Skip to main content
Tag

DBT Archives - Suzanne Wallach

Norman
In DBT

Is DBT Good For Complex Trauma?

Trauma

The Centers for Disease Control and Prevention (CDC), describes trauma as “an event, or series of events, that causes moderate to severe stress reactions… [that are] characterized by a sense of horror, helplessness, serious injury, or the threat of serious injury or death.” Post-traumatic stress disorder (PTSD) is listed in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). It is defined by the Mayo Clinic as “a mental health condition that’s triggered by a terrifying event—either experiencing it or witnessing it.” Unlike PTSD that is caused by a single traumatic event or isolated incidents, complex trauma refers to a series of traumatic events that take place over time. Many symptoms of complex trauma overlap with symptoms of PTSD, some of which include:

  • Anxiousness
  • Flashbacks
  • Avoiding circumstances that are reminders of traumatic events
  • Distorted sense of self
  • Difficulty controlling emotions
  • Relationships challenges

Somatic symptoms (e.g., fatigue, nausea, diarrhea, constipation, joint or muscle pain, headaches, etc.) are also common with complex trauma. More than an estimated 3% of people in America meet the criteria for complex trauma. If complex trauma is left untreated, its symptoms can be pervasively disruptive and interfere with one’s ability to function in his or her daily life.

Dialectical Behavior Therapy

Psychologist Marsha M. Linehan developed dialectical behavior therapy (DBT) in the late 1980s as a means to more effectively treat chronically suicidal individuals diagnosed with borderline personality disorder (BPD). It is founded on the principals of cognitive behavioral therapy (CBT), utilizing standard CBT techniques for emotional regulation and reality testing, and combines concepts derived from Buddhist meditative practice such as awareness, mindfulness, and attentiveness to current situations and emotional experiences.

Psychology Today emphasizes the notion that complex trauma requires multifaceted and sequenced treatment, which involves different components that target the various symptoms that present on the road to recovery. According to the U.S. Department of Veterans Affairs, due to the fact that DBT does not necessarily involve any form of trauma processing, it is not and should not be considered a stand-alone treatment for trauma. However, some studies do indicate that DBT can be used to effectively treat the symptoms of complex trauma. DBT remains the only empirically supported treatment for BPD, and current evidence also recognizes DBT as an applicable and effective treatment method for many other mental health conditions.

Treatment In Calabasas

Calabasas is a city in California. It is a well-known suburb of Los Angeles, located west of the San Fernando Valley and north of the Santa Monica Mountains. Over the past decade, the city of Calabasas has grown in its reputation for luxury as well as for privacy which makes it a hidden gem for residential living for society’s elite, and one of the most desirable destinations in Los Angeles County. It is also home to a plethora of highly qualified mental health clinicians providing an array of therapeutic services and treatment options.

The information above is provided for the use of informational purposes only. The above content is not to be substituted for professional advice, diagnosis, or treatment, as in no way is it intended as an attempt to practice medicine, give specific medical advice, including, without limitation, advice concerning the topic of mental health. As such, please do not use any material provided above to disregard professional advice or delay seeking treatment.

Norman
In DBT

What Type Of Behavior Is The Highest And First Priority Of DBT?

Dialectical behavior therapy

Dialectical behavior therapy (DBT) is an evidence-based psychotherapy treatment that was originally developed by Psychologist Marsha M. Linehan, in the late 1980s, to help better treat chronically suicidal individuals diagnosed with borderline personality disorder (BPD). It is founded on the principals of cognitive behavioral therapy (CBT), but places greater emphasis on the psychosocial aspects of treatment. DBT remains the gold-standard form of treatment for individuals with BPD and according to the National Alliance on Mental Illness (NAMI), has since been recognized as an effective method of treatment for a wide range of other mental health disorders, such as depression, anxiety, post-traumatic stress disorder (PTSD), substance use disorder (SUD), eating disorders, and more. As explained by Behavioral Tech, DBT focuses on teaching four sets or modules of behavioral skills, which include:

  • Core mindfulness: the practice of being completely present and aware in any given moment
  • Distress tolerance: increasing an individual’s tolerance of negative emotions as opposed to attempting to avoid or escape them
  • Emotion regulation: decreasing emotional impulsivity, learning to manage and shift intense, problematic emotions
  • Interpersonal effectiveness: authentically advocating for one’s own wants and needs in a relationship in a way that is both self-respecting and non-damaging

The therapeutic approach is comprised of three different therapy settings, including weekly individual psychotherapy sessions, weekly DBT skills training group therapy sessions, and as-needed phone coaching to provide additional support between the weekly individual and group sessions.

DBT Treatment Targets

DBT relies on a hierarchy of treatment targets to help the therapist determine the order in which problems should be addressed. The first and highest priority target behavior is any life-threatening behaviors, (e.g., suicide communications, suicidal ideation, and all forms of suicidal, non-suicidal self-injury, etc.). The subsequent treatment targets, in order of priority, according to the University of Washington, are:

  1. Therapy-interfering behaviors: This includes any behavior by the client and/ or therapist that interferes with the client receiving effective treatment (e.g., arriving late to sessions, cancelling appointments, etc.).
  2. Quality of life behaviors: This category includes any other type of behavior that interferes with clients having a reasonable quality of life (e.g., disorders, relationship problems, financial or housing crises, etc.).
  3. Skills acquisition: This refers to the need for clients to learn new skillful behaviors to replace ineffective behaviors and help them achieve their goals.

Clients who receive DBT typically have multiple problems that require treatment, which is why the hierarchy of treatment targets is so deeply embedded in the DBT framework.

Treatment In Calabasas

Calabasas is a city in California. It is a well-known suburb of Los Angeles, located west of the San Fernando Valley and north of the Santa Monica Mountains. Over the past decade, the city of Calabasas has grown in its reputation for luxury as well as for privacy which makes it a hidden gem for residential living for society’s elite, and one of the most desirable destinations in Los Angeles County. It is also home to a plethora of highly qualified mental health clinicians providing an array of therapeutic services and treatment options.

The information above is provided for the use of informational purposes only. The above content is not to be substituted for professional advice, diagnosis, or treatment, as in no way is it intended as an attempt to practice medicine, give specific medical advice, including, without limitation, advice concerning the topic of mental health. As such, please do not use any material provided above to disregard professional advice or delay seeking treatment.

Norman
In DBT

What Are The Limitations Of DBT?

dbt

Dialectical behavior therapy (DBT) is an evidence-based, rigidly structured form of psychotherapy. It was developed by psychologist Marsha M. Linehan in the late 1980s as a means to better treat individuals diagnosed with borderline personality disorder (BPD), suffering from chronic suicidal ideation. DBT combines techniques from western cognitive behavioral therapy (CBT), psycho-educational modules, and eastern mindfulness-based practices to foster the systematic learning of new emotional coping skills. It is carried out in three therapeutic settings, including weekly individual psychotherapy (one-on-one therapy) sessions; weekly DBT skills training group therapy sessions, and access to twenty-four-hour support between sessions via phone coaching. Dialectical behavior therapy focuses on teaching skills in four primary areas, which are known as the four modules of DBT. Each module highlights distinct and specific skills that build upon each other and are individually and collectively integral to the success of DBT. Nevertheless, as is true with any mental health intervention, DBT has its fair share of limitations, some of which include:

  • May be ineffective in treating trauma: According to the U.S. Department of Veterans Affairs, due to the fact that DBT does not necessarily involve any form of trauma processing, it is not and should not be considered a stand-alone treatment for trauma.
  • The format and duration of DBT may be a deterrent: The different layers of treatment required for DBT including the amount of time allocated to each of the four modules, the three different therapeutic settings, etc. may be perceived by some as overwhelming and discouraging. As a result, some individuals that could benefit greatly from dialectical behavior therapy view it as overly complex to the point that they are unwilling to try the treatment.
  • DBT is religiously integrated: The foundation of DBT is rooted in mindfulness practice based on Zen Buddhist teachings, therefore some clients (e.g., conservative or orthodox Jews, Christians, Muslims, etc.) may object to certain facets of DBT that are derived from eastern religious philosophies.
  • Large-scale research is lacking: Critics argue that additional research is required to determine if DBT works for those with varied or complex mental health concerns, as most of the available research on the efficacy of DBT includes small sample sizes and focuses on a specific sector of the mental health population.
  • The availability of comprehensive training for providers is insufficient: DBT relies on a detailed manual and demands an intensive amount of training to deliver the services as designed. In many of the research studies where DBT was found to be effective, the providers implementing the DBT treatment were doctoral-level students or higher, which the minimizes the availability of providers.

Treatment In Calabasas

Calabasas is a city in California. It is a well-known suburb of Los Angeles, located west of the San Fernando Valley and north of the Santa Monica Mountains. Over the past decade, the city of Calabasas has grown in its reputation for luxury as well as for privacy which makes it a hidden gem for residential living for society’s elite, and one of the most desirable destinations in Los Angeles County. It is also home to a plethora of highly qualified mental health clinicians providing an array of therapeutic services and treatment options.

The information above is provided for the use of informational purposes only. The above content is not to be substituted for professional advice, diagnosis, or treatment, as in no way is it intended as an attempt to practice medicine, give specific medical advice, including, without limitation, advice concerning the topic of mental health. As such, please do not use any material provided above to disregard professional advice or delay seeking treatment.

Rahul
In Anxiety, Eating Disorders

Can DBT Help With Anxiety?

anxiety-help

Anxiety is the body’s natural response to stress. Anxiety will manifest differently in different people. The feelings of anxiety can range from mild to severe. While fleeting anxiety is unavoidable, it is not healthy for an individual to experience persistent and debilitating symptoms of anxiety. An individual may be struggling with an anxiety disorder when pervasive anxiety interferes with his or her ability to function in daily life. The National Alliance on Mental Illness (NAMI) asserts: “Anxiety disorders are a group of related conditions, each having unique symptoms. However, all anxiety disorders have one thing in common: persistent, excessive fear or worry in situations that are not threatening.” There are currently five distinct types of anxiety disorders listed in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). They include the following: generalized anxiety disorder (GAD), obsessive-compulsive disorder (OCD), panic disorder, post-traumatic stress disorder (PTSD) and social anxiety disorder (social phobia). According to the American Psychiatric Association, close to thirty percent of adults in America struggle with an anxiety disorder at some point in their lives. 

Dialectical Behavior Therapy

Dialectical behavior therapy (DBT) is an evidence-based psychotherapy treatment that was originally developed by Marsha M. Linehan, in the late 1980s to more effectively treat chronically suicidal individuals diagnosed with borderline personality disorder (BPD). Since its inception, dialectical behavior therapy has been and remains the gold standard method of treatment for individuals diagnosed with BPD, and its efficacy has also expanded to other ailments. DBT is based on the cognitive behavioral therapy (CBT) approach that relies on talk therapy and emphasizes the psychosocial aspects of treatment. It utilizes a multifaceted approach that consists of weekly individual psychotherapy sessions, weekly DBT skills training group therapy sessions, and as-needed phone coaching between sessions. DBT strives to help individuals learn to identify triggers outside of themselves and pair those triggers with healthy responses and coping mechanisms. This is accomplished through focusing on and cultivating therapeutic skills in four main areas, known as the four modules, which are: 

  • Core mindfulness: focuses on improving an individual’s ability to accept and be present in the current moment
  1. 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
  2. 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
  3. Emotion regulation: focuses on decreasing emotional impulsivity by shifting intense emotion without reacting instinctively to them

An individual that suffers from debilitating anxiety will benefit most from a customized treatment plan. DBT offers both the ability to provide personalized therapeutic support through the individual therapy sessions, as well as peer support in DBT skills training group therapy sessions. Through DBT an individual can learn an array of effective coping mechanisms and anxiety management strategies that can help to prevent, reduce, and even become more resilient towards anxiety.

The information above is provided for the use of informational purposes only. The above content is not to be substituted for professional advice, diagnosis, or treatment, as in no way is it intended as an attempt to practice medicine, give specific medical advice, including, without limitation, advice concerning the topic of mental health. As such, please do not use any material provided above to disregard professional advice or delay seeking treatment.

Norman
In Eating Disorders

What Type Of Therapy Is Best For Eating Disorders?

woman receiving therapy for an eating disorder

Eating disorders are serious mental illnesses. They are characterized by abnormal, irregular eating habits, and an extreme concern with one’s body weight or shape. There are several different manifestations of eating disorders. The various types are listed in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) under the Disorder Class: Feeding and Eating Disorders. The three most common eating disorders are anorexia nervosa, bulimia nervosa and binge-eating disorder. Eating disorders can be debilitating and can adversely affect a person’s emotions, health, and interfere with one’s ability to adequately function in his or her daily life. If left untreated, eating disorders can result in severe short and long-term consequences. 

Every individual is different and will react distinctly to the array of therapeutic treatment modalities available. The treatment plan for an individual diagnosed with an eating disorder will be directly informed by several contributing factors, such as: the exact diagnosis, how long he or she has been actively engaging in unhealthy eating habits, his or her personal health history, and the presence of any co-morbid disorders. Some of the most frequently relied upon therapeutic treatment methods when treating eating disorders could include, but are not limited to cognitive behavioral therapy, dialectical behavior therapy, and interpersonal therapy.

Cognitive Behavioral Therapy

Cognitive behavioral therapy (CBT) works by addressing one’s thoughts. It holds the basic assumption that one’s thoughts govern one’s feelings, which in turn affects one’s behaviors. Through CBT an individual’s unhelpful cognitive distortions and behaviors are challenged and disrupted, essentially prohibiting one’s ability to maintain dysfunctional eating habits.

Dialectical Behavior Therapy

Dialectical Behavior Therapy (DBT) is recognized as an effective method of treatment for an individual diagnosed with an eating disorder. DBT can help an individual learn useful self-management skills, reduce stress, minimize anxiety, and learn to control destructive eating behaviors. DBT promotes acceptance and teaches individuals how to live in the present moment and cope with emotional triggers that may otherwise perpetuate unhealthy symptoms and behaviors associated with eating disorders. 

Interpersonal Therapy

Interpersonal therapy (IPT) a therapeutic modality that is most often used to treat individuals who suffer from psychiatric disorders such as anxiety disorders, eating disorders, depression, etc. Interpersonal therapy focuses on how a person’s communications and interactions with other people affect one’s own mental health. Through interpersonal therapy an individual will learn to resolve and adjust unhealthy interpersonal problems, resulting in a symptomatic recovery.

When posed with the question: What type of therapy is best for eating disorders? The answer is variable as there are countless factors that must be considered which make it is impossible to provide a definitive answer regarding the universal efficacy of any single type of therapy. In order to provide the most effective treatment, including a variety of different types of therapies into one’s treatment plan may be advantageous.

Disclaimer: 

The information above is provided for the use of informational purposes only. The above content is not to be substituted for professional advice, diagnosis, or treatment, as in no way is it intended as an attempt to practice medicine, give specific medical advice, including, without limitation, advice concerning the topic of mental health.  As such, please do not use any material provided above as a means to disregard professional advice or delay seeking treatment.

Close Menu
Back to top