Introduction to Dialectical Behavior Therapy

Dialectical Behavior Therapy

Introduction

Dialectical Behavior Therapy (DBT) is an innovative treatment which combines cognitive-behavioral therapy with dialectical perspectives and Eastern practices. Developed by Dr. Marsha Linehan at the University of Washington as a treatment approach for individuals diagnosed with borderline personality disorder (BPD), DBT addresses problems in regulating emotions, thinking and behavior. DBT is currently the only psychosocial treatment that has demonstrated efficacy in treating BPD.

Emotions

Heightened emotional sensitivity
Quick and intense emotional reactions
Slow return to baseline (normal) mood
Chronic problems with depression, anxiety, anger or anger expression

Thinking

Extreme (black or white) thinking
Poor self image and unstable sense of self
Difficulty with problem-solving and decision making
Problems with "detached" thinking, ranging from mild inattentive states to episodes of complete dissociation
Difficulty with attention and concentration.

Behavior

Repeated suicide threats or attempts
Self-harm behavior such as cutting or burning
Aggressive behavior
Impulsive and potentially self-damaging behavior in areas such as binge eating and purging, alcohol or drug abuse, high-risk sexual activity, shoplifting, gambling or spending sprees.
Problematic interpersonal behaviors related to fears of rejection or abandonment by others

The Portland DBT Program is organized into three stages, beginning with a pre-treatment stage of assessment and orientation. Each stage is designed to achieve a set of clearly defined treatment goals. Time spent in any one stage is variable and depends on goal attainment and stabilization.

Pre-Treatment: Assessment and preparation are addressed. The goals of this stage are to (1) conduct a thorough assessment, (2) provide an orientation to treatment and (3) establish treatment goals and build commitment to working on them.

Stage One: Specific behaviors are targeted to increase or decrease. Behaviors to decrease include (1) life-threatening behaviors, (2) behaviors that interfere with progress in treatment and (3) behaviors that interfere with any chance of a reasonably good quality of life. Behaviors to increase include (1) the use of skills taught in the skills training groups and (2) dialectical (balanced) thinking and behavior patterns.

Stage Two: Emotional suffering is targeted at this stage. Problems with emotional avoidance, chronic problems with depression or anxiety, or posttraumatic stress disorder are all targeted at this stage.

Stage Three: The focus in stage three is on (1) improving adaptive skills in living and relating to others, (2) improved self-respect, (3) generalization and maintenance of treatment gains, and (4) relapse prevention.

For more information on DBT, we refer you to the following review articles:

Dialectical Behavior Therapy (DBT) for Borderline Personality Disorder, by Marsha Linehan, Ph.D.

Treatment of Borderline Personality Disorder Using Dialectical Behavior Therapy, by Thomas Lynch, Ph.D. and Clive Robins, Ph.D.

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