In the 1960s, Marsha Linehan, then 17, was hospitalized for extreme withdrawal from social engagement. She had a history of self-abuse and suicide attempts, so she was isolated in a seclusion room that was reserved for the highest risk patients. Linehan was diagnosed with schizophrenia, but heavy medication, psychoanalysis, and electroshock treatment provided her no relief.
After leaving the hospital, relapsing, then being hospitalized a second time, Linehan reached a point where she was finally able to endure emotional pain without injuring herself. It wasn’t until she studied psychology for many years that she was able to identify what had caused the change: radical acceptance. She had accepted her reality, and made the realization that the person she dreamed of being was far from who she was. Using this central notion of acceptance, Linehan developed Dialectical Behavior Therapy (DBT). DBT has since helped countless individuals struggling with similar problems, many of whom live with borderline personality disorder (BPD) (Carey, 2011).
What Is Borderline Personality Disorder?
Dr. Linehan’s Cognitive-behavioral Treatment of Borderline Personality Disorder, published in 1993, states that the foundation of BPD is a biosocial personality theory that suggests the characteristics of BPD are an emotional regulation dysfunction. The dysfunction is a result of a combination of biological irregularities and dysfunctional environments (Linehan, 1993).
The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders defines BPD as “a pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity, beginning by early adulthood and present in a variety of contexts.” A diagnosis of BPD is contingent on five or more of the following traits: impulsivity, recurrent suicidal behavior, affective instability, chronic feelings of emptiness, intense anger and difficulty controlling anger, or transient paranoid ideation or dissociative symptoms. The manual also states that 75 percent of individuals diagnosed with BPD are women (American Psychiatric Association, 2013).
How Does DBT Work?
According to the Linehan Institute, there are four sets of skills that are employed in DBT to invoke a regulated response to difficult emotions: mindfulness, distress tolerance, interpersonal effectiveness and emotional regulation. Mindfulness, perhaps the most popularized aspect of DBT, is the act of striving to be present and in the moment. Distress tolerance refers to the validating and accepting of painful emotions and situations, rather than making it worse by using ineffective techniques to get rid of the pain. Interpersonal effectiveness is the strengthening of communication and expression, and staying true to what one needs while respecting oneself and others in interpersonal relationships. Emotional regulation is the understanding of how to alter undesirable emotions (“What is DBT?”, 2016).
The National Alliance on Mental Health states that DBT and Cognitive Behavioral Therapy (CBT), a modality frequently used to treat anxiety, are closely intertwined. What differentiates the two is DBT’s focus on accepting intrusive thoughts, rather than simply struggling against them. Proponents of DBT believe that once an individual confronts and accepts their thoughts, it is easier to start the path of recovery. Practitioners using DBT also direct patients to complete homework assignments between sessions to regiment their practice of the principles and coping mechanisms discussed in therapy (“Psychotherapy”, 2016).
According to the Linehan Institute, the four standard components of DBT are the skills training group, individual treatment, DBT phone coaching, and the consultation team. In the skills training group, groups meets weekly for 24 weeks to learn behavioral skills. Individual therapy, alternately, encourages individuals to apply the behavioral skills to their specific challenges and life events. Individual therapy and skills training groups usually happen simultaneously, and for as long as is necessary. Phone coaching is a tool used in between sessions to provide immediate coaching during difficult situations. The consultation teams meet weekly and consist of individual and group leaders. The teams function to maintain DBT providers’ competency and motivation (Linehan, 2016). The four components are used together to provide the best experience for the individuals participating in DBT.
According to the Dialectical Behavior Therapy National Certification and Accreditation Association (DBTNCAA) website, DBT certification is not mandatory for providers wishing to offer DBT as a therapeutic technique. There are, however, certification programs to further develop providers’ understanding of DBT, and some states do require certification to pay for DBT programming. Providers seeking certification can find training programs through the DBT-Linehan Board of Certification (DBT-LBC) (“Dialectical behavior,” 2016).
The Cochrane Review, a health care research group, recognizes DBT as the best treatment for “the characteristics associated with Borderline Personality Disorder (BPD) including impulsivity, interpersonal problems, emotional dysregulation, self-harm, and suicidal behaviors,” though individuals struggling BPD are often considered very difficult to treat (“Psychological therapies”, 2012).
Though DBT is most commonly referred to as a therapeutic modality to conquer characteristics associated with BPD, it can also be used to aid individuals with other illnesses and symptoms. Studies have shown that DBT can help those suffering from eating disorders, substance use, depression and Posttraumatic Stress Disorder (PTSD) (“What is DBT?”, 2016).
Working with a psychotherapist is an emotionally intimate experience, and what works for one individual may not work for another. With so many clinical approaches to explore, psychotherapy can be a successful part of dealing with psychological disorders or situational depression and anxiety. If you are interested in meeting with a certified DBT provider, visit the DBT-LBC website to search providers by name, city or zip code.
Self-Harm: What to Know and How to Help
Personality Disorders: Is My Personality Broken?
Understanding Trauma and PTSD
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