What is Dialectical Behavioral Therapy (DBT)?
Dialectical Behavioral Therapy (DBT) falls under the umbrella of Cognitive Behavior Therapy. It marries eastern philosophies and behavioral interventions. It is empirically based and has been proven to help individuals with difficult to treat depression, eating disorders, borderline personality disorder, dual diagnosis, those that self-injure, suicidality, substance abuse, anxiety, and PTSD with Prolonged Exposure to name a few. Both adolescents and adults respond well to this treatment. The treatment has been implemented in schools, juvenile detention centers, hospitals, residential centers, and out-patient clinics across the world. Individuals that experience intense emotion dysregulation and low tolerance for distress that gets in the way of functioning effectively would benefit from DBT. However, the implementation of DBT skills has helped high functioning individuals that struggle with a sense of emptiness, lack of connection, and intense emotional distress as well.
Comprehensive DBT is comprised of weekly individual psychotherapy, group skills training, phone coaching, and consultation team. Crisis management, individual goals, and application of skills are targeting during individual therapy. Group skills training is where you learn new skills to replace unhelpful behaviors and improve mental health. The group “chapters” covered are mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness. The aim is to improve self, emotional, interpersonal, cognitive, and behavioral dyscontrol depending on severity of the presenting problems. Phone coaching is not therapy over the phone but more of a “time out” to coach the individual on how to manage a situation in real time. This allows for generalization of skills to their day-to-day life, support when most needed, and improved therapeutic relationship. Consultation team is made up of DBT trained therapist that provide support, case consultation, uphold adherence to the protocol, and to decrease burn out of the therapist.
DBT is broken down by stages. We will assess the stage that you or your loved one would fall into during the assessment.
The DBT Stages and Targets goals are as follows:
Stage I: Severe Behavioral Dyscontrol Stability and Behavioral Control
Stage II: Quiet Desperation Normative Emotional Experiencing & Expression
Stage III: Problems in Living Ordinary Happiness and Unhappiness
Stage IV: Incompleteness Capacity for Sustained Joy
Stage I:
PRIMARY TARGET GOAL
Decrease: Life-threatening behaviors, Therapy-interfering behaviors and Quality-of-life interfering behaviors
Increase: Behavioral skills, Mindfulness, Interpersonal Effectiveness, Emotion Regulation, Distress Tolerance, and Self-Management.
SECONDARY TARGETS
Increasing awareness of, managing, and aiming to allow for the capacity of each of the following factors.
Emotional vulnerability and emotion dysregulation
Apparent competence and active passivity
Unrelenting crisis and inhibited grieving.
Stage II:
Intervention/Treatment
Emotional Experiencing & Expression
Mindfulness of current experience
Capacity for emotional experiencing
Engagement in meaningful activity
Capacity for emotional tolerance
Self-validation/acceptance
Other-validation/acceptance
Target/Goal
Quiet desperation normative
Intrusive experiences
Avoidance of emotions*
Avoidance of situations/experiences
Emotion dysregulation
Self-invalidation/Self-hatred
Other-invalidation/other-hatred
*Behaviors that function as emotional avoidance
DBT Skills Training:
Target/Goal
Identity confusion, Emptiness, and Cognitive dysregulation
Interpersonal chaos and Fears of abandonment
Labile affect, Excessive anger (shame, fear…),
and Emotional Avoidance
Impulsivity, suicidal threats, and non-suicidal self-injury
Skills/Module
Mindfulness (Dissociative behavior)
Interpersonal Effectiveness
Emotion Regulation
Distress Tolerance
