It’s often said that necessity is the mother of invention. And never has this proverb been more relevant than the story of Dr. Marsha Linehan and how her own mental illness contributed to the development of a groundbreaking new psychotherapy treatment called Dialectical Behavior Therapy, better known as DBT.
Marsha Linehan grew up in a big Catholic family in Tulsa, Oklahoma. Her teen years were typical and uneventful. But at 18 and heading into her senior year, the popular student became suicidal, falling abruptly into a pit of despair and depression that would take her years to escape.
Bedridden and suffering from extreme social isolation, the once-thriving teenager was admitted into the Institute for Living in Connecticut in 1961, her body a visual testament to her frequent self-harming behaviors.
During her 26-month stay for the treatment of schizophrenia, a diagnosis she now believes was actually Borderline Personality Disorder (BPD), she was heavily medicated, subjected to forced procedures, and isolated over concerns for her safety. Despite the duration and intensity of her treatments, she was discharged in 1963 with her condition virtually unchanged.
Fortunately, this was not the end of her story but the beginning of an inspirational journey towards a life worth living, free of the personal demons that imprisoned her.
A visit to a church four years after she left the institution led to an epiphany and, ultimately, the foundation of her eventual scientific therapeutic breakthrough—self-acceptance and self-love.
With determination and a renewed sense of purpose, she continued her education, eventually earning a Ph.D. in psychology with a focus on behavior therapy. Her work in the psychology field would prove to be transformative not just for herself, but for thousands like her. Her remarkable story, captured in her memoir, Building a Life Worth Living, is a testimony to the resiliency of the human spirit.
What is Dialectical Behavior Therapy (DBT)?
A form of Cognitive Behavioral Therapy (CBT), DBT is an evidence-based talk therapy treatment, developed to teach emotional and behavioral management skills through key concepts like mindfulness and self-acceptance.
It was Dr. Linehan’s work with patients who suffered Borderline Personality Disorder and the suicidal, self-harming thoughts and interpersonal problems that often come with it that compelled her to develop DBT and incorporate it into her therapy practice in the late 1980s.
During her clinical sessions, Dr. Linehan’s patients often felt that their intense feelings were being invalidated, a response that she often experienced herself during her own treatments. This distress often became a stumbling block to progress and change. Dr. Linehan set out to find a way to help her patients without diminishing their experiences, reflecting on her life-changing experience in that church so many years before.
Dialectic, a term rooted in philosophy, is defined by Merriam-Webster as an argument that juxtaposes opposed or contradictory ideas and usually seeks to resolve their conflict; a method of examining and discussing opposing ideas in order to find the truth.
At the heart of Dialectical Behavior Therapy is the integration of two seemingly contradictory philosophies.
DBT teaches the willingness to accept what is without judgment while recognizing the need for change. The former validates the existence of emotional suffering, something that was lacking in traditional therapy methods, while the latter motivates the person to adopt new behaviors and thought processes to reduce anguish and pain.
DBT works to bridge the gap between life as it is and life as it should be. This “radical acceptance,” as Dr. Linehan calls it, helps patients to:
•Regulate emotions
•Increase tolerance to stress and negative feelings
•Stay present and in the moment
•Improve interpersonal relationships
•Reduce destructive thought patterns and behaviors
•Recognize strengths
•Improve communication and listening skills
Dr. Linehan’s award-winning work has helped to transform the lives of thousands of patients in the three decades since. Today, DBT isn’t limited to the treatment of Borderline Personality Disorder, but for a variety of mental health conditions.
The Differences Between DBT and CBT
While Dialectical Behavior Therapy is a modified version of Cognitive Behavior Therapy (CBT) there are notable distinctions between them.
While both are designed to help people to understand and manage their feelings and behaviors, CBT aims to help patients avoid negative emotions; DBT teaches people to accept them while working towards needed change.
DBT is more skills-driven (mindfulness, self-acceptance) and more focused on psychosocial aspects of treatment like conflict resolution and improvement relationships than its closely related cousin.
Typically, patients participate in cognitive behavior therapy in private, one-on-one sessions with their therapist. DBT, other the other hand, lends itself to various therapy settings, including private, group, and remote outreach and, in fact, often includes all three.
How DBT Works
There are four primary skills or components taught through DBT: mindfulness, emotional regulation, distress tolerance, and interpersonal effectiveness.
DBT Cornerstone One: Mindfulness
One of the foundational skills of DBT is mindfulness, best defined as living in the moment and tuning in to present circumstances without judgment. Mindfulness practices remind us to slow down, just be, stay calm, and avoid harmful thought patterns and impulsive behaviors of the past. Meditation with a focus on breathing is a primary mindfulness practice.
DBT Cornerstone Two: Distress Tolerance
At one point or another, we’ve all come unglued and overwhelmed during stressful situations. Intense emotions are part of the human experience but learning how to prepare for them is empowering. While traditional therapy interventions work to change circumstances, DBT works to change the responses to them through acceptance and meaning. Simply put, DBT teaches tolerance and recognition of pain instead of avoidance. Common distress tolerance techniques include distractions, self-soothing and what is called improving the moment through things like prayer, breaks, imagery and relaxing activities.
DBT Cornerstone Three: Emotional Regulation
Simply said, emotional regulation helps to deal with powerful feelings—anger, frustration, depression, anxiousness—in healthy ways that are more conducive to positive experiences and healthier relationships. Emotional regulation skills associated with DBT include accurately labeling emotions, reducing susceptibility to harmful behaviors when emotions are high, as well as mindfulness and distress tolerance practices.
DBT Cornerstone Four: Interpersonal Effectiveness
Improving interpersonal behaviors and patterns are an integral component of DBT. DBT helps people develop conflict resolution, assertiveness, listening and communication skills that strengthen relationships and the capacity to deal with the inevitable conflicts that come with them. Ultimately, the goal is to ensure that needs are met in ways that do not cause harm in interpersonal relationships.
The acronym GIVE is often used as part of interpersonal effective skills training to remind patients of approaches that nurture the development of healthy relationships.
Be Gentle
Show Interest & Listen
Validate the Feelings of Others
Nurture an Easy, Light-Hearted Spirit
DBT for Mental Health Challenges
While DBT was first developed to treat patients diagnosed with Borderline Personality Disorder, particularly those with suicidal thoughts, it has become a primary therapy for other mental health conditions, particularly for people who have not responded well to other therapies.
Studies have shown DBT to be effective at producing significant and long-lasting improvements including decreasing the frequency and severity of harmful behaviors and motivating change through positive reinforcements and recognition of personal strengths.
DBT for Borderline Personality Disorder
Dr. Linehan originally developed DBT to treat those diagnosed with Borderline Personality Disorder and the harmful self-image, emotional and relationship issues that accompany it, as well as suicide ideations. Today, DBT is considered the most effective, gold-standard treatment for BPD in the behavioral health field.
DBT for Depression
With an integrative approach that combines behavioral, cognitive and acceptance therapies, DBT helps patients find relief from depressive symptoms, even when other therapies have failed, including apathy, irritability, focus and persistent sadness. The skills that are taught through it help to offset depression and foster more positive, joyful mindsets.
DBT for Anxiety
Anxiety is a natural and unavoidable part of life. But when anxiousness rises to the clinical level with incessant worry, avoidance behaviors and concentration difficulties, help is often needed. Through DBT, people can learn to tolerate negative emotions, reduce their intensity and make them more manageable. Mindfulness, in particular, helps people to focus on the here are now, not problems of the past and worries for the future.
DBT for Addiction
Dialectical Behavior Therapy has been adapted to address addiction and substance abuse and was added to the official DBT Skills Manual in 2014. It is particularly helpful in addressing relapse, which has the potential to derail recovery. While DBT encourages abstinence, it encourages patients to accept temporary failures and continue efforts to overcome dangerous and harmful dependencies on drugs, alcohol and activities like gambling, sex and shopping.
DBT for Post-Traumatic Stress Disorder
People who suffer from PTSD often have trouble controlling emotions, frequently experience troubled interpersonal relationships and can engage in impulsive, risky behaviors. Dialectical Behavior Therapy has been shown to help people diagnosed with PTSD decrease the frequency and intensity of anxiety and depression symptoms. Newly learned skills acquired through DBT help to regulate their emotions, control impulses, set boundaries, and build trust in themselves and others.
DBT Providers & Hope for Mental Health Improvement
As one of the newer modalities in the field of behavioral health, it can be a challenge to find a professional skilled and experienced in the practice of Dialectical Behavior Therapy. But Hope Therapy and Wellness in northern Virginia can help.
If you are wondering if DBT may be right for you, give us a call today.