Dialectical Behavior Therapy (aka - "DBT")
Intro to DBT
What is this thing I call “Dialectical Behavioral Therapy”? DBT was invented in 1967 by Dr. Marsha Linnehan. Diagnosed with Schizophrenia while in the hospital in Hartford, Connecticut, she endured harsh medications but little meaningful treatment. Left to her own devises after she left the hospital, she ended up inventing Dialectical Behavioral Therapy first and foremost as a means to manage her own mental illness and to help others in as much distress as herself.
Ultimately, DBT is about the client learning how to balance thought processes and behavioral reactions using the balance to affect change for themselves (Miller, Kori 2011). Dr. Linnehan included Buddhist philosophy of “mindfulness” in the therapy as an entire set of coping skills the client could use to help manage painful/destructive emotions, thoughts and behaviors.
DBT can help the person manage muscle and breathing relaxation; learn how to observe the self without judgment; accept and tolerate emotional pain; having compassion for the self while working through tough emotions and to learn how to actively modify feelings towards a particular therapeutic direction (Berking, Eichler, Luhmann, Diedrich, Hiller, & Rief, 2019).
A client who receives DBT skill training along with traditional talk therapy gains many benefits such as greater improvements in psychiatric symptoms over time and regular practice (Soler , Valdepérez, Feliu-Soler, Pascual, Portella, Martín-Blanco, Alvarez, Pérez, 2012); assists the person in identifying and changing destructive thinking patterns; clients learn to replace black or white thinking with “and” thinking (Miller, Kori 2011). For example, a person can be spiteful AND kind, angry AND sympathetic, etc. The concepts of DBT are taught easily and are applicable/usable by everyone, not just people in emotional distress. In my own work, I have found teaching my clients DBT skills has been endlessly effective.
In my practice I teach DBT skills and I tend to concentrate on the “presenting problem” with clients in that whatever is bothering them the most is where we begin. Eventually I will teach a client all the skills, however I find starting with Mindfulness skills and Emotion Regulation is most effective.
For more information on DBT, follow the link for a video on this type of therapy.
References:
Berking, Eichler, Luhmann, Diedrich, Hiller, & Rief. (2019). Affect regulation training reduces symptom severity in depression – A randomized controlled trial. PLOS One. doi:10.1371/journal.pone.0220436.
Chowdhury, M.R. (2020). The Five Facet Mindfulness Questionnaire (FFMQ) – found online at
https://positivepsychology.com/five-facet-mindfulness-questionnaire-ffmq/
Linnehan, M. (1993) Cognitive-Behavioral Treatment for Borderline Personality Disorder and Skills Training Manual for Treating Borderline Personality Disorder. Guilford Press, London
Miller, K. (2020) https://positivepsychology.com/mindfulness-therapy/
Soler , Valdepérez, Feliu-Soler, Pascual, Portella, Martín-Blanco, Alvarez & Pérez. (2012). Effects of the dialectical behavioral therapy-mindfulness module on attention in patients with borderline personality disorder. Behaviour Research Therapy. ;50(2):150-157. doi:10.1016/j.brat.2011.12.002.
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Intro to Mindfulness
What is “Mindfulness”? This word is often thrown about these days. “Mindfulness” seems like something hidden and mysterious, revered as some magical ‘end all and be all’ of therapy. I am hoping to demystify this topic. “Mindfulness” is simple a way to stay in the present moment, learning how to hold attention ‘right here, right now’ and not lapsing into rumination about the past or the future.
Many small actions of daily life can be used as a mindful activity. It is applying ‘conscious awareness’ to tasks and making the decision to pay attention and to be aware. Mindfulness is not just relaxation, although, it can produce it.
Some of the skills you will learn within Mindfulness are:
Conscious awareness
Openness and non-judgement
Square Breathing (focusing breath to bring relaxation)
Observe and Describe (observe and describe objects or situations with 'just the facts’)
Non-Judgmental Stance (observe and describe without judging the facts, thoughts or feelings).
The point, or the utility of each skill is to increase awareness of thoughts, feelings and actions that keep us stuck, hindering therapeutic progress and keep us spinning the wheels of unhelpful thoughts and to mitigate and calm the raging emotions that cloud the person’s ability to think clearly and to choose those helpful actions and behaviors. Chowdhury (2020), discovered all of the varying therapeutic modalities that utilize Mindfulness can improve stress, promote positive thinking, help the user develop deep and meaningful insight, robust coping skills and to build emotional resilience.
Often Mindfulness is combined with other sorts of therapy, which is how I practice because when a person in therapy learns to become aware, they are then able to choose how to respond differently and in a way that is helpful instead of hurtful.
Now, mindfulness is not easy. It sounds easy, but to hold your thoughts on only what is right here, right now is challenging. The mind naturally wanders, its normal. Within mindfulness, learning how to bring yourself back to the present moment AND without judgement are all part of the lessons. Mindfulness can include meditation, but doesn’t have to every time. We will get into the meditation part later in the book. Holding yourself in mindfulness does not have to be done for long periods of time. You will build up your abilities to remain in mindfulness with practice.