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How Dialectical Behavior Therapy (DBT) Works + Benefits

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DBT therapy - Dr. Axe

If you’ve reached out to a therapist for help dealing with difficult emotions, there’s a chance that dialectical behavior therapy (DBT) may be recommended.

What is DBT used to treat? DBT therapy was originally introduced in the 1980s as a form of psychotherapy suited best for people with borderline personality disorder, which is characterized by intense and difficult emotions, mood instability, and a distorted view of oneself.

People with borderline personality disorder often struggle with feelings of worthlessness, insecurity, depression, impulsivity and stressful relationships.

As DBT has gained more attention — and has been shown in many studies to improve self-esteem, emotional control and coping skills when faced with stress — it’s been adapted to treat other mental health conditions, such as bipolar disorder, substance abuse and suicidal behaviors.

What Is Dialectical Behavior Therapy?

What does DBT mean? It stands for dialectical behavior therapy, which is a type of psychotherapy in which people learn to manage negative emotions and conflicts.

“Dialectical” means “relating to the logical discussion of opposing ideas and opinions.” In other words, dialectical behavior therapy involves conversations about contradicting beliefs.

The underlying notion of DBT is that two opposing ideas can both be true at the same time, meaning there are different ways to view any situation.

During DBT sessions, patients and therapists discuss how the patient is feeling and what types of thoughts the patient is having that are contributing to behaviors and problems. Then, the discussion turns to looking at different perspectives.

The goal isn’t to completely change someone’s point of view, but to open the person up to the idea that there’s both positive and negative aspects associated with every person and every life event. This mindset is helpful for getting unstuck from extreme moods and also brings more balance into people’s lives.

DBT Focus and Techniques

DBT therapy is simultaneously about both acceptance and change. Self-acceptance is a big component, since this is the basis of positive behavioral change.

What are the four focuses of DBT?

Dialectical behavior therapy focuses on four key areas:

1. Mindfulness and Acceptance

The first step is gaining self-awareness about the present situation and then working on acceptance. This can include acceptance of oneself, others in one’s life and the current circumstances.

The idea is that a problem cannot be solved until it is first accepted. This step combined with the next one requires someone to acknowledge and feel feelings, rather than denying or escaping them.

2. Distress Tolerance

The second step is all about improving how one handles difficulties and negative feelings, including stress, anger, sadness, disappointment, hurt and so on. This is done with help from stress-relieving techniques, such as mind-body practices like deep breathing, journaling, etc., that are useful for calming down racing thoughts and physical tension.

While getting rid of all stress isn’t realistic, it’s possible to learn to cope better with stress and still be productive despite it.

3. Emotion Regulation

Next, the goal is to learn to adjust one’s emotions that are disrupting the patient’s life. A focus here is on broadening one’s perspective and also avoiding black and white thinking (also called “all-or-nothing thinking”), instead staying open to different points of view.

One way to remain open to new opinions and possibilities is to replace the word BUT with AND, such as: “This conversation is tough AND helpful.”

4. Interpersonal Effectiveness

This step involves learning communication techniques that help improve and strengthen relationships, rather than escalating conflicts.

What’s the difference between CBT and DBT?

CBT, which stands for cognitive behavioral therapy, is one of the most popular types of psychotherapy. It’s used to help treat anxiety, depression, substance abuse and many other mental health problems.

DBT is actually one form of CBT. The main difference is that with DBT there’s more emphasis on acceptance strategies and self-acceptance before trying to change behaviors.

DBT essentially adds on another layer to CBT: the need for self-validation and accepting oneself just the way he or she is. While behavioral change is one goal of DBT (just like CBT), acceptance needs to happen first in order to stabilize one’s extreme emotions/moods.

How and When It Works

Today, DBT is used to help treat those with:

  • Borderline personality disorder
  • Bipolar disorder
  • Depression
  • Anxiety disorders
  • Eating disorders, including bulimia and binge eating
  • Post traumatic stress disorder (PTSD)
  • Substance abuse disorders, which commonly occur with other mental health issues
  • Suicidal thoughts and behaviors

In many cases, if someone works with a DBT therapist that person will attend both individual therapy sessions and group therapy sessions. DBT skills are practiced one-on-one between a therapist and client, as well as with a group setting that helps participants learn how to communicate effectively.

Homework and phone calls between sessions are also commonly involved.

In terms of how long it takes to see progress, most people require at least six months of regular outpatient therapy to see substantial improvements in their moods and quality of life. If someone attends an inpatient program, about five to six weeks is enough time to benefit considerably.

Consistency is very important, meaning attending regular weekly meetings and sessions, since this helps build skills most effectively.

Benefits

According to psychotherapists, DBT therapy offers patients some of the following benefits:

  • Builds self-esteem and self-trust.
  • Decreases emotional volatility (such as extreme mood swings).
  • Improves coping skills in difficult situations, such as by lowering one’s “fight or flight” stress response and physical arousal.
  • Reduces conflict in relationships by improving communication and respect, even when people need to assert themself.
  • May help decrease substance abuse and suicidal thoughts.

How to Do It (Plus Other Considerations)

If you want to start using DBT to improve your mental health and outlook, it’s best to first work with a licensed and trained mental health professional, such as a psychologist, psychotherapist or social worker.

Look for a therapist who has been trained specifically in DBT, since this type of therapy requires certain skills. You also need to feel connected with the therapist and trust him or her.

A comfortable and trusting client-patient relationship is very important for DBT, so be sure to work with someone whom you feel you can open up to and who sees you in the best light possible.

Can you practice DBT on your own at home?

Yes. Much like with CBT, you can use DBT techniques on your own to change your mindset, improve your outlook on life, and gain skills that help you deal with stress and conflict.

Here are some ways to focus on both acceptance and change (the basis of DBT) and go about building your tolerance to stress:

  • Guided meditation, which helps you learn to acknowledge and accept the present moment. Meditation is all about observing what’s happening both inside and outside of yourself, experiencing sensations in your body that are tied to emotions, and allowing your thoughts and feelings to come and go instead of judging or fighting them.
  • Journaling about what you can and can’t change. This helps you recognize that some things are just out of your control and not worth stressing over, but you do usually have some choices (including how you react in any situation).
  • Cold temperature exposure, such as cold showers, splashing your face with cold water or holding ice cubes in your hand. This gives you something physical to focus on when your mind is racing and can give you a shot of adrenaline, which lifts your mood.
  • Intense exercise, which releases “feel good”chemicals, including endorphins. Yoga can also be helpful if you find gentler exercises to be a better fit for you.
  • Deep breathing exercises, such as diaphragmatic breathing or box breathing. (Breathe in for four seconds and out for six to eight seconds.)
  • Progressive muscle relaxation (similar to body scan meditations), in which you release tense muscles throughout your body.
  • Visualization, in which you picture yourself somewhere calm doing something relaxing.
  • Taking care of your body, including by sleeping enough, eating a healthy diet, taking any medications that you’ve been prescribed and avoiding mood-altering drugs (like alcohol and others) that can lead to anxiety and depression.

Risks and Side Effects

Like any other type of therapy, DBT is not guaranteed to help everyone. It’s generally not recommended for individuals with intellectual disabilities or uncontrolled schizophrenia.

For those who have experienced trauma, such as people with PTSD, it’s recommended that DBT be combined with other treatment approaches that involve trauma processing. If substance abuse is an issue, other techniques might also be used to help the patient deal with withdrawal symptoms.

The best way to know if DBT therapy can be helpful for you is to contact a therapist who is trained in DBT. The therapist can evaluate your situation.

Remember to discuss any medications you’re taking or have been prescribed with your therapist, and never stop taking prescribed medications without guidance, since this can alter your mood and potentially lead to issues, such as depression.

Conclusion

  • DBT stands for dialectical behavior therapy, which is a type of psychotherapy in which people learn to manage negative emotions and conflicts.
  • DBT therapy was first created for people with borderline personality disorder but is now used to help treat many issues, such as depression, anxiety, substance abuse and PTSD.
  • There are four focuses in DBT: acceptance of the present moment, distress tolerance, emotional regulation and respectful communication with others.
  • Benefits of this type of therapy include improving self-esteem, self-reliance, relationships, communications skills, and the ability to function even when stressed or upset.

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