Psychologist Marsha M. Linehan developed dialectical Behavior Therapy (DBT) in the late 1980s. It was initially intended to help better treat chronically suicidal individuals diagnosed with borderline personality disorder (BPD). It is a specific type of cognitive-behavioral therapy (CBT) that prioritizes the psychosocial aspects of treatment. Since its development, DBT has proven to be an effective treatment method for other kinds of mental health disorders, such as substance use disorder (SUD), depression, post-traumatic stress disorder (PTSD), anxiety, eating disorders, and more. DBT works by providing individuals with new skills to manage painful emotions and reduce relationship conflicts. When regularly applied, the DBT skills can help an individual improve his or her ability to regulate emotions, learn to better tolerate distress and negative emotions, remain mindful and present in the moment, and learn to communicate and interact more effectively with others.
While it is normal for an individual to experience bouts of anxiety at various time throughout his or her life, if the worry becomes debilitating it may be indicative of a clinical mental health disorder. Anxiety is listed in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), as Generalized Anxiety Disorder (GAD). According to the Anxiety and Depression Association of America (AADA), in order to be clinically diagnosed with GAD an individual must experience severe difficulty controlling his or her worry on more days than not for at least six months and present with at least three or more of following signs and symptoms:
- Having a sense of impending danger, panic and/ or doom
- Increased heart rate
- Difficulty sleeping (due to trouble falling asleep and/ or staying asleep, restlessness at night, and/ or unsatisfying sleep)
- Hyperventilation (breathing rapidly)
- Excessive sweating
- Feeling weak and/ or tired
- Impaired concentration and/ or feeling as though the mind goes blank
- Increased muscle aches and/ or soreness
- Gastrointestinal (GI) problems (i.e. nausea, diarrhea, vomiting…etc.)
The above criteria differentiate GAD from normal bouts of anxiety and/ or worry that may manifest from a specific set of stressors or for a more limited period of time. An individual that struggles with GAD will likely experience a large percentage of his or her waking hours excessively worrying about something, even when there is no specific threat present. Reports have noted that GAD affects nearly 6.8 million adults, which makes up over 3% of the population in America.
DBT is comprised of individual therapy sessions and DBT skills group sessions. One-on-one therapy sessions allow the providing mental health clinician the ability to focus on the nuanced mental health needs of the individual in treatment. The individual therapy sessions are also a place for the individual to process any challenges that may arise during the week and practice applying and integrating the DBT skills learned into his or her daily life. A qualified mental health clinician conducts the DBT skills group sessions. DBT focuses on providing therapeutic skills in four fundamental areas, which include the following (as provided by the Linehan Institute):
- Mindfulness: focuses on improving an individual’s ability to accept and be present in the current moment
- Distress Tolerance: focuses on increasing an individual’s ability to tolerate pain that may arise from difficult situations, as opposed to trying to change and/ or escape it
- Interpersonal Effectiveness: focuses on teaching techniques that enable a person to communicate with others in a way that is assertive, maintains self-respect, and simultaneously strengthens relationships
- Emotion Regulation: focuses on methods to successfully change unwanted emotions
The participants of the group are encouraged to share their experience and provide mutual support. After each DBT skills group session the facilitator will assign homework to reinforce actively practicing the material taught in the session. The DBT skills group sessions are typically held on a weekly basis and meet for around six months, though the timeframe can vary depending on the specific needs of the group members. The individual therapy sessions are often held once a week in conjunction with the DBT skills group sessions, though frequency of one-on-one sessions can be increased or reduced based on the individual’s needs. Every individual is different and when in treatment for a mental health illness, such as anxiety, will likely respond best to a tailored treatment plan. DBT offers both the ability to provide customized therapeutic support through the individual therapy sessions, as well as peer support though the DBT skills group sessions. Depending on the individual’s specific needs, DBT may be a suitable treatment option for an individual struggling with anxiety.