Dialectical Behavior Therapy (DBT)
Marsha Linehan (1991) is the pioneer of Dialectical
Behavior Therapy (DBT), DBTstresses the idea that psychosocial
treatment is as important as traditional psychotherapy and pharmacotherapy.
Concomitant with this belief is the importance of establishing
a hierarchical structure of treatment goals: 1) Reducing parasuicidal
(self-injuring) and suicidal behaviors, 2) Reducing behavior
that interferes with therapy and the treatment process, 3)
Reducing behaviors that negatively impact one's quality of
life, and 4) Secondary targets which lead to primary target
behaviors (e.g., emotional dysregulation, active passivity,
apparent competence, crisis generating behavior, inhibited
grieving). Dr. Linehan published the results of her study in
1991, and the clients involved in the treatment study proved
to do remarkably well at achieving these goals.
Dialectical
Behavior Theory
Basically, DBT maintains that some people, due
to invalidating environments during upbringing and due to biological
factors as yet unknown, react abnormally to emotional stimulation.
Their level of arousal goes up much more quickly, peaks at
a higher level, and takes more time to return to baseline.
This explains why some individuals experience crisis-strewn
lives and extreme emotional lability (emotions that shift rapidly).
Because of past invalidation, some individuals have not learned
methods for coping with such sudden, intense surges of emotion.
DBT is a therapeutic model of teaching coping skills which
have been proven to greatly reduce pain and suffering, and
crisis in one's life.
How DBT Model Works
DBT consists of two crucial components:
1. Weekly therapy sessions in which a particular
problematic behavior or event from the past week is explored
in detail, beginning with the chain of events leading up to it,
going through alternative solutions that might have been used,
and examining what kept the client from using more adaptive solutions
to the problem:
Both between and during sessions, the therapist
actively coaches and reinforces adaptive behaviors, especially
as they occur within the therapeutic relationship. . . the emphasis
is on coaching patients how to manage emotional trauma rather
than reducing or taking them out of crises. . . . Phone coaching
with the individual therapist between sessions is part of DBT
procedures (Linehan, 1991).
DBT targets behaviors in the following descending hierarchy:
* decreasing high-risk parasuicidal (self injury) and suicidal
behaviors
* decreasing responses or behaviors (by either therapist or
patient) that interfere with therapy
* decreasing behaviors that interfere with/reduce quality of
life
* decreasing and dealing with post-traumatic stress responses
* enhancing respect for self
* acquisition of the behavioral skills taught in group
* additional goals set by patient
2. Weekly group therapy [or an additional weekly session for
individual skills coaching] in which the following Core DBT
Skills are taught (you may click on any of the skills to download
a PDF file courtesy of Dr. Linehan):
1) MINDFULNESS (pdf)
2) EMOTIONAL REGULATION (pdf)
3) DISTRESS TOLERANCE /
REALITY ACCEPTANCE (pdf)
4) INTERPERSONAL
EFFECTIVENESS (pdf)
Note: Group therapists are not available over
the phone between sessions; instead, they are trained to refer
clients in crisis back to the clients' individual therapist.
