Dialectical behavioral theory

What It Is & Purpose

Overview

What is dialectical behavior therapy (DBT)?

Dialectical behavior therapy (DBT) is a type of talk therapy (psychotherapy). It’s based on cognitive behavioral therapy (CBT), but it’s specially adapted for people who experience emotions very intensely.

Cognitive behavioral therapy (CBT) is a type of talk therapy that helps people understand how thoughts affect emotions and behaviors.

“Dialectical” means combining opposite ideas. DBT focuses on helping people accept the reality of their lives and their behaviors, as well as helping them learn to change their lives, including their unhelpful behaviors.

Dialectical behavior therapy was developed in the 1970s by Marsha Linehan, an American psychologist.

What is dialectical behavior therapy (DBT) used for?

Dialectical behavior therapy (DBT) is especially effective for people who have difficulty managing and regulating their emotions.

DBT has proven to be effective for treating and managing a wide range of mental health conditions, including:

Borderline personality disorder (BPD).
Self-harm.
Suicidal behavior.
Post-traumatic stress disorder (PTSD).
Substance use disorder.
Eating disorders, specifically binge eating disorder and bulimia.
Depression.
Anxiety.

It’s important to note that the reason DBT has proved effective for treating these conditions is that each of these conditions is thought to be associated with issues that result from unhealthy or problematic efforts to control intense, negative emotions. Rather than depending on efforts that cause problems for the person, DBT helps people learn healthier ways to cope.

How do I find a DBT therapist?

A therapist can be a psychiatrist (a medical doctor who can prescribe medications), psychiatric nurse, psychologist, social worker or family therapist.

Finding the right therapist is often a time-consuming task, and DBT therapy isn’t any different. Try not to become discouraged. Talk to people you trust to give you a referral for a therapist who uses dialectical behavior therapy, whether it’s your primary healthcare provider or a friend or family member.

You can also search for therapists online through local and state psychological associations.

Be sure that any therapist you’re interested in seeing is a state-certified and licensed mental health professional and that they treat your area of concern (for example, eating disorders, borderline personality disorder, self-harm, etc.).

Most therapists’ websites list the conditions and problems they treat. If you have questions, call or email the therapist’s office before you choose.

It may be helpful to ask a potential DBT therapist the following questions:

What is the nature of your training in DBT?
Do you provide comprehensive DBT or a modification? If not comprehensive DBT, why not?
Do you belong to a DBT consultation team?
What’s your policy on phone calls and emails during the week?
How much time will you initially ask me to commit to for the entire therapy process?

Procedure Details

How does dialectical behavior therapy (DBT) work?

The main goal of therapists who use dialectical behavior therapy (DBT) is to strike a balance between validation (acceptance) of who you are and your challenges and the benefits of change. Your therapist will help you learn new skills to improve emotion regulation.

The structure of dialectical behavior therapy can vary some from therapist to therapist, but, in general, DBT involves these four types of sessions:

DBT pre-assessment.
Individual therapy.
Skills training in groups.
Telephone crisis coaching.

DBT pre-assessment

Your therapist may offer an assessment before starting DBT. They’ll determine how suitable DBT is for you by asking you questions and explaining how DBT works. If you decide that DBT is the right therapy for you, they’ll ask you to commit to the treatment and the length of treatment.

Individual DBT therapy

Individual DBT therapy involves weekly sessions with your therapist. Each session lasts about 40 minutes to 60 minutes.

Individual DBT therapy sessions have the following goals:

To help keep you safe by reducing suicidal and self-harming behaviors, if applicable.
To limit behaviors that get in the way of productive therapy.
To help you reach your goals and improve your quality of life by addressing what’s blocking your progress, such as mental health conditions or relationship issues.
To help you learn new skills to replace unhelpful behaviors.

Your therapist will likely ask you to keep a diary to track your emotions and actions and to look for patterns of behavior. You’ll bring this diary with you to your sessions so you and your therapist can decide what to work on for each session.

DBT skills training in groups

In these sessions, your therapist will teach you skills in a group setting. This isn’t to be confused with group therapy, in which you discuss your problems with others. Think of it more like a teaching and learning session in a classroom setting.

DBT skills aim to help enhance your capabilities in day-to-day life. The four skills your therapist will teach include:

Mindfulness: This is the practice of being fully aware and focused in the present instead of worrying about the past or future.
Distress tolerance: This involves understanding and managing your emotions in difficult or stressful situations without responding with harmful behaviors.
Interpersonal effectiveness: This means understanding how to ask for what you want and need and setting boundaries while maintaining respect for yourself and others.
Emotion regulation: This means understanding, being more aware of and having more control over your emotions.

Telephone crisis coaching

DBT often involves telephone crisis coaching to support you in your daily life. This means you can call your therapist at certain times for support between sessions.

Examples of when you may need to call your therapist include:

When you need help with an immediate crisis, such as wanting to self-harm.
When you’re trying to use the DBT skills you learned but want some advice on how to do it.

However, your therapist will set clear boundaries about when you can call them, such as during an agreed-upon range of time during the day.

Crisis coaching functions on an as-needed basis. The calls are usually brief, and they shouldn’t replace the work of individual or group sessions.

Risks / Benefits

What are the benefits and risks of dialectical behavior therapy (DBT)?

Dialectical behavior therapy (DBT) has been proven to help people with their mental health conditions in several studies. For people with borderline personality disorder, in particular, DBT results in:

Less self-harm behavior and anger.
Fewer days of inpatient hospitalization.
Less drug and alcohol misuse.
Improved depressive symptoms.

However, DBT isn’t for everyone, and it can be very difficult. DBT is more likely to work for you if you:

Are committed to making positive changes.
Are ready to fully commit to therapy and do homework assignments.
Are ready to focus mostly on your present and future, rather than your past.
Feel able to do some sessions in a group with others.

Recovery and Outlook

How long will I need dialectical behavior therapy?

Dialectical behavior therapy (DBT) usually takes at least six months to a year. However, each person is unique, and mental health conditions are complex. You shouldn’t expect to be completely free of symptoms or no longer have problematic behaviors after one year of DBT.

Many therapists believe that the treatment for borderline personality disorder, in particular, can often take several years.

Try not to get discouraged by how long it may take to be able to better manage your emotions and have a better quality of life. The important thing is that you’re seeking help. Any progress is good progress.

When to Call the Doctor

When should I see my healthcare provider or therapist while doing DBT?

It’s important to go to all of your scheduled individual DBT therapy sessions and group skill training sessions.

If you’re experiencing a crisis, such as feeling suicidal, and can call your therapist, do so.

If your therapist is unavailable, call the National Suicide Prevention Lifeline at 1.800.273.8255. Someone will be available to talk with you 24 hours a day, seven days a week. You can also call 911 or go to the nearest emergency room.

A note from Cleveland Clinic

Dialectical behavior therapy (DBT) is an effective treatment to help people who experience very intense, negative emotions. Although it may be difficult and time-consuming to find the right DBT therapist for you, it’s important to keep trying. The sooner you can start therapy — and stay committed to it — the sooner you’ll have an improved quality of life.

What It Is & Purpose

Overview

What is dialectical behavior therapy (DBT)?

Cognitive behavioral therapy (CBT) is a type of talk therapy that helps people understand how thoughts affect emotions and behaviors.

Dialectical behavior therapy was developed in the 1970s by Marsha Linehan, an American psychologist.

What is dialectical behavior therapy (DBT) used for?

Dialectical behavior therapy (DBT) is especially effective for people who have difficulty managing and regulating their emotions.

DBT has proven to be effective for treating and managing a wide range of mental health conditions, including:

Borderline personality disorder (BPD).
Self-harm.
Suicidal behavior.
Post-traumatic stress disorder (PTSD).
Substance use disorder.
Eating disorders, specifically binge eating disorder and bulimia.
Depression.
Anxiety.

How do I find a DBT therapist?

A therapist can be a psychiatrist (a medical doctor who can prescribe medications), psychiatric nurse, psychologist, social worker or family therapist.

You can also search for therapists online through local and state psychological associations.

Most therapists’ websites list the conditions and problems they treat. If you have questions, call or email the therapist’s office before you choose.

It may be helpful to ask a potential DBT therapist the following questions:

What is the nature of your training in DBT?
Do you provide comprehensive DBT or a modification? If not comprehensive DBT, why not?
Do you belong to a DBT consultation team?
What’s your policy on phone calls and emails during the week?
How much time will you initially ask me to commit to for the entire therapy process?

Procedure Details

How does dialectical behavior therapy (DBT) work?

The structure of dialectical behavior therapy can vary some from therapist to therapist, but, in general, DBT involves these four types of sessions:

DBT pre-assessment.
Individual therapy.
Skills training in groups.
Telephone crisis coaching.

DBT pre-assessment

Individual DBT therapy

Individual DBT therapy involves weekly sessions with your therapist. Each session lasts about 40 minutes to 60 minutes.

Individual DBT therapy sessions have the following goals:

To help keep you safe by reducing suicidal and self-harming behaviors, if applicable.
To limit behaviors that get in the way of productive therapy.
To help you reach your goals and improve your quality of life by addressing what’s blocking your progress, such as mental health conditions or relationship issues.
To help you learn new skills to replace unhelpful behaviors.

DBT skills training in groups

DBT skills aim to help enhance your capabilities in day-to-day life. The four skills your therapist will teach include:

Mindfulness: This is the practice of being fully aware and focused in the present instead of worrying about the past or future.
Distress tolerance: This involves understanding and managing your emotions in difficult or stressful situations without responding with harmful behaviors.
Interpersonal effectiveness: This means understanding how to ask for what you want and need and setting boundaries while maintaining respect for yourself and others.
Emotion regulation: This means understanding, being more aware of and having more control over your emotions.

Telephone crisis coaching

DBT often involves telephone crisis coaching to support you in your daily life. This means you can call your therapist at certain times for support between sessions.

Examples of when you may need to call your therapist include:

When you need help with an immediate crisis, such as wanting to self-harm.
When you’re trying to use the DBT skills you learned but want some advice on how to do it.

However, your therapist will set clear boundaries about when you can call them, such as during an agreed-upon range of time during the day.

Crisis coaching functions on an as-needed basis. The calls are usually brief, and they shouldn’t replace the work of individual or group sessions.

Risks / Benefits

What are the benefits and risks of dialectical behavior therapy (DBT)?

Less self-harm behavior and anger.
Fewer days of inpatient hospitalization.
Less drug and alcohol misuse.
Improved depressive symptoms.

However, DBT isn’t for everyone, and it can be very difficult. DBT is more likely to work for you if you:

Are committed to making positive changes.
Are ready to fully commit to therapy and do homework assignments.
Are ready to focus mostly on your present and future, rather than your past.
Feel able to do some sessions in a group with others.

Recovery and Outlook

How long will I need dialectical behavior therapy?

Many therapists believe that the treatment for borderline personality disorder, in particular, can often take several years.

When to Call the Doctor

When should I see my healthcare provider or therapist while doing DBT?

It’s important to go to all of your scheduled individual DBT therapy sessions and group skill training sessions.

If you’re experiencing a crisis, such as feeling suicidal, and can call your therapist, do so.

A note from Cleveland Clinic

How dialectical behavioral therapy works and how it can be useful for healthy people

Fashionable today "mindfulness", Zen Buddhism and behaviorism at first glance are completely incompatible things. However, all of this is at the heart of Dialectical Behavioral Therapy (DBT), an unusual modification of the well-established cognitive-behavioral therapy. Balancing rational CBT with New Age techniques, the creators of DBT recommend it to those who are prone to self-destructive behavior, lose their identity in romantic relationships, and find it difficult to forgive themselves for past mistakes.

T&P understands how appealing to "mindfulness" helps not to kill self-esteem on the way out of the comfort zone and why pleasant emotions need a schedule. nine0003

Awareness instead of "Thinking rationally!"

"Mindfulness" is perhaps the most popular word in the modern dictionary of pop psychology and causes only a smirk in many. However, in the case of DBT, this concept is combined with the cognitive-behavioral approach, one of the most popular and respected branches of psychotherapy in the West with a very strong evidence base.

“It is not facts and events that upset a person, but how he looks at them” - this quote from the Stoic philosopher Epictetus can describe the main idea of cognitive behavioral therapy. Its supporters believe that many mental problems are caused by irrational thinking, due to which a person interprets events and situations in such a way that he experiences more than he could. CBT teaches a person to think rationally (cognitive therapy) and reinforce "correct" thought patterns through real-life experiments (behavioral therapy based on behavioral principles). However, the American psychologist Marsha M. Linehan, who suffered from borderline personality disorder (a mental illness characterized by an unstable sense of self, suicidal thoughts, self-injurious behavior, etc.), noticed that CBT is ineffective for patients with this ailment. nine0007

A mind-control and change-of-mind approach won’t help if you’re used to thinking, “My thoughts are wrong, my emotions mean nothing, and my actions are wrong, so I’m completely defective.”

(Linehan noted that patients with BPD grew up and brought up in a similar environment: their personality was not accepted, they constantly demanded changes and self-control, which, coupled with biological sensitivity, formed extreme reactions).

Cognitive behavioral therapist Yaroslav Isaikin says that Linehan faced recurring problems: clients interrupted sessions, and therapists burned out. So she decided to balance the change-oriented CBT approach with an acceptance mindset (of herself, her emotions, etc. ) and “mindfulness” training. Hence the word "dialectic": DPT combines opposites promising a healing synthesis. nine0007

Criticism and effectiveness

One of the first randomized clinical trials of DBT was published in 1991. In it, Linehan and her colleagues point to significant improvements in the condition of chronically suicidal women with BPD. However, most of these studies focus on a specific group of people and have a small sample size. The researchers also note that DBT does not work as well with key BPD factors as other types of psychotherapy, with the exception of suicidality. nine0007

Yaroslav Isaikin believes that DBT is effective for a wider range of problems - from working with adolescents and post-traumatic disorder to drug addictions and eating disorders. But it is not suitable for short-term assistance (within 3-5 weeks). If you are interested in working on a specific (not the most time-consuming) query and a quick result, you should pay attention to the classic CBT approach.

“I went to a private psychotherapist for a year, and despite some improvements, my general condition deteriorated so much that I began to think about suicide,” says Psychologies journalist and columnist Syuyumbike Davlet-Kildeeva, who has done DBT. - I decided to go to another specialist and, on the advice of a friend, I went to the clinic, where I told about my difficulties: problems with alcohol and psychoactive substances, difficulties in interpersonal relationships, uncontrolled spending of money and compulsive overeating. I didn’t choose DPT myself and didn’t know about this direction at all: I was offered this therapy based on specific complaints.” nine0007

DBT helped her learn to deal with stress without resorting to destructive problem solving: “I can drink a couple of glasses of wine once a week, but it's nothing compared to what I used to be. At my last job, a cocktail of a full glass of whiskey and ten grams of cola was named after me, and one of my most popular texts is called "I didn't drink all February. " Now I plan my life for several years ahead and look to the future with a pleasant feeling - before, my horizon was limited to the fog of bad habits and the desire to simply survive. nine0007

Zen instead of "Everything is bad!"

Mindfulness, the central skill that DBT seeks to develop, Linehan borrowed from Zen Buddhism. Patients are offered to learn how to meditate, concentrate on breathing and focus on specific objects and sensations. Practicing nonjudgmental presence in the present moment helps you get out of autopilot mode and stop habitual impulsive reactions (in other words, do not lose your temper). As a result, clients learn to consciously experience emotions that they previously wanted to avoid and realize that

even the most unpleasant feelings are not fatal - you don't have to run away from them.

“When describing some events, one should avoid impulsive irrational judgments. Do not say: “I had a hell of a hard week,” but describe facts, events and your attitude towards them. This reduces the degree of emotions, makes you calmer and more objective,” says Davlet-Kildeeva.

Not running away from problems, but diverting attention

In the process of developing DPT, Linehan asked herself the question: why some people cannot cope with suffering, while others, even after going through terrible and traumatic events, continue to live fully? The difference is that some people spend a lot of time and energy resisting what can no longer be changed (if you ever could not fall asleep, replaying your shame at a three-year-old party in your head, then you understand what it is about). Others get used to the past, continuing to live on. nine0007

It is this kind of “radical acceptance” that Linehan sees as a skill that helps people bounce back from shocks and crises. Acceptance exercises help you to let the past and present be what they are and spend energy on things that are really controllable and changeable.

Of course, not every situation can be "accepted", especially if something unpleasant is happening here and now and causes inevitable stress in a person. For this case

DBT therapists teach to resist external stimuli: switch attention to pleasant memories, sex fantasies, breathing, mental counting and everything that can distract a person from negative emotions, but does not harm.

This is followed by muscle relaxation, meditation, or something personal (for example, listening to music). The main goal is to maintain a stable emotional state.

Plan and have fun

Typically, during DPT, clients keep a diary in which they record their emotions and feelings throughout the day. By carefully analyzing these records, you can identify characteristic triggers and patterns of behavior, pay attention to irrational reactions. And after studying yourself with the help of a diary, think about ways to avoid stressful situations and respond to annoying factors. nine0007

“One of the skills from the emotion regulation group is not to dramatize. I was surprised at how he makes my life easier, - Syuyumbike shares. - And number one in my personal top is the accumulation of positive emotions in the short term. Behind this cumbersome title (the translation of DPT literature into Russian leaves much to be desired) hides a simple idea that

you need to plan in advance a daily dose of positive emotions.”

Scott and Dryden distinguish the following main types cognitive behavioral therapy:

formation coping skills - based on stress coping training when in training, with clients practice action skills and communications in crisis situations;
problematic oriented cognitive-behavioral therapy - human life viewed as a decision process tasks, clients learn to understand problems that arise in the process social functioning, are trained effective ways of planning and action evaluations; nine0007
structural cognitive therapy - therapy for change in thinking and motor stereotypes, as a result of which they change customer behavior patterns;

According to American researcher E. Gumbrill, behavioral theory influenced on the development of the theory and practice of social work, it highlights the following components, the theoretical constructs:

socio-systemic the nature of the description of phenomena and phenomena; nine0007
collection of positive and negative information allows quickly change the learning process;
case statistics, allows access to objective patterns of interaction;
the role of social employee is not limited to helper functions, but enriched research functions.

Behavioral social work approach is associated with models of social adaptation, modification behavior, with the practice of socialization, in based on behavioral psychology and behavioral therapy. nine0007

Person in behavioral approaches, is considered as an individual having problems with behavior. Individual expands its repertoire of behavior, through social learning processes, recognizing your mistakes. During social work conditions are created to study the mechanisms of individual behavior, the experience of productive behavior for the real environment environment.

Ambient Wednesday pending as a source of incentive management and reinforcements that either form, or neutralize the behavior of the client. Hence individuals have difficulty when they behave in a non-adaptive manner, as a result inappropriate or inadequate systems reinforcements in the environment. nine0007

proceeding of this, in behavioral patterns social work process estimates focused on the behavioral aspects of the individual functioning, customer problem defined in terms of non-adaptive behavior in the context of reflection environment.

Grade includes an interview that focuses on the following:

Estimated

in what is the problem; nine0007
on What is the client complaining about?
in than a behavioral problem;
when there was a problem with the behavior;
is typical behavior problem infrequent, not inherent to the client;
who could be an intermediary;
How the client would like to change;
It has whether the client is motivated to change.

According to concepts of Herbert, social worker after evaluation determines the people, place, time, situations needed to change behavior.

Ambient environment in behavioral social work is primarily other people whose role in the therapeutic process is defined as the source, reinforcing behavioral stimuli.

Contract in social behavioral work regarded as a specific aid, aimed at modification behavior , with clearly prescribed program and results changes.

Modification behavior directed to help individuals in order to obtain their patterns of behavior that enable them to function successfully in the environment environment. This is achieved thanks to implementation of socialization programs and educational programs, including experience of the current situation of the client's life, turning it into a positive experience study. Help is new knowledge of the situation, competence in behavioral repertoires and social roles determined by life situations. The main effort of social employees are aimed at forming reinforcement systems in the environment and the formation of social systems support for certain adaptive behavior patterns. nine0007

Social worker performs in the behavioral model of help as expert, teacher, guide, covers a wide range of adaptive, socializing, therapeutic functions.

AT the table below reflects trends in the formation of behavioral approaches and theories of social learning, that have influenced behavioral methods in the theory and practice of social work.

nine0260

Considers social problems through the prism social function and "does not notice" social context.

BEHAVIORISM		THEORY SOCIAL LEARNING
classic Watson's definition. operant learning. Skinner		Late theory of learning. Main representative A. Bandura.
CHARACTERISTIC nine0007		SIGNS
home the role belongs to the externally observable behavior. Behavior is the result of learning. Learning based on interaction events and consequences of actions person. wide use of animals in research, attempts to experiment with humans. nine0007		AT learning plays a role not only behavior, but also thinking and feeling person. Learning occurs when active links to previous experience. Explores learning in social situations.
MODELS		ACTION
Adjustment behavior that directly reflects behaviorist theory. Methods, based on the principles of behaviorism, applied in those institutions social work, where behaviorism included in the theoretical basis of the work.		Short term Reid and Epstein models oriented for problem solving. nine0007
VALUABLE		ORIENTATIONS
AT the moment of birth man was considered like an empty box. Personality formed through learning. At right learning can create person in accordance with social order. nine0088 planning teaching people can set direction development of society.		Person learning how to behave that would ensure his survival and the best existence. Person learns by interacting with the environment, and at the same time able to influence learning abilities; the person is very is active and can change the environment. nine0007
BEHAVIORISM	THEORY OF SOCIAL LEARNINGS
ORIENTATION	RELATIONSHIPS
Depends on learning; man adopts inappropriate behaviors and learn appropriate forms. Careful behavioral analysis is carried out before the stage of choosing measures of influence.	Relationship task oriented and limited in time. Aimed at problem solving, where the goal is often is a change in social function. Also can change the foundations of social function, related to the environment. nine0088
	CRITIQUE
Mechanistic perspective on human learning. Impact on human behavior at work can be used for the purposes patient manipulation. Rejection using punishment as a negative the consequences of behavior.

Are common findings
Cognitive and behavioral concepts in theory social work presented numerous approaches, and are connected, First and foremost, learning theory cognitive theory. nine0007 Based on them received their development and corresponding types of therapeutic practices that can be directed to education mental and sensory processes as well as changing thoughts and feelings, and as well as behavioral changes. Cognitive and behavioral concepts have many in common with task-oriented model, as well as with humanistic and constructivist concepts aimed at developing relationships thinking and behavior. nine0007

Are common findings

Cognitive and behavioral concepts in theory social work presented numerous approaches, and are connected, First and foremost, learning theory cognitive theory. nine0007

Based on them received their development and corresponding types of therapeutic practices that can be directed to education mental and sensory processes as well as changing thoughts and feelings, and as well as behavioral changes.

Cognitive and behavioral concepts have many in common with task-oriented model, as well as with humanistic and constructivist concepts aimed at developing relationships thinking and behavior. nine0007

Exercise 1.

Learn more