Peter (not his real name) once asked me: “Do you think that DBT is a modern cure for today’s psychological problems?” In a typical therapist reaction I responded that his concern was valid. I further mentioned that there are several schools of thought in psychology that assist people to get better and function more adequately.
“Well” sounding very hesitant, “then what is the point of DBT, if it is like any other therapy?” Peter had a point which brings me to the aim of this blog.
Dialectical Behaviour Therapy or DBT as it is commonly known is an evidence based therapy that has shown to be extraordinarily successful in treating a variety of psychiatric and psychological conditions. These conditions range from depression or mood disorders, anxiety, eating disorders, self-harm and suicide, ADHD, borderline personaltiy disorder and bipolar mood disorder.
DBT was developed in the early ‘90s by Marsha Linehan. It was initially developed for people with borderline personality disorder. Suicide and self-harm are often features of the disorder…
DBT is based on the premise of a pendulum – oscillating between two opposite truths or opposing views where each side has some form of truth. An example would be when two people look at an object. They look at the same object but describe it differently based on their perspectives etc. Another example would be suicide ideation in which a person oscillates between wanting to die but at the same time wanting to live. This leads to conflict which ultimately leads to change. DBT advocates that change is possible within the realm of acceptance.
The efficacy of DBT is not only due to it being evidence based, but due to the fact that it is quite comprehensive and intensive. DBT has two facets – that of individual therapy and group skills program. During individual therapy issues are dealt with and worked through while skills are cemented. In a way individual therapy guide the person to be more aware of dysfunctional behaviour and thought patterns.
Group skills is not similar to group therapy. In group skills program there is a greater emphasis teaching skills. There are four Core Skills in DBT:
1. Mindfulness – this skill, or rather these skills are central to DBT. It is like a runway at an airport. If there is no runway, planes cannot land or take off… Being mindful means being more aware and more present. It can also be described as a guard that is on duty – alert, awake and aware…
2. Interpersonal Effectiveness Skills – the focus with these skills is to improve on current interpersonal skills in terms of obtaining objectives while maintaining relationships and self-respect. The skills further focus on developing and maintaining important relationships.
3. Emotional Regulation Skills – painful emotions are often difficult to regulate and often we want to get rid ofthese painful emotions. Dysfunctional behaviours, such as suicide, self-harm, substance abuse, eating disorders, over-control, interpersonal mayhem, etc are often behavioural solutions to these extremely painful emotions. Emotional regulation skills teaches one how to effectively deal with these emotions.
4. Distress Tolerance – so often in therapy we as psychologists focus on changing distressing events and circumstances. This however is not always possible. I often say to clients who want to change their current jobs due to a rude or obnoxious manager, that with the next job the manager may even be worse!!! The distress tolerance skills focus on finding meaning and accepting the situation as it is. It further focuses on being able to tolerate the distressing emotions. Pain and distress are part of life. Accepting it leads to decreased pain and suffering, and furthermore leads to change – the ultimate goal of DBT.
The efficacy in DBT is also found in the homework that coincides with the skills group. Members are given certain tasks pertaining to the weeks topic to practice at home. This ensures that the skills are well consolidated and solidified. Homework, or as we like to call it – self-help tasks – is not always comfortable, but if done consistently the reward is growth and dealing with issues more effectively.
Furthermore it needs to be emphasised that DBT is not a one-size-fits-all or be-all-and-end-all type of therapy, but it is extremely effective.
DBT has a motto, and with this I end:
Build a life worth living!