Dialectical Behavior Therapy: A Comprehensive Guide to DBT and Using Behavioral Therapy to Manage Borderline Personality Disorder

By Christopher Rance

DIALECTICAL BEHAVIOR THERAPY
 

This book covers the topic of Dialectical Behavior Therapy, or DBT. Inside, you will learn all about the history of DBT, the four modules that it teaches, and the large number of disorders that it can be used to treat, including borderline personality disorder. 
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• Language: English
• Publisher: Ingram Publishing
• Release date: Dec 26, 2019
• ISBN: 9781761031724

Book preview

Introduction

Thank you for taking the time to read this book on Dialectical Behavior Therapy.

This book covers the topic of Dialectical Behavior Therapy, or DBT. In the following chapters, you will learn all about the history of DBT, the four modules that it teaches, and the large number of disorders that it can be used to treat, including borderline personality disorder.

You will soon discover the different applications of DBT and gain an understanding of not only how it is implemented, but also, why it works.    

It is my hope that through this book, you will gain a better understanding of human emotions, and the mental health disorders that are becoming increasingly prevalent in modern society.

If after reading this book you decide that DBT is something you would like to pursue, then I strongly encourage you to speak to a therapist or medical professional about beginning treatment. As you will soon find out, Dialectical Behavior Therapy can be truly life changing. 

Once again, thanks for choosing this book. I hope you find it to be helpful!

Chapter One: What is DBT?

DBT is short for Dialectical Behavior Therapy. This form of therapy is most effective when implemented alongside cognitive behavioral therapy or CBT; however, the two are very different. The goal of DBT is to replace negative thinking patterns and behaviors with positive thinking patterns and behaviors. DBT is primarily used for people with eating disorders and helps them learn to regulate their emotions, build self-management skills, reduce anxiety and stress, live in the moment, improve personal relationships, and control destructive eating habits.

In addition to eating disorders such as bulimia and anorexia, DBT is also used in the treatment of other mental illnesses such as anxiety, borderline personality disorder, and substance abuse (addictions). It helps patients that have self-destructive habits. It can also help treat people with post-traumatic stress disorder, or people that show severe signs of depression and want to harm themselves or others.

When an individual is undergoing DBT, they will typically partake in three therapeutic settings:

A classroom where the individual is taking tests, completing assignments, and role-playing ways to interact with other people.

One-on-one professional therapy where the skills learned are confined and tailored around the individual’s personal needs.

One-on-one phone coaching where the individual can contact their therapist through the phone to receive guidance on how to act or what to do at the moment.

Professional therapists who work with their clients one-on-one will often consult with their patients on a regular basis to keep them motivated and help them navigate through the complicated and complex issues they may be experiencing.

History

In the late 1980s, Dr. Marsha Linehan, a professor and researcher at the University of Washington, and her colleagues developed DBT when they discovered cognitive behavioral therapy did not work successfully in patients who suffered from Borderline Personality Disorder (BPD). Dr. Linehan and her colleagues added strategies to CBT and developed a treatment which addresses the individual needs of those who suffered from BPD.

DBT originates from a philosophical process called dialectics. Dialectics is the art of explaining or examining the truth of opinions. In this case, with DBT, the D is based on the concept that everything has an opposite, and that change only occurs when the opposing force is stronger than the current prevailing force.

Dialectics in DBT -

Recognizes that change is the only constant and is a process.

Recognizes that everything is made of opposing forces.

Combines the most important parts of the opposing factors to form a new meaning, perspective, or outcome in a particular circumstance.

Holds the Core Dialectic of: Acceptance and Change

Together, the DBT therapist and the client work to resolve contradictions between self-acceptance and change. The aim is to successfully create positive changes in the patient.

A different technique that Linehan and her colleagues created was validation. With validation, alongside the push for positive change, their patients were more likely to cooperate while showing a significant decrease in distress symptoms over the idea of change. With this approach, the therapist reflects the patients' thoughts and actions, making them feel as though what they have done or said makes sense. This makes the patient feel secure, while the therapist isn’t necessarily agreeing that the decisions made by the patient are the best approach to solving their issues.

Linehan and her colleagues created DBT for the purpose of helping people struggling with suicidal tendencies. Since it revolves around regulating your emotions and understanding your intrusive thoughts, DBT was generated under the study of cognitive behavioral therapy but is a subset of the more general classification of CBT. Therapies that exist under the CBT umbrella are: rational emotive behavior therapy, cognitive therapy, rational behavior therapy, rational living therapy, and schema-focused therapy.

However, DBT combines some of these therapies, including the standard techniques from CBT for regulating emotions, mindfulness awareness, and distress tolerance. Some of the exercises in DBT were even derived from Eastern meditative practices. DBT has been proven to be an effective, natural treatment for binge eating, depression, anxiety, and mood disorders such as major depressive disorder, bipolar, substance-induced mood disorders, disruptive mood dysregulation disorder, and borderline personality disorder, to name a few.

The Four Modules

At its simplest, DBT is the existence of opposites. People will learn the two opposite strategies of acceptance and change. They learn that their experiences and behaviors are valid and that they have to make positive changes to regulate their emotions in order to move forward through difficulties.

DBT is divided into four stages, which are defined by how serious an individual’s behaviors are:

Stage one consists of the individual being miserable with out-of-control behavior. The goal here is to get the person to become more in control of themselves, their emotions, and their behaviors.

Stage two consists of the individual feeling as if they are living a life of quiet desperation. Although their life-threatening behavior is manageable, they are still suffering. The goal here is to come out of the quiet desperation and into a life full of emotional experiences.

Stage three consists of individual learning to define their personal goals, build self-respect, and discover peace and fulfillment. The goal here is to have the person live a healthy life that balances unhappiness and happiness.

Stage four has the goal of helping the person find a deeper meaning of life through their spiritual existence.

Whether an individual takes on therapy in a group classroom setting, one-on-one in an office setting, or over the phone in the comfort of their own home, they have to implement four modules of DBT.

The four modules – core mindfulness, distress tolerance, interpersonal effectiveness skills, and emotion regulation – are designed to assist individuals in their specific needs for recovery. The intent of these four modules is to help people address their emotions such as depression, anxiety, irritability, or anger. Also, to help them with managing themselves in situations with other relationships (especially chaotic ones), acting on impulse, and dealing with stressful environments, or feelings of emptiness are what the last module works on.

Core mindfulness focuses solely on how to center yourself and focus on the present moment by paying complete attention to everything being done. Distress tolerance helps the client learn acceptance of their current situation, and they learn crisis survival skills to reduce the chances of engaging in problematic behavior. Emotion regulation skills teach the individual how to label emotions, identify problems surrounding the emotions, reduce habits based on their feelings, and increase positive emotions by changing the way they think. Finally, interpersonal effectiveness skills teach useful strategies to ask and go after what they need and want, saying no and not feeling guilty, and coping with close, bonding relationships like friends and family, or intimacy.

Core Mindfulness

Mindfulness skills are commonly taught in Eastern spiritual traditions, and the practice is a key component of DBT. Mindfulness teaches an individual to focus on what is happening in the present. Through mindfulness, individuals learn grounding techniques that help them stay focused on the present moment. If the person becomes anxious or gets stuck in a cycle of overthinking, they can use the techniques they have learned to slow down their mind and focus on what they are doing in that moment rather than on excessively worrying about the past or future.

Distress Tolerance

When emotions run high, it can become difficult to process your feelings. Distress tolerance teaches people how to self-soothe in healthy ways when they feel overwhelmed by emotions. It teaches acceptance and how to calm your thoughts and feelings when dealing with them, rather than avoiding them or becoming overwhelmed by them.

Rather than falling into destructive patterns and acting on impulse, the individual will learn how to make wise decisions about how to act when they feel these intense emotions. Crisis survival skills are taught for the purpose of the individual learning how not to engage in problematic behaviors which can make the situation worse. Problematic behaviors can include blaming or belittling others, refusing to follow rules, throwing temper tantrums