Dialectical behavior therapy

Dialectical behavioral therapy (DBT) is a psychological method developed by Marsha M. Linehan to treat patients with borderline personality disorder. (BPD) Research indicates its' application to also be effective in treating patients who represent varied symptoms and behaviors associated with spectrum mood disorders, including self-injury. Key elements DBT practitioners emphasize include, behaviorist theory, dialectics, cognitive therapy, and, DBT's central component, mindfulness.

There are two essential parts of the treatment, and without either of these parts the therapy is not considered "DBT adherent."

1. An individual component in which the therapist and client discuss issues that come up during the week, recorded on diary cards and follow a treatment target hierarchy. Self-injurious and suicidal behaviors take first priority, followed by therapy interfering behaviors. Then there are quality of life issues and finally working towards improving one's life generally. During the individual therapy, the therapist and client work towards improving skill use. Often, skills group is discussed and obstacles to acting skillfully are addressed.
2. The group, which ordinarily meets once weekly for two to two-and-a-half hours, learns to use specific skills that are broken down into four modules: core mindfulness skills, emotion regulation skills, interpersonal effectiveness skills and distress tolerance skills.

The four modules

Mindfulness

The essential part of all skills taught in skills group are the core mindfulness skills. Mindfulness is derived from the Zen tradition and can be studied in Zen literature.

Interpersonal effectiveness

Interpersonal response patterns taught in DBT skills training are very similar to those taught in many assertiveness and interpersonal problem-solving classes. They include effective strategies for asking for what one needs, saying no, and coping with interpersonal conflict.

Individuals with borderline personality disorder frequently possess good interpersonal skills in a general sense. The problems arise in the application of these skills to specific situations. An individual may be able to describe effective behavioral sequences when discussing another person encountering a problematic situation, but may be completely incapable of generating or carrying out a similar behavioral sequence when analyzing his or her own situation.

This module focuses on situations where the objective is to change something (e.g., requesting someone to do something) or to resist changes someone else is trying to make (e.g., saying no). The skills taught are intended to maximize the chances that a person’s goals in a specific situation will be met, while at the same time not damaging either the relationship or the person’s self-respect.

Distress tolerance

Most approaches to mental health treatment focus on changing distressing events and circumstances. They have paid little attention to accepting, finding meaning for, and tolerating distress. This task has generally been tackled by religious and spiritual communities and leaders. Dialectical behavioral therapy emphasizes learning to bear pain skillfully.

Distress tolerance skills constitute a natural development from mindfulness skills. They have to do with the ability to accept, in a non-evaluative and nonjudgmental fashion, both oneself and the current situation. Although the stance advocated here is a nonjudgmental one, this does not mean that it is one of approval: acceptance of reality is not approval of reality.

Distress tolerance behaviors are concerned with tolerating and surviving crises and with accepting life as it is in the moment. Four sets of crisis survival strategies are taught: distracting, self-soothing, improving the moment, and thinking of pros and cons. Acceptance skills include radical acceptance, turning the mind toward acceptance, and willingness versus willfulness.

Emotion regulation

Individuals with borderline personality disorder and suicidal individuals are frequently emotionally intense and labile. They can be angry, intensely frustrated, depressed, or anxious. This suggests that these clients might benefit from help in learning to regulate their emotions. Dialectical behavioral therapy skills for emotion regulation include:

• Identifying and labeling emotions
• Identifying obstacles to changing emotions
• Reducing vulnerability to emotion mind
• Increasing positive emotional events
• Increasing mindfulness to current emotions
• Taking opposite action
• Applying distress tolerance techniques

== This is just a small correction, but there is no such thing as a plural behavior i.e. behaviors. (Journal of Applied Behavior Analysis) ==

Books

• The Miracle of Mindfulness by Thich Nhat Hanh ISBN 0-8070-1239-4
• Skills Training Manual for Treating Borderline Personality Disorder by Marsha M. Linehan ISBN 0-89862-034-1
• Cognitive Behavioral Treatment of Borderline Personality Disorder by Marsha M. Linehan, 1993
• Fatal Flaws: An Introduction to Disorder of Personality and Character by Stuart C. Yudovsky

See also

• Cognitive therapy
• Cognitive behavioral therapy
• Rational emotive behavior therapy
• Nonviolent Communication
• Marsha M. Linehan
• Aaron Beck
• Albert Ellis
• Marshall Rosenberg
• Emotional dysregulation
• Borderline personality disorder
• Behavior Therapy

External links

• An Overview of Dialectical Behaviour Therapy - Psychiatry Online
• National Institute of Mental Health (NIMH) Home Page*