What Is Dialectical Therapy?
By: Sarah Fader
Updated February 18, 2021
Medically Reviewed By: Whitney White, MS. CMHC, NCC., LPC
Dialectical Behavioral Therapy or DBT was developed out of CBT or cognitive behavioral therapy. CBT helps people change their thoughts and modify their feelings. DBT does the same thing, and tacks on additional components. Marsha M. Linehan is the founder of DBT. She saw the benefits of CBT but recognized that it had some deficits and improved upon them. CBT was great for identifying negative thought patterns and changing them, but it lacked a component of how to handle situations when a person's emotions were heightened. Linehan wanted to develop a form of mental health treatment that could help people when they were experiencing emotional pain. That's where the origin of DBT began.
What Is DBT?
DBT helps people to manage emotional distress. It provides an individual with a toolbox of skills to help them deal with pain. Some of the things that you learn in DBT are mindfulness, distress tolerance, and the ability to navigate relationships. It helps us in four key areas. When we talk about mindfulness, we accept our feelings in the moment and don't try to change them. With distress tolerance, we're able to recognize pain and sit with it instead of running from it. The third area that DBT can help us in is emotional regulation. Emotional regulation allows people to understand what their feelings are and ride the wave of emotions: emotions can feel intense and overwhelming, but when people learn to ride the wave of their emotions, they learn to sit with that feeling and merely feel it.
Lastly, DBT teaches interpersonal skills, which allow us to better communicate with others. Learning these emotional skills helps us gain assertiveness, stand up for ourselves, respect others, draw boundaries, and maintain stable relationships.
How Do We Use DBT?
Initially, Marsha M. Linehan developed DBT to treat individuals living with Borderline Personality Disorder (BPD). People with BPD often have low emotional pain tolerance, and they have difficulty with emotional regulation. One of the things that individuals with BPD might struggle with is black-and-white thinking, and it can be challenging to navigate relations when you're consistently in emotional pain and are unable to see things from someone else's point of view because you're overwhelmed by your feelings. Marsha M. Linehan saw that they lacked coping skills needed to maintain interpersonal relationships and that they struggled to live with intense emotions and knowing how to handle them. DBT is highly effective in treating Borderline Personality Disorder, but it's also helpful in treating other conditions such as Bipolar Disorder, Anxiety, Depression, OCD (Obsessive Compulsive Disorder,) eating disorders, substance abuse issues, and more. It's useful for anyone who struggles to regulate their emotions or compulsions in the moment and would benefit from learning how to be more present.
What To Expect
When an individual enters DBT, they may be struggling to cope with emotional distress. Their pain tolerance could be extremely low. When people have difficulty tolerating emotional pain, they may engage in self-destructive behaviors. For example, some people who are living with Borderline Personality Disorder, and have a low tolerance for emotional pain, engage in self-harm or harmful behaviors to cope with this distress. If that is the case, the most urgent goal is to get the client to a place where they're safe. If a client is experiencing suicidal ideation, self-harming, or if they're using other dangerous behaviors, a therapist will first help them get to a place where they are no longer at risk of harming themselves.
Emotional pain tolerance and emotional distress are often the first aspects worked on when someone starts integrating DBT when that is the immediate concern, and things like mindfulness, self-compassion, self-respect, self-awareness, and interpersonal relationships will come a little bit later on. A DBT therapist will help an individual in learning how to cope with emotions and acknowledge how they're feeling without necessarily trying to change it.
DBT Group Therapy
You may learn DBT skills in individual therapy, but DBT is commonly received in group settings. People in DBT groups talk about their challenges with emotional regulation and learn to manage their feelings by hearing from other group members and their experiences. Many people find it helpful to attend group therapy in addition to seeing a therapist one-on-one. Group therapy sessions are usually led by a certified and trained DBT therapist. Individuals participating in the group will learn the standard components of DBT such as mindfulness, emotional regulation, distress tolerance, and effective interpersonal communication skills together. Like individual therapy sessions, a group therapy session often lasts for roughly one hour. There's no standard length of time that a person attends a DBT group for - you may engage in group sessions for months or years depending on your needs and what you feel is the best for you.
The Core Beliefs Of DBT
Using dialectical thinking, we learn that there are primary emotions and secondary ones.
Primary emotions are the initial response we have to an event. You are triggered by something that happens to you or around you in your environment.
Secondary emotions are the feelings you have after the primary response. You have a gut reaction to an event, and then you have a thought-out reaction after that. You can't control the first reaction, but the secondary emotions you can work with and manage.
Primary emotions can be natural feelings to something that happens. For example, when you're going through a divorce, you experience sadness, grief or anger. Secondary emotions are ones that we have more control over. We can choose how to respond to these feelings. For example, you might feel angry when you're getting divorced, and you have a choice as to how to deal with that anger. You could angrily call your ex up and yell at them. It might feel good in the moment to do that, but you probably will end up feeling shame or guilt afterward. Another idea is to write in a journal about your anger or talk to a therapist about it. You can accept your primary emotions, because they're instinctual, and work on how you express the secondary ones. Be mindful of how you let your anger out, and do it in a way that's healthy for you rather than one that hurts you.
Differentiating Between What's An Effective Or Ineffective Behavior?
You might find that you're engaging in an act that is not getting you what you want. It's hurting you rather than helping you. For example, making someone feel guilty for not doing something for you is probably not going to help you achieve your goal. It will make you feel bad, and make the other person feel shame. That would be an ineffective behavior. A useful response would be directly asking the person for what you want.
Using A Non-Judgmental Approach
DBT relies on a non-judgmental approach. You don't judge yourself, and your therapist doesn't pass judgement on you. You notice your emotions, experience, process, and feel them. You don't judge yourself for handling them a particular way. You're allowed to feel your feelings. Mindfulness is one of the principles in DBT where you can practice being non-judgmental. Maybe you notice that you're feeling sad because your boyfriend hasn't called you. You start to judge yourself and think "I shouldn't be sad. It's only been a day since I spoke to him." Instead of feeling guilty for being sad about not getting a call from your partner, allow yourself to feel sad. Those feelings are real. There's no such thing as a "wrong" emotion. You're allowed to feel however you feel.
The Importance Of Maintaining A Therapeutic Relationship
DBT is a unique form of mental health treatment. You are learning to manage your emotions, and eventually you'll be able to do it on your own. Until then, you're in therapy to learn skills. Your therapist is also a teacher in DBT. They're showing you a skill set to use when you're feeling intense emotions. They're teaching you how to be aware of your feelings with mindfulness, regulate your emotions, maintain positive interpersonal relationships, and handle distress tolerance. When you learn these DBT skills, you'll be able to practice them every day and use them in your life.
Why Choose DBT?
DBT isn't just for people living with Borderline Personality Disorder. It was developed for people who have BPD to help with emotional regulation and maintaining interpersonal relationships, but since the time of its creation, DBT has been used for many different kinds of mental health issues including anxiety, depression, eating disorders, and more. Nearly anyone can benefit from learning DBT skills. If you're seeking to regulate your emotions, handle distress or impulses in a more productive way, communicate better in interpersonal relationships, gain a better self-image, or manage the thoughts that come with conditions like depression or anxiety, DBT is an excellent choice for you. Whether you decide to work with a therapist in your local area or find someone who can help you with DBT skills online here at BetterHelp, DBT is a great form of therapy to engage in to get well.
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