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Dialectical Behavioral Therapy

Dialectical behavioral therapy (DBT) is a type of cognitive behavioral therapy. Cognitive behavioral therapy tries to identify and change negative thinking patterns and pushes for positive behavioral changes.

DBT may be used to treat suicidal and other self-destructive behaviors. It teaches patients skills to cope with, and change, unhealthy behaviors.

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What's Unique About Dialectical Behavioral Therapy?

The term "dialectical" comes from the idea that bringing together two opposites in therapy -- acceptance and change -- brings better results than either one alone.

A unique aspect of DBT is its focus on acceptance of a patient's experience as a way for therapists to reassure them -- and balance the work needed to change negative behaviors.

Standard comprehensive DBT has four parts:

  • Individual therapy
  • Group skills training
  • Phone coaching, if needed for crises between sessions
  • Consultation group for health care providers to stay motivated and discuss patient care

Patients agree to do homework to practice new skills. This includes filling out daily "diary cards" to track more than 40 emotions, urges, behaviors, and skills, such as lying, self-injury, or self-respect.

What Conditions Does DBT Treat?

Dialectical behavioral therapy focuses on high-risk, tough-to-treat patients. These patients often have multiple diagnoses.

DBT was initially designed to treat people with suicidal behavior and borderline personality disorder. But it has been adapted for other mental health problems that threaten a person's safety, relationships, work, and emotional well-being.

Borderline personality disorder is a disorder that leads to acute emotional distress. Patients may have intense bursts of anger and aggression, moods that shift rapidly, and extreme sensitivity to rejection.

People with borderline personality disorder may have difficulty regulating emotions. They experience instability in:

  • moods
  • behavior
  • self-image
  • thinking
  • relationships

Impulsive behavior, such as substance abuse, risky sex, self-injury, and repeated life crises such as legal troubles and homelessness, are common.

The American Psychiatric Association has endorsed DBT as effective in treating borderline personality disorder. Patients who undergo DBT have seen improvements such as:

  • less frequent and less severe suicidal behavior
  • shorter hospitalizations
  • less anger
  • less likely to drop out of treatment
  • improved social functioning

Substance abuse is common with borderline personality disorder.  DBT helps substance abusers with borderline personality disorder but hasn't proven effective for addiction alone.

Researchers are investigating whether DBT may be effective in treating these conditions:

  • mood disorders
  • binge eating
  • ADHD
  • post-traumatic stress disorder

How Does DBT Work?

Comprehensive DBT focuses on four ways to enhance life skills:

  • Distress tolerance: Feeling intense emotions like anger without reacting impulsively or using self-injury or substance abuse to dampen distress.
  • Emotion regulation: Recognizing, labeling, and adjusting emotions.
  • Mindfulness: Becoming more aware of self and others and attentive to the present moment.
  • Interpersonal effectiveness: Navigating conflict and interacting assertively.

DBT offers a commonsense, multistage approach:

  • Stage 1: Treats the most self-destructive behavior, such as suicide attempts or self-injury.
  • Stage 2: Begins to address quality-of-life skills, such as emotional regulation, distress tolerance, and interpersonal effectiveness.
  • Stage 3: Focuses on improved relationships and self-esteem.
  • Stage 4: Promotes more joy and relationship connection.

WebMD Medical Reference

Reviewed by Joseph Goldberg, MD on February 20, 2014

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