Overview of Dialectical Behavior Therapy (DBT)
For most people, an average day contains at least one thing that is upsetting. Cars cut us off in traffic during the morning commute, friends break lunch plans with us, pets disobey us, and children argue. Any of these situations is bound to cause at least a little discomfort and/or upset. But for some people, these situations are absolutely intolerable.
These people have extreme emotional responses to common stimuli. Where another person might feel mild sadness or anger, these individuals are overcome with distress. The feeling comes on strong, and it lasts for a very long time. Psych Central suggests that this trait is often found in people who have borderline personality disorder (BPD), and people like this may not succeed in traditional forms of therapy.
Thankfully, there is a form of therapy that was designed to meet the needs of people with BPD, and since its development, it has been used as a tool to fight a number of other mental health concerns, too. The therapy is known as Dialectical Behavior Therapy (DBT).
In a traditional treatment program for a mental health concern, the person in therapy works with a mental health professional who encourages questioning and challenges. In essence, the person in therapy is confronted with the idea that the thoughts and behaviors that stand behind the mental illness are somehow incorrect or untrue, and that changing those thoughts and behaviors could make life a whole lot better.
Many people who enroll in programs like this seem willing to accept the somewhat confrontational nature of therapy in order to reap the rewards that come with healing. But, for people with BPD, that confrontation can be really distressing. These people need to feel accepted, supported, and even loved in order to benefit from therapy. Any confrontation sends them into emotional chaos.
The National Alliance on Mental Illness reports that DBT practitioners emphasize validation in their work.
Rather than pushing people to confront their thoughts or label them as “bad” or “dysfunctional,” DBT practitioners encourage coming to terms with those thoughts and accepting them for what they are.
These clinicians try to help people accept themselves, so they may be able to make slow and gradual changes that lead to big behavior changes. There is no direct confrontation or emotional outburst involved.
DBT clinicians may also work to form close relationships with the clients they serve. They may work to boost feelings of connection and understanding with their clients through anecdotes, personal stories, and the appropriate use of touch. Some sessions might even seem like elaborate getting-to-know-you chats between a clinician and a client. The idea here is to help people with BPD understand that they are in a safe and accepting environment, so they can really open up and not worry about judgment. For some people with BPD, relationships have always been problematic. The close tie these people form with a therapist may work as the first or only positive relationship these people have ever had, and it could work as a template for future positive relationships, too.
Since DBT is focused on loving acceptance and a slow and steady pace, it does not progress as quickly as other forms of therapy. Some people stay in DBT therapy for several months, and the lessons they learn in DBT could have a deep impact on the way they address all sorts of life issues.
The Linehan Institute suggests that there are four sets of behavioral skills taught as part of DBT. They include:
- Emotional regulation, or the ability to change emotions that are distressing or overwhelming
- Interpersonal effectiveness, or the ability to ask for something that’s required and maintain relationships with others
- Tolerance of distress, or the capability of accepting pain in difficult situations, without moving to remove or address that discomfort
- Mindfulness, or the practice of being present in the moment as it unfolds
Some of these DBT lessons are taught in one-on-one therapy sessions with a trained professional, but some people benefit from group sessions with others who also struggle with their mental health. Some people have DBT homework to complete between their lessons, so they can solidify their skills in real time in real-life situations.
DBT for BPD
For people with BPD, this form of therapy can be truly revolutionary. As mentioned, these people may have years of struggles behind them, in terms of forming healthy and appropriate relationships, and they may have abandoned other forms of therapy, as they found the techniques to be dismissive and/or cruel. With DBT, they may finally feel accepted and safe, and that can help them to learn and change.
The skills taught in DBT are specifically designed to help people with BPD. Emotional regulation sessions can help them to deal with those big surges of emotion, while distress tolerance can help them to accept the fact that life can be unpleasant from time to time.
Without therapy, people with BPD tend to look for their own solutions, and that solution might involve suicide. Someone with BPD can feel isolated, attacked, and utterly alone, and someone like this might lean on death to make the pain stop.
DBT has been proven effective in reducing suicide risks in people with BPD. In one such study, published in JAMA Psychiatry, researchers found that people who had DBT were half as likely to make a suicide attempt than were people who did not get the therapy. This is a remarkable outcome, and it demonstrates why clinicians might lean on DBT for people with BPD.
Use in Addiction
People with BPD can, and often do, choose to self-medicate with substances of abuse. When they do, they can develop addictions that are complicated by the presence of that mental illness. These people can get better, but they might need specialized approaches to get there. DBT can work wonderfully well for people like this.
In one such study of effectiveness, published in Addiction Science and Clinical Practice, researchers found that people with addictions and BPD were much more likely to stay in treatment if they got DBT. Of those who got DBT, 64 percent stayed in care, while only 27 percent of people who did not get DBT stayed in care. The people who got DBT were much more likely to reduce their drug use, and they kept those gains at the 16-month follow-up mark. These are amazing changes, and they are available to people who have addictions without BPD, too.
Some of the lessons taught as part of the DBT package could be of great use to people who have a long history of addiction. For example, in a study of people enrolling in addiction care, published in the Journal of Global Drug Policy and Practice, researchers found that 58.3 percent of the families of people enrolling in care reported that the person they loved had difficulty in asking for help. These people clearly needed help in order to overcome the addiction, but they did not know whom to turn to. The interpersonal effectiveness module of DBT could be vital in helping people like this learn how to ask for assistance from others in a way that is polite, appropriate, and likely to be successful.
This back-to-basics approach could help people with addictions to simply feel better about everything happening with their bodies, and that could help them to avoid another trigger to use drugs.
Finally, DBT focuses on making small changes one step at a time. Rather than feeling as though they need to stop using all drugs for all time, right now, people can make a commitment to stop using drugs for the next five minutes. The goals are very short, and people take those goals as they happen, one day at a time.
This is a thinking that is pervasive in the 12-Step recovery movement, and some people with addictions find it quite helpful. Rather than worrying about how they can get through the next 10 years without even one hit of drugs, they can focus on the minutes that are right in front of them. Doing so could bring about very real and persistent changes down the line.
If DBT is part of the treatment program, people enrolling in care can do a little advanced work in order to prepare. Often, that work involves thinking about being open, honest, and realistic as therapy progresses. The more people share, even if it seems unpleasant, the more they might benefit. Any advanced work people can do to open their minds and hearts before therapy is bound to be beneficial when the treatments begin.