Dialectical Behavioral Therapy Archives - Suzanne Wallach

Dialectical behavior therapy (DBT) 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. It is a rigidly structured, evidence-based psychotherapy that emphasizes the psychosocial aspect of treatment. It is comprised of three distinct therapeutic settings, which include: weekly individual psychotherapy sessions, weekly DBT skills training group therapy sessions, and as-needed phone coaching. 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. Dialectical behavior therapy focuses on teaching skills in four primary areas, also known as the four modules of DBT. Each module highlights specific skills that build upon each other and are individually and collectively integral to the success of DBT.

Module One: Core Mindfulness

The Oxford English Dictionary defines mindfulness as “a mental state achieved by focusing one’s awareness on the present moment, while calmly acknowledging and accepting one’s feelings, thoughts, and bodily sensations.” There have been studies that indicate that the tranquility effects of practicing mindfulness can be directly correlated to a reduction in one’s stress levels, which can subsequently have a positive effect on one’s immune system. Skills during this module help individuals learn to slow down and focus on mindfully acknowledging and experiencing emotions without reacting impulsively and/ or destructively. It teaches skills to help individuals avoid taking things personally, garner a better understanding of their emotions, become active listeners, and learn to sit with emotions instead of trying to ignore, expel, or dismiss them.

Module Two: Distress Tolerance

Distress tolerance is often conceptualized as “one’s ability to tolerate and withstand negative or uncomfortable emotional states.” Distress tolerance skills, also known as crisis survival skills, are short-term coping strategies intended to help manage emotional pain to avoid destructive behavior. Distress tolerance skills help an individual learn to acknowledge, process, and integrate emotions and situations in a way that is non-evaluative and nonjudgmental. The purpose of the distress tolerance modules is to bolster one’s ability to cope with feelings that do not have an immediately known resolution.

Module Three: Emotion Regulation

Emotion regulation can be explained as “the ability to exert control over one’s own emotional state.” The goals of this module are threefold: to understand one’s emotions, reduce emotional vulnerability, and decrease emotional suffering. The emotion regulation module focuses on skills that are aimed to help an individual learn to decrease the intensity of their emotions, sit with, and experience strong unwanted emotions, without impulsively acting on them.

Module Four: Interpersonal Effectiveness

The interpersonal effectiveness module is intended to teach people skills to navigate interpersonal problem solving, improve assertiveness, hone social skills to modify aversive environments, and to realize goals in interpersonal encounters. These skills involve helping individuals identify and understand their own needs in a relationship. Interpersonal effectiveness skills also help an individual learn to cultivate, engage, and maintain healthy relationships with others that enable one’s needs to be met. This includes advocating for one’s needs and communicating in way that is non-damaging, assertive, maintains self-respect, and strengthens relationships.

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.

Nowadays there are a variety of different types of therapy available for individuals in need. While many therapeutic methods can be utilized concurrently, certain therapeutic techniques can be especially beneficial for certain ailments. Any qualified mental health professional will be able to assist in deciding the best course of action regarding one’s therapy plan. Having a broad understanding of the similarities and differences of some of the therapeutic modalities that are frequently utilized in mental health treatment can be helpful for a client. Certain therapeutic methods have tangential methods that are widely used. For example, Psych Central indicates that dialectical behavioral therapy (DBT) is actually a form of cognitive behavioral therapy (CBT). 

Cognitive Behavioral Therapy

The American Psychological Association asserts that cognitive behavioral therapy (CBT) is a common form of psychological treatment. CBT can be an effective form of treatment for many health disorders, such as anxiety disorders, depression, Posttraumatic Stress Disorder (PTSD), phobias, eating disorders, obsessive-compulsive disorder (OCD), sleep disorders, bipolar disorders, substance use disorder, sexual disorders, and schizophrenia. It can also be helpful with managing situational emotional challenges. The Mayo Clinic provides various examples of these, which can include, but are not limited to, the following:

• Overcoming emotional trauma related to abuse and/ or violence
• Resolving relationship conflicts
• Coping with grief and/ or loss
• Coping with a medical illness
• Managing chronic physical symptoms

Cognitive behavioral therapy uses tools to help teach healthy coping mechanisms for regulating emotional challenges. It focuses on helping people learn how thoughts affect feelings and behaviors. In shifting one’s thought patterns, an individual is more capable of releasing negative feelings and breaking unhealthy behavioral patterns. One of the goals of CBT is to help a client learn techniques to enable them to be their own therapist. Through various exercises (conducted both in and out of therapy sessions) a client develops coping skills to learn to change his or her own problematic emotions, damaging thinking patterns, and unhelpful thoughts. Mental health clinicians that integrate CBT into their treatment plans generally practice talk therapy that is reliant upon several guiding features. 

Dialectical Behavioral Therapy

The term “dialectical” derives from the idea that combining two opposites in therapy (acceptance and change) yields better results than either would on its own, as is described by WebMD. DBT was created out of a need to help diagnose individuals with borderline personality disorder (BPD). While DBT is housed under the larger umbrella of CBT as a form of mental health treatment, this type of specialized treatment has been known to be highly effective in helping clients that struggle with self-harming behaviors. It is also commonly used to help treat individuals struggling with the following ailments:

• Sexual trauma survivors
• Borderline personality disorder
• Chronic suicidal ideations
• High risk and/ or difficult to treat patients

Dialectical behavioral therapy (DBT) is a type of CBT that is tailored towards helping a client acknowledge the pain and discomfort he or she feels, while being empowered to choose healthy behaviors instead of engaging in harmful actions to simultaneously allow him or herself to feel and move through the uncomfortable emotions. The following four components make up DBT:

• Individual therapy: focused on improving client motivation and helping clients apply and integrate skills learned to navigate specific life challenges.
• Group skills training: focused on improving and teaching healthy client behavioral skills, as well as provide a forum to practicing integrating the skills.
• If needed, distance/ phone coaching: in-the-moment coaching to assist in and provide crisis management support between sessions
• Consultation team: this component is solely for the mental health provider treating the client. A consultation team serves as support for the clinician in treating clients with severe, complex, and/ or challenging to treat disorders. 

In DBT there is some emphasis placed on dealing with and navigating thoughts, however the primary focus is placed on helping clients learn to identify triggers outside of themselves and pair those triggers with healthy responses and coping mechanisms. 

What’s Best for Me?

Every individual is complex with nuanced needs and will respond to different forms of treatment for mental illness uniquely. With the wide variety of therapeutic modalities available, certain types have been proven more effective for certain mental health ailments. For example, a therapy technique that works well for individuals struggling with depression and/ or anxiety may exacerbate an individual struggling with an eating disorder. CBT focuses on rationale and reasoning, DBT heavily relies upon mindfulness skills to assist in effectively regulating emotions. Both types of therapy techniques can yield successful results. The best way to figure out which type of therapy treatment is best is to consult a mental health professional. Any qualified mental health professional will consider all symptoms, health history, and goals of a client when recommending the best course of action regarding his or her treatment plan.