Developed in the 1990s by Marsha Linehan, DBT seeks to treat those who suffer from Borderline Personality Disorder. For years, those who suffered from BPD were considered the most difficult patients to work with because of their self destructive behaviors and their lack of ability to commit to treatment. The ideas behind DBT address these issues and, in using a variety of modalities, have achieved a high success rate in changing and challenging the behaviors of those who suffer from BPD.
What is Dialectical Behavioral Therapy?
The theory behind DBT maintains that those who suffer from Borderline Personality Disorder are suffering from a bio/social disease. The theory maintains that a person raised in a non-validating environment who carries a biological sensitivity to emotions cannot easily react normally in emotional situations. DBT teaches behavioral techniques that can help a BPD sufferer cope with the rapidly shifting emotions, poor sense of self, and self harming behaviors that are characteristic of BPD.
The practice of the therapy includes a weekly individual psychotherapy session and a set of group classes designed to teach coping strategies that allow someone with the disorder to better regulate and control their life and emotions.
The Goals of DBT
DBT has three therapeutic goals. First, the patient learns to reduce life threatening behaviors. Secondly the patient works on reducing therapeutically interfering behaviors that prevent them from using the help they are given. Finally, the patient learns to deal with traumatic experiences that are usually responsible for their eratic behavior, and learns also to reduce behaviors that interfere with their quality of life. Ultimately, the goal of DBT is to help the patient create a life worth living out of all the suffering they have endured.
This is achieved through the practice of four sets of skills designed to aid the patient in improving how the patient lives his/her life. The first set of skills is mindfulness skills. Most practitioners of DBT would say that these are the guiding skills for all the rest. Being mindful of every moment gives the patient the opportunity to look at behavior as it is happening. Encouraged to observe and describe the behavior non judgmentally the patient has the chance to step back and examine behavior before it gets out of control.
The next set of skills is interpersonal skills. These skills encourage communication that allows the patient to get what they need or want while retaining their self respect and keeping the relationship intact. It fights against the Borderline's tendency to lash out by giving the patient a variety of skills to be thought over before making a request, so that the best result can be achieved.
Patients are also taught distress tolerance skills. Most Borderline sufferers are unable to tolerate strong emotions whether they are good or bad. When the emotions are painful often sufferers will turn back to self harming behaviors such as cutting, drinking, drugs or other equally damaging things. While distress tolerance will not change the situation, it is designed to distract one from the bad situation.
Finally, patients are taught to regulate their emotions. This is done through a series of skills that teach the patient to distract or improve their situation by actively seeking positive experiences. Patients are also encouraged to not disregulate by doing good things for themselves while accepting the reality of the situation.
These skills when used together can help a person with Borderline Personality Disorder to keep themselves in safe positive positions. They can help relieve the depression that many BPD sufferers experience as well as help them manage the symptoms of the disorder.
DBT Translated
In addition to those who suffer from Borderline Personality Disorder; there has been reported success in using DBT as a strategy in addiction treatment and the treatment of bi-polar disorder. Its behavioral design seeks to make the patient responsible for themselves and for their own change and healing. Many times however, traditional medication therapy is used in conjunction with DBT in dealing with these illnesses to allow the patient the relief to begin to study and utilize these skills.
The Future of DBT
It is now believed that the continued success of DBT for Borderline Personality Disordered patients will create a sense of healing and success for the patient that only a few years ago was thought to be impossible for this population. BPD is a difficult illness to treat because it generally involves major trust issues which often interfere with treatment. In creating and using these skills patients are invited to take a pause and re-evaluate situations before they get out of hand. This often allows treatment to proceed less eventfully and more evenly. As such sufferers from this disorder begin to feel for the first time that life is worth living and that they are not sentenced to a life of disordered thinking, feeling and reacting.
