Mental health challenges have increased worldwide, raising concern about the trend. According to the National Alliance on Mental Health, 1 in 20 American adults face severe mental disorders yearly.
Fortunately, dialectical behavior therapy (DBT), a special type of cognitive behavioral therapy (CBT), has come to the rescue of millions of people facing a variety of mental health issues by equipping them with the necessary coping skills.
This post explores DBT, its goals, benefits, the common techniques used in treatment, and their examples.
What is dialectical behavior therapy?
DBT is an evidence-based form of talk therapy that allows patients to develop coping skills to create a life worth living.
Specifically, dialectical behavioral therapy teaches people how to live in the present moment and develop healthy coping mechanisms for challenges such as distress, anxiety, stress, etc.
Through DBT therapy, individuals who experience intense emotions can effectively control their emotions and improve their relationships with others.
In DBT therapy, therapists help clients learn to accept that their experiences and behaviors are valid. Clients learn coping skills that help them control their emotions and live fulfilling lives.
Dialectical behavior therapy can help people struggling with emotional dysregulation. As such, it is an effective treatment for people struggling with:
- Borderline personality disorder (BPD)
- Suicidal behaviors
- Depression
Additionally, DBT therapy can treat conditions such as substance use, eating disorders, and post-traumatic stress disorder.
DBT vs. cognitive behavioral therapy: How do they differ?
While both DBT and CBT are forms of psychotherapy, a significant difference exists between the two. While DBT focuses on both acceptance and change — hence the term dialectic — CBT focuses on change. ‘Dialectic’ means bringing together opposite ideas, and that change occurs when there’s a dialogue between these ideas.
In dialectical behavior therapy, patients learn to accept their emotions, thoughts, behaviors, and strategies for changing them.
On the other hand, cognitive behavioral therapy aims to teach patients how to replace their unhelpful behaviors and thoughts.
Components of dialectical behavior therapy
The common components of DBT therapy include:
Group Skills Training
Clients learn behavioral skills in a group setting. Often, group sessions combine formal practice of techniques, lessons, and psychoeducational discussions.
Group sessions often occur once a week for 2.5 hours, and the curriculum takes 24 weeks to complete.
Individual Therapy
During individual therapy, you work collaboratively with your mental health professional to strengthen your commitment to participating in treatment and/or building a life worth living. In addition, your therapist seeks to understand how your emotions, expectations, and beliefs led to your current issues. The goal is to help you develop new skills and approaches to thrive in the world in a more functional way.
Phone Coaching
Also called in-the-moment coaching, phone coaching is a powerful tool for contingency management purposes. Therapists offer guidance on how to use the learned skills to clients via telephone to prevent a full-blown crisis.
Case Management Techniques
Case management techniques empower you to take good care and control of your life. Therapists use the acquired skills to teach you how to be autonomous and become your own case manager.
Consultancy
The consultation team supports those who offer dialectical behavior therapy, for instance, therapists and case managers. Consultancy focuses on maintaining and improving the capability and motivation of DBT providers.
Stages of DBT therapy
According to Stacy Thiry, a licensed mental health counselor and a provider with Grow Therapy, DBT is often broken up into three stages. They include:
- The foundation stage – In the foundation stage of DBT, the goal is to create a sense of stability. This is accomplished through harm reduction and learning to control behaviors that are life-threatening (self-harm, substance abuse, suicidal ideation).
- Intermediate stage – The second stage of DBT is focused on increasing the individual’s coping skills to help them learn to regulate their emotions. The goal is to increase their distress tolerance and identify triggers and process trauma so the person can manage triggers without being self-destructive. Therapists help clients move from a quiet desperation to full emotional experiencing and expression.
- The resolution stage – The third stage of DBT involves defining life goals and exploring what the individual needs to feel fulfilled in life. Once the person can feel empowered to manage distress, they can become curious to explore experiences that will help them build self-worth, acceptance, and a sense of connection to others.
Dialectical behavior therapy also includes a pre-treatment stage. According to Thiry, “the clinician and client work collaboratively during the pre-treatment stage to determine whether DBT is the right treatment for the client. In this stage, your therapist may offer an assessment before starting DBT. They’ll determine how suitable DBT is for you by asking questions and explaining how DBT works.
She adds that the pretreatment stage has other steps. “In the next steps, the clinician and client will work together to map out a treatment plan and set goals and objectives.
The clinician will provide psycho-education so the client has a full understanding of the DBT principles and will communicate expectations and determine commitment level. It is recommended that this stage involves weekly individual and also group sessions and it may last up to 4 sessions.”
Benefits of dialectical behavior therapy
DBT therapy confers a number of benefits to people who struggle with overwhelming emotions and the ensuing negative behaviors. Through DBT, you
Understand and name your emotions better
Dialectical behavior therapy is pivotal in creating awareness of your thoughts and emotions. With DBT treatment, you better understand the intense emotions and structures of thought that affect your choices and behaviors. Understanding and naming your emotions helps you to make healthy decisions and live in the present.
Enhance relationship with yourself and others
DBT skills training allows you to develop better self-esteem and relationships with others by fostering and reinforcing effective communication skills and boundary setting. In addition, the treatment motivates you to recognize yourself as a complex individual and acknowledge your strengths to improve your mental well-being.
Develop effective thinking and behavior skills
DBT improves communication skills, interpersonal effectiveness, and conflict resolution skills. You also develop strategies you can depend on in complex situations and daily life. Therefore, with DBT, you can learn to better manage depression, anxiety, disordered eating, among others.
Finally, dialectical behavior therapy helps to improve your quality of life.
Intense and disruptive emotions can affect your quality of life severely. Through DBT, you learn how to change unwanted emotional responses by learning to check the facts, thus improving your life’s quality.
Checking the facts means reacting to the facts of an event rather than to your thoughts and interpretations of the event. Changing your assumptions, beliefs, and interpretations of events to fit the facts can change your emotional reactions.
DBT therapy techniques
Like other forms of cognitive behavioral therapy, therapists use various techniques in dialectical behavior therapy. However, the choice of these approaches depends on the client’s situation and their ability to implement them.
“It’s possible to practice DBT skills on your own, but working with a trained therapist who teaches you first is ideal because some techniques may feel overwhelming,” says Shakia Mayer, a licensed mental health clinician and personal development coach at Grow Therapy.
Initially, the client and therapist will determine if a DBT program is an appropriate treatment approach. If the client and therapist decide to proceed with this treatment approach, the therapist will provide psychoeducation during pre-treatment, covering the principles, core modules, expectations, and goals.
This education assists clients in gaining a deeper understanding of the therapeutic approach, its objectives, and the skills they will acquire throughout the process.
Therapists teach the following skills in DBT:
Mindfulness
An essential benefit of dialectical behavior therapy is the establishment of mindfulness skills. Through mindfulness, you learn ‘the what’ and ‘the how’ skills. The ‘what skills’ involve what you do to cope, including:
- Wordless observing
- Describing what you observe
- Put your attention into what’s happening in the present moment
The ‘how skills’ are about the measures you take to cope. They include the following:
- Acting nonjudgmentally
- Acting one-mindfully
- Acting effectively
These skills allow you to live in the moment and focus on the present. In addition, mindfulness skills create awareness of what is happening inside you — impulses, sensations, feelings, and thoughts.
Further, the skills help you to apply your senses non-judgmentally in tuning what is happening around you.
Example
Mindful walking: Take a walk around your apartment or home compound and take heed of the sensation of your feet striking the ground. Pay attention to any sounds and smells. What do you hear? What do you see or smell? Let go of the emotions, thoughts, and other distractions, and keep walking as if it’s vitally important.
Emotional regulation
Through emotional regulation training, you develop cognitive and behavioral skills to reduce unwanted emotional responses and increase desired emotions. These skills include problem solving, reality checking, and opposite action, where you go against the desires of your feelings.
Emotional regulation skills teach you how to:
- Change emotional responses
- Recognize and describe emotions
- Manage intense emotions
- Limit vulnerability to negative feelings
Example
Noticing and labeling emotions: Tune in to yourself and identify your feelings and reactions to these emotions. Take note of sensations in your body parts. That is, is your heart beat increasing? Is your stomach upset? Is there tension in your head or neck?
After noticing your emotions, try naming them. Is it anger, resentment, or sadness? Then, dig deeper to establish what you are angry or sad about.
Emotional regulation skills teach you that emotions are brief, involuntary, and patterned responses to external and internal stimuli.
Distress tolerance
Distress tolerance is another essential DBT technique that helps you deal with difficult situations. Distress tolerance skills help you to accept yourself and the problems you’re facing. Additionally, these skills allow you to manage your emotions in difficult or stressful situations without responding with harmful behaviors.
In particular, dialectical behavioral therapy teaches you distress tolerance skills such as the following:
- Self-soothing
- Distraction
- Improving stressful situations
In addition, radical acceptance is another skill you learn in dialectical behavioral therapy. This skill teaches you to accept unchangeable feelings, thoughts, and experiences. Furthermore, it teaches you how to recognize and accept situations as they are, for instance, losing a loved one.
However, radical acceptance doesn’t mean you approve of every situation but accept it to move forward.
Example
Using the STOP SKILL:
- S – Stay in control
- T – Take a step back rather than act based on your emotions
- O – Observe, with all the senses, everything that is happening without making conclusions
- P – Proceed mindfully – that is, take a pause and then proceed to make an educated decision.
Interpersonal effectiveness
Interpersonal effectiveness skills allow you to increase assertiveness in relationships while still keeping them healthy and positive. Specifically, interpersonal effectiveness teaches how to:
- Communicate clearly
- Set boundaries
- Say no
- Get what you need without compromising your self-respect
With interpersonal effectiveness skills, you’ll learn how to navigate stressful situations and handle your relationships more easily.
Example
Think of an important relationship, and ask yourself what you expect from it. Do you feel you want to give or receive support? Do you like spending time with other people? Do you accept their requests or do you need to set better boundaries with them?
Take note of your priorities and rate their importance to you and the relationship.
Finding a dialectical behavioral therapist
With the number of psychologists increasing — the National Bureau of Statistics projects a 6% growth by 2032 — choosing a DBT therapist can be overwhelming. However, making an informed decision about choosing a therapist based on qualifications, experience, and preferences is essential.
Important considerations to make when looking for a therapist include the following:
Licensure: Look for a licensed mental health professional, such as a social worker, psychologist, or a professional counselor.
Insurance: Check if the provider will accept your health insurance and if there are limits to the sessions covered by the insurance. If you don’t have health insurance, check out low-cost clinics, training clinics, or DBT providers whether they provide sliding-scale treatment.
Referrals: Ask your physician or friends to suggest a DBT therapist they trust.
Cost of Therapy: Check out how much they will charge you for treatment and if there are any costs for missed sessions.
Find out the Cost of Therapy with Insurance
Location and Availability: Find out where the provider is situated, whether in a community health center, clinic, or independent practice. Additionally, check when they are available for your treatment.
Training and Experience: Look for a licensed provider who is specifically trained and has experience in dialectal behavior therapy.
Furthermore, when you are looking for a therapist for effective treatment, here are important questions to ask:
- How will your treatment change my current problem?
- What is your experience and training in DBT?
- How will we monitor the progress of your therapy?
- How many sessions do I need for this treatment?
- Do you have alternative interventions for my situation?
- What is your expertise in this type of treatment?
- What sorts of changes have you seen in others’ lives when practicing DBT?
Ultimately, ask yourself whether you are satisfied with the provider and if they are worth your money, effort, and time.
Connect With a Therapist Today
As mental health conditions increase globally, various treatment options are available.
DBT, a type of cognitive behavior therapy, helps patients overcome mental health issues by equipping them with the necessary coping skills. Whether you struggle with depression, borderline personality disorder, or suicidal thoughts, dialectal behavioral therapy can help.
A provider who offers this type of therapy can use various DBT techniques that will help improve your well-being. At Grow Therapy, we make it easy for you to connect with a therapist in your comfort zone, whether at home or in person.
