A Few Online Resources For DBT
A Few Online Resources For DBT
A Few Online Resources For DBT
About DBT?
(from https://www.goodtherapy.org/learn-about-therapy/types/dialectical-behavioral-therapy)
Dialectical behavior therapy (DBT), a comprehensive cognitive behavioral treatment, aims to treat
individuals who see little or no improvement with other models of therapy. This treatment focuses on problem
solving and acceptance-based strategies within a framework of dialectical methods. The term dialectical refers
to the processes that synthesize opposite concepts such as change and acceptance.
Certified practitioners of DBT offer acceptance and support to people in therapy, many of whom have
conditions described as "difficult to treat," as they work to develop techniques in order to achieve
goals, greater overall mental and emotional well-being, and lasting positive change.
1. Capability enhancement: DBT provides opportunities for the development of existing skills. In
treatment, four basic skill sets are taught: Emotion regulation, mindfulness, interpersonal effectiveness,
and distress tolerance.
2. Generalization: DBT therapists use various techniques to encourage the transfer of learned skills across
all settings. People in therapy may learn to apply what they have learned at home, at school, at work, and
in the community. For example, a therapist might ask the person in treatment to talk with a partner about
a conflict while using emotion regulation skills before and after the discussion.
3. Motivational enhancement: DBT implements individualized behavioral treatment plans in order to
facilitate the reduction of problematic behaviors that might negatively affect quality of life. For example,
therapists might utilize self-monitoring tracking sheets so individual sessions can be adapted to address
the most severe issues first.
4. Capability and motivational enhancement of therapists: Because DBT is often provided to people
who experience chronic, severe, and intense mental health issues, therapists receive a great deal of
supervision and support to prevent things like vicarious traumatization or burnout. For example,
treatment-team meetings are held frequently to give therapists a space to provide and receive support,
training, and clinical guidance.
5. Structuring of the environment: A goal of therapy is often to ensure positive, adaptive behaviors are
reinforced across all environmental settings. For example, if an individual participates in multiple
treatment programs within one agency, the therapist might make sure each program was set up to
reinforce all the positive skills and behaviors learned.
The standard form of DBT consists of individual therapy, skills training group, phone coaching, and a
therapist consultation team. Those in standard DBT attend therapy and a skills training group
weekly. The groups are designed to help those in treatment develop behavioral skills through group
work and homework assignments. These assignments provide individuals with the opportunity to
practice learned skills in day-to-day life. Phone coaching is also an important component of DBT, as
it allows people in treatment to reach their therapist for support when a challenging situation
presents itself between sessions.
Due to the complexity and severity of the issues faced by many individuals participating in DBT, a
consultation team is considered essential for DBT providers. The team, made up of group leaders
and individual therapists, can offer support, motivation, and therapy to the therapists working with
difficult issues.
After analyzing these problems, Linehan devised several adaptations to CBT that directly addressed
the needs of the population. Acceptance-based techniques were included to ensure participants felt
supported and validated before they were asked to focus on change. In addition, dialectics were
incorporated to allow therapists and participants in treatment to focus on the synthesis of polar
opposites, such as acceptance and change, in order to avoid becoming trapped in patterns of
extreme position-taking.
These and other adaptations were added to the practice of CBT, and in 1993, Linehan published the
first official treatment manual, Cognitive Behavioral Treatment of Borderline Personality Disorder. Since
then, the practice of DBT has grown in popularity. Over the last several decades, a great deal of
research has supported the efficacy of DBT, and this form of therapy is now practiced in dozens of
countries around the world. It is also listed in SAMHSA's Registry of Evidence-Based Programs and
Practices.
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DBT Theory
Three major theoretical frameworks—a behavioral science biosocial model of the development of
chronic mental health issues, the mindfulness practice of Zen Buddhism, and the philosophy of
dialectics—combine to form the basis for DBT.
The biosocial theory attempts to explain how issues related to borderline personality develop. The
theory posits that some people are born with a predisposition toward emotional vulnerability.
Environments that lack solid structure and stability can intensify a person's negative emotional
responses and influence patterns of interaction that become destructive. These patterns can
harm relationships and functioning across all settings and often result in suicidal behavior and/or a
diagnosis of borderline personality.
DBT draws mindfulness techniques from Zen Buddhism in order to use here-and-now presence of
mind to help people in therapy objectively and calmly assess situations. Mindfulness training allows
people to take stock of their current experience, evaluate the facts, and focus on one thing at a time.
Dialectics are used to support both the therapist and person in treatment in pulling from both
extremes of any issue. Therapists use dialectics to help people accept the parts of themselves they
do not like and to provide motivation and encouragement to address the change of those parts.
Synthesizing polar opposites can reduce tension and help keep therapy moving forward.
Stages and Goals in DBT
This form of therapy is designed to systematically and comprehensively treat issues in order of
severity. Because DBT was initially intended for people with suicidal tendencies and extreme
emotional issues, treatment happens in stages so all concerns are eventually addressed. DBT
involves the following four stages:
Findings from multiple studies reflect the efficacy of DBT, especially for the treatment of borderline
personality issues, posttraumatic stress, self-harm, and suicidality.
• Stage 1: The focus of this stage is stabilization. People in therapy may be dealing with things like suicidal
thoughts, self-harm, or addiction. They often report feeling like they are at an all-time low point in their
lives. Therapy is centered on safety and crisis intervention. The goal of this stage is to help people
achieve some control over problematic behaviors.
• Stage 2: In this stage, behaviors are more stable, but mental health issues may still be prevalent.
Emotional pain is typically brought to the surface, and traumatic experiences are safely explored. The
goal of this stage is for people in treatment to fully experience their emotional pain instead of silencing or
burying it.
• Stage 3: This stage focuses on enhancing the quality of life through maintenance of progress and
reasonable goal-setting. The goal of this stage is the promotion of happiness and stability.
• Stage 4: During this stage, therapists support people in advancing their lives to the next level. In therapy,
people may improve upon learned skills or work toward spiritualfulfillment. The goal of this stage is to
help people achieve and maintain an ongoing capacity for happiness and success.
•
How Effective Is DBT?
Findings from multiple studies reflect the efficacy of DBT, especially for the treatment of borderline
personality issues, posttraumatic stress, self-harm, and suicidality.
• A controlled trial conducted in an inpatient setting by Bohus et al. (2004) found people in therapy who
received three months of DBT improved at a greater rate than those who received treatment as usual.
• According to the SAMHSA National Registry of Evidence-based Programs and Practices, multiple
controlled trials and independent studies found that one year of DBT decreased the instances of self-
harming behaviors at a greater rate than alternative treatments. One such study reported that the
participants who received DBT had only .55 incidents of self-injurious behavior over one month,
compared to 9.33 incidents among those who received treatment as usual.
• A study conducted by Linehan et al. (2006) suggests DBT may be effective in reducing suicide attempts.
This study reported those who received DBT were half as likely to attempt suicide, had less psychiatric
hospitalizations, and were less likely to drop out of treatment compared to those who received
psychotherapy from professionals considered to be experts in the treatment of suicide and self-harm.
•
Certification Requirements for DBT
Some mental health practitioners offering DBT are not certified by the Linehan Board of Certification.
The DBT-LBC program is the only developer-approved treatment program in the United States.
Other programs may not provide practitioners with the necessary training to provide DBT effectively,
and treatment from a provider who is not appropriately qualified may simply be unsuccessful but
may also cause harm.
Because DBT is a type of therapy currently in high demand, many practitioners may wish to offer this
therapy in their practice. It is important for all practitioners who wish to offer DBT to obtain
certification through the DBT-LBC program. Linehan herself discusses the importance of this
certification in a live presentation for Family Action Network.
Practitioners interested in becoming certified must apply to take an exam, which is based on
Linehan's training manual and skills training manual. Those who pass the exam are then required to
submit first a treatment conceptualization for a person they wish to treat with DBT and then three
videotapes of consecutive treatment sessions with that same individual. If this completed Work
Product adheres to DBT standards, and the practitioner has demonstrated the ability to effectively
provide DBT, the practitioner can then obtain certification as an Individual Therapist in DBT.