DBT for Adults
What is DBT for Adults?
From a DBT perspective, behaviors like binge-eating, purging, dietary restriction, compulsive exercise, and/or self-harm are believed to serve an “affect regulation” function. In other words, these behaviors may be used with or without awareness to escape, block, or numb negative emotions. DBT treatment addresses the functional use of problematic behaviors by guiding the individual to more adaptive, health-affirming, and sustainable strategies for coping with emotion.
DBT focuses on building the client’s capabilities to remain steady and effective even under the most challenging circumstances. Through the teaching and practice of skills, and there are dozens of them in the DBT repertory, clients are able to manage emotions, problems, or crises without using food, exercise, self-harm, drugs, or other problematic coping strategies.
DBT learning is structured around four major domains: emotion regulation, distress tolerance, interpersonal effectiveness, and mindfulness.
The emotion regulation domain focuses on getting good at accurately identifying how you’re feeling in the moment, steadying emotional ups and downs, reducing impulsive or reactive behaviors in response to negative emotions, increasing positive emotions, and applying techniques for self-soothing.
Distress tolerance involves learning to cope through intense emotions or crises without engaging in impulsive or destructive behaviors. Distress tolerance skills include strategies for problem-solving and remaining level-headed when tensions rise – to get through tough times without inadvertently making things worse! Many of us can relate to the experience of getting angry and then yelling or saying things we later regret. DBT helps us remain in control in tough situations. We learn to access the “wise mind” in those moments to support the most positive outcome and to maintain self-respect and self-esteem in the process.
Interpersonal effectiveness strategies focus on maintaining healthy and fulfilling relationships. This module focuses on skills for increasing assertiveness, setting interpersonal limits, coping with conflict, and being all together most effective in communications with others.
Mindfulness training is about staying in the moment and experiencing emotions fully but with perspective. Mindfulness is thought of as the foundation for DBT skills since self-awareness is so central to self-regulation.
DBT for Eating Disorders
At Columbus Park, our clients receive the highest level of skills training and coaching with therapists who are not just experts in DBT but in DBT adapted specifically for eating disorders. Columbus Park has been leading the NYC eating disorder community since 2008 and has successfully treated thousands of individuals over these years using comprehensive DBT-ED.
DBT-ED, the version of DBT adapted to target eating disorder behaviors, involves a very specific and deliberate structure:
Skills Training Group: DBT participants attend a weekly skills group. The structure is didactic with a facilitator teaching skills step-by-step in the small group setting. The communal nature of the service allows for peer support and accountability, serving as an ideal encouraging space to learn and practice new methods for coping. Some of our clients participate in optional supported group meals at our center as a way of augmenting their DBT treatment. The group meals allow clients to practice skills in real-time, as they’re challenged by integrating fear foods and expanding the variety and adequacy of their meals.
Individual DBT: DBT clients see their individual provider once per week. This session is designed to support the client in setting and prioritizing treatment goals, monitoring progress, generalizing skills learned in group and troubleshooting challenges of the week. In DBT-ED, we address eating disorder behaviors through self-monitoring, regular eating strategies, and targeted skill use around mealtimes.
Coaching: An important component of DBT is between session coaching – essentially your provider being on call for you to support your efforts in real-time. Brief check-in phone calls are designed to help patients deploy skills in-the-moment when they’re experiencing distress and/or facing obstacles. Over the phone, the therapist identifies the problem, evaluates the skills the client used already, and then offers additional skill options for managing the struggle. This intervention helps clients replace emotion-driven, impulsive behaviors with active, competent self-directed skill use.
DBT Team Approach: In addition to preparing for patient sessions, the DBT therapists meet weekly as part of a DBT consultation team focused on providing support to the therapists and utilizing a team approach to encourage the most skillful and effective delivery of the treatment. So in DBT, it’s as if the client is being treated by a team of experts as opposed to one therapist in isolation – the more input, the better.
If you’re wondering if DBT is right for you, we encourage you to contact us. After an initial phone intake, we can decide together if it makes sense to move forward with an assessment. The assessment involves obtaining a full history and a clear snapshot of the current challenges. We will provide a diagnosis and will outline the targets of treatment along with a thorough recommendation for a treatment course. We have specific criteria to guide whether DBT will be the treatment protocol of choice or if another treatment would be more appropriate. An initial assessment will give you a great deal of information about the nature of the problem and the best strategy to address it.