Dialectical Behavior Therapy (DBT)
DBT is the commonly used abbreviation for Dialectical Behavior Therapy. This treatment approach was pioneered over 30 years ago by American psychologist Dr. Marsha Linehan. In short, it teaches you how to regulate and balance your emotions, relationships, thoughts, and behaviors. These are skills that most people learn in early childhood. When we don’t learn how to do this, or a trauma occurs, it’s necessary to formally learn these skills. DBT is a type of talk therapy that uses the cognitive-behavioral approach. DBT focuses on psychological and social factors causing distress in everyday life.
Using DBT
DBT was originally used to treat individuals with Borderline Personality Disorder. Now it is also used to treat other personality disorders, ADHD, PTSD, Bipolar disorder, eating concerns, suicidality, depression, and self-injurious/destructive behaviors (most noticeably cutting). People that may benefit from DBT generally have fast, acute, negative emotional responses towards emotional situations and relationships. From the outside it looks like the individual has extreme swings in emotions and are usually in crisis/drama. This can wreak significant havoc in their personal, social, romantic, and work lives. This can be seen in frequently changing friend groups, inability to keep a job, frequent changes in romantic partners or consistent romantic turmoil.
The Basis of DBT
DBT is based in the doctrines of radical acceptance and mindfulness. The treatment focuses on two principles: accepting life as it is (not how it “should” be), and the necessity of change – because life is not how it “should” be. The idea is that you don’t have to like what is happening, but you have to accept that it is happening. Fighting against how things are (in favor of how they “should” be) results in more emotional pain and suffering. Radical acceptance argues that if you accept yourself, and how things actually are, you will be better equipped to move through difficult times. Radical acceptance is best used in situations in which we have no control.
Examples include the death of a loved one, a pandemic, a crippling breakup, illness, bankruptcy, and drastic changes in life plans. All of these examples could result in rage, denial, pain, confusion, and fighting -or- each of these situations can be accepted as the individual’s new normal and then they can move forward instead of being stuck in the past. As a personal example, currently the world is shut down because of COVID-19. The airports in my country are closed. My mother lives in a different country; this means I cannot visit my mother should she get ill. Do I like this? No, absolutely not. Can I change a worldwide pandemic and forcibly open airports? No, I cannot. I don’t like it, yet I accept it and move forward. Mindfulness, on the other hand, is simply being present in the current moment. Mindfulness, in practice, means that you are not overthinking, invalidating yourself and others, or passing judgment. It means that you are showing up now and accepting what is happening right now.
Constituents of DBT Treatment
DBT treatment consists of four skill modules: Core Mindfulness Skills, Distress Tolerance Skills, Interpersonal Effective Skills, and Emotion Regulation Skills. The treatment is collaborative between the therapists and client, cognitive based, and focuses on building strengths. In many ways DBT treatment is like going back to school. It is highly structured; there are lectures, readings, homework, and discussion in groups all focused on learning and mastering the new skills. The treatment is designed for clients to be in weekly individual psychotherapy sessions as well as weekly DBT group therapy sessions. The Core Mindfulness Skills module focuses of mindfulness and radical acceptance; this is always the first module. The Distress Tolerance Skills module is particularly helpful for people with self-injurious behaviors. These skills help with learning how to be more resilient and survive crises and severe emotional pain. The Interpersonal Effectiveness Skills module focuses on using effective communication skills when in emotional pain. These skills help people learn to appropriately voice their needs or concerns when they are in a state of emotional dysregulation. The final module is Emotion Regulation Skills in which people learn to identify and label emotions, think more objectively when in emotional pain, as well as increase mindfulness and positive emotional situations.
DBT vs Cognitive Behavioural Therapy
DBT is different than Cognitive Behavioral Therapy (CBT). DBT is a specific form of CBT. DBT focuses on how people interact in their relationships and environment; CBT does not address this in the same detail. DBT incorporates both individual and weekly therapy groups, CBT does not. DBT is more effective in treating personality disorders, and is particularly effective for individuals who engage in self-harming behaviors (ex. cutting, burning, etc.).
As a psychotherapist, I currently enjoy using DBT more than CBT with my clients. The reliance on mindfulness and radical acceptance in the treatment is not only very helpful for the clients, but is also a pleasure to teach and engage in as a therapist.
Make sure to check out Dr. Anne’s previous article with EMPWR.
Dr. Anne Justus is Senior Clinical Psychologist and Director at the Maadi Psychology Center, New Cairo. To make an appointment with her please visit the online scheduler: https://www.therapyportal.com/p/annejustus/
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