group.
DBT pre-treatment requirements:
Initial intake interview(s) to determine eligibility
and readiness for DBT skills training.
- Completion of DBT Orientation and Commitment group.
- Agreements with individual therapist and groups skills
leaders, including insurance reimbursement and releases of
information, reviewed and signed.
Skills Modules taught in DBT
- Core Mindfulness - being present and non-judgmentally
aware in the moment
- Distress Tolerance - managing difficult feelings without
acting impulsively
- Emotion Regulation - learning to skillfully use or
change emotions
- Interpersonal Effectiveness –relating skillfully
with others
DBT assumptions about participants:
- People in DBT are doing the best they can.
- People in DBT want to improve.
- People in DBT need to do better, to work harder, and be
motivated to change.
- The lives of suicidal individuals are unbearable as they
are currently being lived.
- People in DBT must learn new behaviors in all areas of
their lives.
- People cannot fail in DBT.
DBT assumptions about therapists
:
- All therapists, no matter how well trained, are fallible.
- We make every reasonable effort to conduct competent and
effective therapy.
- We obey standard ethical and professional guidelines.
- We are available for weekly therapy sessions, phone consultations,
and provide needed therapy back-up.
- We respect the integrity and rights of the patient.
- We maintain confidentiality.
- We meet regularly to obtain consultation and support to
be effective in the work we do.
Targets of DBT treatment:
(in order of priority)
- Decreasing high-risk suicidal and self-harming behaviors
- Decreasing therapy interfering behaviors by either therapist
or patient
- Decreasing quality of life interfering behaviors
- Learning and mastering behavioral skills for mood-independent
life choices
- Decreasing symptoms related post-traumatic stress, other
anxiety, and depression
- Enhancing and sustaining self-respect
- Additional goals set by patient to create a life worth
living
Stages of DBT treatment:
Stage One
- Decreasing or eliminating life-threatening behaviors (suicide
attempts, suicidal thinking, self-injury, homicidal and aggressive
behaviors)
- Decreasing or eliminating therapy-interfering behaviors
(missing sessions, not doing homework, behaving in a way that
burns others out)
- Reducing or eliminating hospitalization as a way of handling
crisis
- Decreasing behaviors that interfere with the quality of
life (eating disorders, not going to work or school, addiction,
chronic unemployment)
- Increasing behaviors that will enable the person to have
a life worth living
- Increasing behavioral skills that help to build relationships,
manage emotions and deal effectively with various life problems
Stage Two
- Continuing and building on Stage One skills
- Targeting and decreasing symptoms of Post Traumatic Stress
Disorder (PTSD) and other Anxiety or Depression related symptoms
Stage Three
- Increasing love and respect for self and others
- Affirming individual life goals
- Solving ordinary life problems
Stage Four
- Developing the capacity for freedom and joy
- Creating a life worth living!
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