Columbus Park’s Spotlight on DBT Series
Dialectical Behavior Therapy (DBT) is a type of cognitive-behavioral therapy designed to decrease emotional reactivity, increase effective coping, and by extension, improve quality of life. DBT was originally developed in the 1970s as an intervention for individuals with borderline personality disorder, self-injurious behaviors, and/or chronic suicidal ideation. There have been more than 30 randomized controlled trials in nine countries over the last four decades demonstrating its efficacy. Due to its dramatic impact on individuals with hard-to-treat psychiatric conditions, DBT was named one of the top 100 scientific discoveries in Time Magazine in 2011.
Over the years, it has been adapted as an effective treatment for a wide range of conditions including substance use disorders, post-traumatic stress disorder [related to childhood sexual abuse], treatment-resistant major depression, bipolar disorder, ADHD, and eating disorders. Among its advantages, it is an efficient, time-limited, and change-oriented therapeutic intervention that can be used across the lifespan – with adults, adolescents, and even children.
Skills Training and the Four DBT Domains
From a DBT perspective, many of the problems clients struggle with are caused by a “skills deficit” or in other words, a lack of critical, foundational inner resources/tools for coping. For example, if someone has limited skills for tolerating distress or getting through a crisis, they may try to escape or soothe themselves by self-harming (i.e. cutting), getting drunk, using drugs, binge eating, or engaging in high-risk sexual encounters. In some cases, a skills deficit may even lead to suicide. Given the understanding of the function of maladaptive behavior to escape or self soothe, DBT focuses on building the client’s capabilities in several critical domains: emotion regulation, distress tolerance, interpersonal effectiveness, and mindfulness.
- Mindfulness: increasing self-awareness and activating one’s “wise mind” for the most effective decision-making
- Emotion regulation: understanding and managing emotions in a skillful way
- Interpersonal effectiveness: strategies for maintaining healthy and fulfilling relationships
- Distress tolerance: coping through intense emotions or crises without engaging in impulsive or destructive behaviors
So what’s with the snazzy name, Dialectical Behavior Therapy? The term “dialectical” in the treatment name comes from the concept of dialectics, or the idea that two seemingly opposing truths can exist at the same time. DBT’s emphasis on dialectics helps keep the therapist and the client from getting too stuck in any extreme; instead, we create a synthesis of what can seem like two opposing sides. Since this sounds rather esoteric, let’s provide an example: the most central dialectic is acceptance and change. Balancing acceptance and change means that you can accept yourself as you are and still work towards change in service of improving your life. Similarly, you can accept the reality of your challenge or pain at the moment and also work to fight against it. Much of the therapeutic work is about validating the individual’s current struggles while at the same time, encouraging transformation.
The format for DBT is intensive, with clients participating weekly in skills group, individual therapy, skills homework, and phone coaching between meetings. The therapist has their own “homework” – in addition to preparing for patient sessions, they meet weekly as part of a consultation team focused on providing support to the therapist and utilizing a team approach to encourage the most skillful and effective delivery of the treatment.
The gold standard provider training institute for DBT is Marsha Linehan’s Behavioral Tech. Clinician training in DBT is quite involved and labor-intensive. It takes many years of practice, consultation, and support in order to deliver DBT most effectively. When delivered with fidelity to the treatment model, it is an enormously powerful and transformative intervention.
DBT has become a “hot” treatment in the mental health field and many practitioners integrate these strategies into treatment. That said, true DBT is intended to be delivered in a very particular way and with fidelity to the treatment model. It’s discouraging to hear when a patient shares that they’ve “had DBT” but it “didn’t work” when they actually received a severely watered-down version – not an adherent protocol. The team at Columbus Park has been intensively trained in DBT through Behavioral Tech Institute and has received years of expert consultation and supervision to hone their skills. We are determined to give our clients the right “dose” and quality of DBT so that this treatment “stop” is their last.
If you or a loved one is in need of eating disorder treatment, please reach out to our team at firstname.lastname@example.org to discuss our telehealth treatment options.
Please check back for our next blog, DBT for Eating Disorders, as we continue our November 2020 spotlight on DBT.
Part 2: DBT for Eating Disorders
Part 3: Adolescent DBT
Part 4: Integrating DBT and Family-Based Treatment (FBT) for Adolescent Eating Disorders