Dialectical Behavior Therapy is an evidence-based form of counseling that was developed for the treatment of borderline personality disorder (BPD). Marsha Linehan developed the model by combining the commonly used concepts of Cognitive Behavioral Therapy (CBT) with mindfulness and meditation practices. Research has demonstrated that dialectical behavior therapy is an effective treatment for BPD and has contributed to improvement in overall functioning for adolescents.
Dialectical Behavior Therapy – Four Phases
DBT consists of four phases and four modules of treatment. Each phase is focused on a specific area of treatment with the overall goal of decreasing self-harm, improving compliance with counseling, and reducing other high risk behaviors.
Phase one of treatment focuses on establishing safety by reducing self-harm behaviors. Self-harm is viewed as the culmination of a chain of events that begin with powerful emotions. Emotional dis-regulation stemming from an internal or external trigger overwhelms the client leading toward the use of self-harm to stop the unbearable feelings. DBT assists clients in learning to tolerate the overwhelming emotions through the use of more adaptive and less harmful coping strategies.
Phase two of treatment is focused on desensitization of past traumatic experiences and events. Unresolved traumatic experiences and messages are susceptible to present triggers leading toward overwhelming emotions. Once safety has been established and the clients window of emotional tolerance has been widened they are ready to process the experience at the core of the issue.
Phase three of Dialectical Behavior Therapy centers around building everyday life skills and behaviors. This phase focuses on self-respect, individual goals, and the application of new learning to future endeavors.
Phase four of the treatment plan involves the integration of spirituality, acceptance of self, individual goals, coping skills, and future planning. This phase seeks to apply the newly acquired skills to a broader context and looks toward future growth and achievement.
Dialectical Behavior Therapy – Four Modules
The four modules of DBT are interspersed through out the four phases of treatment. These modules are core mindfulness, emotion regulation, interpersonal effectiveness, and distress tolerance.
Mindfulness is the practice of “Paying attention in a particular way; on purpose, in the present moment, and non-judgmentally” Jon Kabat-Zinn.
DBT assists the client in focusing on the experience of all five senses in the present moment. The counselor might ask the client to notice 5 colors, 4 sounds, 3 smells, and 1 taste right at this time. This focus on the present pulls the client out of the overwhelming emotions and into the safety of the therapy room. Mindfulness can be used to increase emotion tolerance and ground oneself in reality when experiencing difficult flashbacks or negative thoughts.
Emotion regulation enhances the client’s ability to regulate oneself in the moment. It focuses on adaptive coping strategies rather than harmful ones. These strategies may involve understanding and labeling emotions, increasing positive emotional experiences to counterbalance negative experiences, and decreasing emotional pain by letting go and taking the opposite action.
Interpersonal effectiveness focuses on enhancing the client’s communication and relationship skills. The main objective is to enhance one’s ability to ask for what is needed and to say no when appropriate.
The fourth module of Dialectical Behavior Therapy is distress tolerance. Sometimes people avoid uncomfortable feelings, in DBT however, the goal is to understand that negative feelings are a normal part of life. Since negative feelings are normal it is helpful to learn to accept these feelings. DBT teaches adaptive ways of coping with the difficulty in the moment. Distress tolerance skills are distract, self-sooth, improve the moment, and focus on the pros and cons.
Dialectical Behavior Therapy – What next?
DBT is a well researched treatment model that helps adolescents and adults struggling with emotion regulation, self-harm, depression, or anxiety. If you are looking for a therapist trained to provide DBT go HERE to meet Danielle. If you have questions about getting started in DBT treatment or would like to schedule an appointment Call 217-231-1413.
Goodtherapy.org articles on DBT:
Underwood, L.A. & Dailey, F. L. (2017). Counseling Adolescents Competently. Los Angeles, CA: Sage.
Seligman, L. & Reichenberg, L.W. (2014). Theories of Counseling and Psychotherapy: Systems, Strategies, and Skills (4th ed.). Boston, MA: Pearson.