Dialectical Behavior Therapy – what in the world is that?
DBT, as we call it, is a cognitive behavioral therapy developed by psychologist Dr. Marsha Linehan in the late 1980s. Originally designed to treat people who struggle with chronic thoughts of suicide and self-harm, it has now become the premier evidenced-based treatment for addressing these issues. Research has shown that DBT is helpful in treating depression, anxiety, post-traumatic stress disorder, eating disorders, and substance dependence.
The word “dialectical” describes the notion that two opposing ideas can be true at the same time. It can be when you simultaneously want something and you don’t want that thing. For example, you might feel lonely and wish for company; at the same time, the last thing you want is to be around anyone. This is a dialectic. Dialectics are a very common part of the human experience. They add complexity to life, and often you want things to be one way or the other, not both. You might judge yourself for having opposing thoughts or feelings, and accuse yourself of being “stupid” or “indecisive.” Yet in reality, your mind is complicated and the world is complex. DBT teaches skills for decreasing self-judgments and accepting that you often have opposing thoughts or feelings, and that both of these thoughts or feelings are valid. When you are struggling in life, a common dialectic is “I want to change my life” and “I don’t want to change anything, because it’s too scary and hard.” DBT therapists address this dialectic by understanding and validating your current life predicament AND helping you learn skills for making changes in this predicament. DBT is especially effective if you have difficulties regulating emotions, thoughts and behaviors, and consequently experience serious relationship problems and intense self-hatred.
Through DBT, you learn to access your “Wise Mind,” which means drawing simultaneously from both your “Emotion Mind” and your “Reasonable Mind.” If you are a person who has difficulties
identifying and managing your emotions, you probably operate mostly out of Emotion Mind, making decisions based primarily on emotions (even when you aren’t certain what you are feeling). This can lead to serious problems, and an important goal in DBT is to learn to exercise wisdom rather than responding reactively when faced with life challenges. Learning mindfulness is a great way of learning to access your Wise Mind. Mindfulness is about learning to focus on the present, putting aside thoughts about past and future. Researchers have shown that people who are able to “be present in the present” are more satisfied and less anxious. The Prairie View DBT Team has existed since 2000, and in those years many patients have moved from a life of despair to “a life worth living,” by learning and regularly practicing mindfulness and the many other skills taught in DBT.
Life becomes richer and less difficult when you learn to live mindfully. In DBT, there are several mindfulness skills: observing and describing, being non-judgmental, doing one thing at a time,
doing what works and participating in the current activity. In order to learn an example of an “Observe” skill, take a moment to simply observe your breath. Notice the speed of your breaths. How deeply are you breathing? What parts of your body move when you breathe? How do your shoulders feel when you exhale? What thoughts do you notice entering your mind as you focus on your breathing? If your mind wanders from your breathing (and it will), simply bring your attention back to your breath. This is something you can practice throughout the day, no matter where you are or what you’re doing. It only takes a moment.
Participating in DBT involves attending a weekly two-hour skills-training group where you learn Mindfulness, Emotion Regulation, Distress Tolerance, and Interpersonal Effectiveness. You also see a DBT-trained therapist for individual therapy on a weekly or bi-weekly basis. Doing DBT means learning and practicing new skills, doing weekly homework and keeping a daily diary card of emotions and behaviors, which is reviewed regularly with your individual therapist. Together, you will identify “target behaviors” that you want to change. “Target behaviors” might be such things as suicidal thinking, self-harm, anger outbursts, binging/purging, and isolating. In addition to the skills-training group and individual therapy, you receive coaching from your individual therapist on how to use your newly-learned skills in real-life situations. This coaching might occur via phone or e-mail. DBT requires commitment and hard work, and typically lasts an entire year. It is a life-changing investment.
Kathryn Minick, PhD, is a licensed psychologist at Prairie View’s Newton office. She is a member of the Prairie View DBT Consultation Team.