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Reviewing DBT

Reviewing DBT

Dialectical Behavioral Therapy is a cognitive form of treatment originally designed for parasuicidal patients

DBT is one form of Cognitive Behavioral Therapy (CBT) that is commonly used to treat borderline personality disorder, a mental disorder that causes extreme mood instability. The development of Dialectical Behavioral Therapy (DBT) started with psychologist Marsha Linehan’s desire to treat women suffering from emotional inclinations towards self-harm. What she eventually developed was a system of cognitive intervention that focused particularly on parasuicidal therapy. Though initially it seems that the therapy format led patients to feel misunderstood and therefore abandon treatment, further research and development have stabilized her techniques. One of the main improvements of the therapy has been to promote a sense of acceptance for and from the patient.

According to the National Alliance on Mental Illness, “The core principles of CBT are identifying negative or false beliefs and testing or restructuring them.” First developed in the 1980s, over time DBT has done just that. In more recent years it saw wider use, proving successful also in treating abuse disorders. DBT is closely related to other forms of cognitive therapy, but nonetheless has its own unique techniques and characteristics.

How it Works – Principal Functions of DBT

Instead of following one simple treatment method, DBT is characterized as a program of treatment, with cooperation of individual, group, and professional team therapy and network consultations. This form of application is extremely involved, hence some clinicians shy away in fear that it will require a regimen too complicated to follow.

There are five main functions of DBT treatment. The first two are often described as enhancing and generalizing capabilities. According to this function therapists and patients need to approach therapy with the acknowledgement that life skills are initially sorely lacking. This may be evident in an inability to regulate emotions, pay due attention or put one’s mind into his or her surroundings, tolerate distressing situations, or effectively maneuver interpersonal interaction. Generalizing capabilities aims to ensure that the treatment is successfully applied outside of the treatment sessions. The generalizations are made to link treatment methods to each individual’s circumstances and attitudes. Therapists are often available throughout the week by phone so that patients can call for help if needed.

Improving motivation to reduce nonproductive behaviors and enhancing and maintaining therapist motivation and capabilities are the third and fourth function points of standard DBT. The patient is helped to combat thoughts and actions that devalue life. First, patients are given diary cards to help the therapist interpret which behaviors need to be focused on. The therapist can then help the patient to examine what led to each behavior. Consequences are also analyzed. Reasons for commitment to more positive behavior are developed as a team, and the patient is sent home with practical suggestions and motivation to make better future decisions.

DBT frequently employs weekly group sessions where patients interact in real or virtual problematic settings and discuss new skills gained in their individual lives. Homework assignments are often given to help patients practice skills throughout the week from session to session.

It is extremely important that therapists also keep a high level of motivation throughout a therapy program. Especially when rewards seem to be low, the stamina and commitment of even the best of therapists can be tried. Therapists must receive support and continued feedback to build skills and determination. Therapists participating in DBT meet in teams every week for one or two hours. Team meetings encourage therapists to adapt to their specific difficulties with compassion and professional skill.

The final function of DBT theory is to structure the patient’s environment. The environment must be remodeled to encourage progressive positivism rather than facilitate pitfall. For abuse disorder patients this can be especially important. Often substance abusers need to be consistently encouraged to rid themselves of access to their drugs and to associations that will continue to put them into contact with temptation. If the environment is too triggering for a patient to control in his or her condition, the therapist may actually take practical action to implement changes for the patient.

Treating Emotional and Substance Abuse Disorders

Commonly, DBT therapy is used to treat women with BPD, or borderline personality disorder. Patients suffering from this disorder are often considered either genetically programmed or environmentally shaped for a chronically confusing emotional status, and commonly have extreme problems maintaining productive thinking.

They may be overly sensitive to others’ comments or facial expressions, prone to reckless behavior, and experience unsettling interpersonal relationships as a result. Emotion vulnerability causes intense reactions to come from minimal stimuli, and there is a lack of development of successful coping or problem solving ability. Anxiety, depression and suicidal thoughts run strongly among BPD sufferers. DBT uses emotion regulation to set healthy patterns into cognitive response. Because of the positive emotional impact of the therapy, it is often also applied in trauma situations.

Another large patient group shows consistent benefit from DBT— substance abuse disorder patients. In fact studies show that over a 12 month treatment period with a 16 month follow up exam, women who coupled opiate abuse treatment with this form of cognitive therapy had greater abstinence results than those who followed other simplified cognitive training programs.

Please call our toll-free helpline if you have any questions or concerns about DBT. There is a wide array of addiction and emotional disorder help available; take advantage of the positive benefits today!

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