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What Is DBT and Who Needs It?

| 05/19/2022

pursuer-distancer Illustration by Sara Wong

When we experience trouble with our mental health, we’re often met with a lack of balance in our lives. One thing that can get out of balance quickly is how our desire to change can fight our willingness to accept ourselves. It’s hard to find self-acceptance when your mind is telling you terrible things about who you are. And unfortunately, when we’re told that we need to take action to get better, we may find self-acceptance to be even more difficult. But that’s where DBT comes in.

What Is DBT?

You may have heard of cognitive-behavioral therapy (CBT), but dialectical behavior therapy (DBT) is essentially an offshoot of CBT. Although it was initially intended to help those with borderline personality disorder (BPD), studies show success with other mental health conditions, especially those with self-destructive behaviors, like eating disorders.

Originally, psychologist Marsha Lineham sought to create a form of treatment for suicidal women experiencing emotion-related difficulties by studying literature on psychosocial treatments for those conditions. However, Lineham ran into an issue because, when she tried to enact interventions based on her research, many patients dropped out of treatment altogether. The patients found Lineham’s methods were focused on changing behaviors so much that they felt invalidated and misunderstood. 

At its core, DBT is a form of treatment that’s all about finding balance.

Out of this issue, Lineham saw an opportunity to change how we treat mental health conditions. Instead of making the treatment focused on changing the individual, she began using interventions that help the patient feel accepted and learn to accept themselves and the world around them. It’s here where DBT was born out of a reliance on dialectical philosophy, where therapists strive to balance acceptance with strategies that help the patient grow and change. 

DBT became a resource for helping those with BPD. Standard treatment included weekly individual therapy sessions, a weekly group skills training session, and a therapist consultation team meeting. However, DBT’s structure can change as long as it follows some essential aspects.

What Is Included in DBT?

DBT may have to change to suit the patient’s needs, but every form of DBT treatment must consist of the five functions of treatment, biosocial theory, dialectical philosophy, and mindfulness. These aspects are unique to DBT, and a treatment without any of these characteristics wouldn’t be DBT. 

The first function is enhancing capabilities. Improving skills such as regulating emotions, navigating difficult interpersonal situations, and tolerating stress is a starting point for DBT. Those who go through DBT training, particularly those with BPD, often have trouble with these crucial skills. DBT gives them the building blocks to strengthen their abilities. In the second function, generalizing capabilities, patients learn to apply what they’ve developed to their daily lives. 

The third function, improving motivation and reducing dysfunctional behaviors, is especially crucial for those who experience behaviors that reduce their quality of life. The patient is asked to track their targets for treatment so that the therapist can focus on which behaviors stand in the way of reaching their goals. 

The fourth function, enhancing and maintaining therapist capabilities and motivation, is both for the therapist and for the patients they’re treating. An essential part of DBT is having a support network so therapists can most effectively and compassionately continue DBT treatment. This is where the therapist consultation team meeting comes in, as this meeting allows therapists to problem-solve together in the face of clinical challenges. 

In function five, the therapists structure their patients’ environment to promote progress and not allow them to fall into destructive behaviors. For instance, a therapist may encourage someone who abuses drugs to remove themselves from circles of friends where drug use is common.

By applying DBT’s teachings to everyday life, you’re creating an internal stability within yourself, helping you navigate whatever the world throws your way. 

Biosocial theory in BPD explains that those with the condition are biologically prone to emotional vulnerability. This is why DBT focuses so strongly on emotional regulation. Through the use of biosocial theory in DBT, patients learn behavioral skills to recognize, understand, and adapt their emotions. 

Dialectical philosophy is the groundwork on which DBT is based, as it plays a crucial role in helping the patients want to continue treatment. Essentially, dialectical philosophy strives to find a balance between two opposing forces: the patient’s need for change and their need to be accepted. The therapist must find that balance to encourage the patient to live a fulfilling life while respecting and loving themselves on their journey. This also ties into another essential feature of DBT, mindfulness. Through the use of mindfulness skills, the patient can feel more tied to the present and more willing to engage in acceptance of themselves, others, and the greater world.

How Can You Use DBT?

If you’re experiencing BPD or other mental health conditions that diminish your quality of life, you should speak to a therapist about undergoing treatment. DBT treatment is structured very regimentally because it relies not upon one form of intervention but multiple types that intertwine, such as a therapist needing a consultation team meeting after individual therapy sessions. Without one form of intervention, the other may not be as effective.

That said, even if you don’t have BPD, you can still benefit from many of DBT’s teachings. And one of the best places to start is with mindfulness. Mindfulness is a moment-by-moment awareness of our thoughts. Using mindfulness can help you reduce stress, manage depression, boost your self-image, strengthen your relationships, become a more empathetic person, and even improve your memory and attention span. There are many ways to build your mindfulness, but one place to start is by using breath-based meditations, where you focus on the sensation of your breath entering and leaving your body. Another common way to boost mindfulness is by practicing body scans. Acknowledge each part of your body, starting from your head and ending all the way at your toes. 

Another way to use DBT in your everyday life is to embrace radical acceptance. Although DBT focuses on accepting ourselves, it also strives to teach acceptance of the world around us. There are many things in this world that we simply cannot change. And radical acceptance is the ability to accept situations out of our control without judgment, helping to end our suffering over things we have no control over. Although mindfulness can help with radical acceptance, you can also focus on other relaxation techniques that help you feel calmer when you’re struggling to accept what’s happening. Negative thoughts play a significant role in fighting against acceptance, so another way to practice radical acceptance is by acknowledging those thoughts and coming up with strategies to counteract them, such as positive affirmations

At its core, DBT is a form of treatment that’s all about finding balance. You can find a balance between being an engaged member of society and not allowing societal woes to diminish your quality of life. You can find balance in how you accept yourself and your willingness to grow. And you can find balance in not judging others but creating a space for yourself free of potential triggers. By applying DBT’s teachings to everyday life, you’re creating an internal stability within yourself, helping you navigate whatever the world throws your way. 

 

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