According to the World Health Organization, more than 7 lakh people die every year due to suicide. Suicide is associated with numerous psychological disorders, particularly borderline personality disorder and major depressive disorder. To treat these disorders and to reduce the occurrence of self-harm and suicides, a specific type of psychotherapy called Dialectical Behaviour Therapy (DBT) is used. DBT is known as the “gold standard” for borderline personality disorder.
Background of Dialectical Behaviour Therapy
Developed by Marsha Linehan in the 1980s, DBT draws from the essence of Cognitive Behaviour Therapy (CBT) but goes on to include psychosocial aspects of therapy. Like CBT, DBT also helps clients address and change dysfunctional thought and behaviour patterns. However, DBT expands its focus to include collaborative relationships that offer support for the clients and help them learn skills that could enhance their everyday lives. Another important feature of DBT is that it is focused on acceptance and change.
The term “dialectical” in DBT refers to the acknowledgement and acceptance of two opposing ideas or forces, often through a constant Socratic dialogue with oneself and investigating the truth of these ideas and forces thoroughly. DBT is particularly helpful for clients diagnosed with borderline personality disorder, but can also be used in treating individuals with suicidal thoughts and tendencies to engage in suicidal or self-harm behaviours.
DBT is also used to treat other mental disorders such as substance abuse, eating disorders, post-traumatic stress disorder, general anxiety disorder, and obsessive-compulsive disorder. In other words, DBT helps in treating any mental disorder or psychological condition that involves emotional dysregulation, that could be traced back to biological factors and adverse childhood experiences.
Stages of Dialectical Behaviour Therapy
The process of Dialectical Behaviour Therapy could roughly be categorized into four stages.
- Stage 1: At the beginning of DBT, the most serious issues and self-destructive behaviours are addressed. These behaviours include self-harm and suicidal tendencies.
- Stage 2: In this stage, issues affecting the client’s quality of life and daily functioning are addressed.
- Stage 3: In this stage, issues associated with the client’s self-esteem and interpersonal relationships are addressed. At this stage, the client also learns to improve their self-esteem and the quality of their interpersonal relationships.
- Stage 4: At this stage, the therapist assesses if the client can transfer the skills they have learned at therapy into their daily life. This generalizing capability would ensure that the client can deal with their life and get the most out of it.
Components of Dialectical Behaviour Therapy
There are four components to DBT: individual weekly therapy sessions, group skill training sessions, phone consultation and therapist consultation team.
1. Individual weekly therapy sessions
At the beginning of Dialectical Behaviour Therapy, the client and the therapist start with a one-to-one session where they address and discuss the most serious issues. The six key areas addressed in the individual sessions are parasuicidal behaviours, behaviours that interfere with therapy, behaviours that interfere with the client’s quality of life, behavioural skills acquisition, post-traumatic stress behaviour, and self-respect behaviours.
As the therapeutic alliance progresses, the client attends individual therapy sessions every week wherein their weekly progress is reviewed. These individual sessions also provide a safe space for the clients to confide in, feel accepted and receive validation.
2. Group skill training sessions
Individuals receiving DBT often struggle to maintain healthy interpersonal relationships, tolerate distress, and manage their emotions safely and securely. This is where the group skill training sessions help. In these sessions, individuals undergo training in four main modules namely interpersonal effectiveness, distress tolerance, emotion regulation and mindfulness.
Read More: DBT For Teenagers
Fostering interpersonal effectiveness can help individuals be assertive while interacting with others in potentially distressing situations. In such scenarios, the skills they learn in the interpersonal effectiveness module will help them put their points and voice their opinions while still maintaining their relationship with the other person.
This module helps individuals accept reality without getting distressed. Skills taught in this module help deal with crises in a healthy manner. Some skills taught in the distress tolerance module include:
- Pros and cons analysis: Thinking about the pros and cons of a distressing situation would open one’s perspective to the potential lessons that the situation offers.
- Distraction: For example, one can distract oneself from destructive thoughts and emotions by engaging their body through physical activities
- Improving the moment: This strategy involves actively looking for and engaging in opportunities that would improve the present moment.
- Radical acceptance: This includes accepting what one cannot change and focusing more on what one can change.
- Self-soothing strategies: This also includes using bodily sensations to soothe oneself.
- Spirituality and visualization are also potential strategies to deal with distressing situations.
This module directly deals with one of the major issues of individuals undergoing DBT. The steps and strategies taught in this module include:
- Increasing positive emotional events
- Identification and labelling of emotions
- Acting opposite to undesired emotions
- Identification of the obstacles to changing undesired emotions
- Reducing the tendency to be vulnerable to the “emotional mind”
Mindfulness is typically known as ‘being in the here and now’. In the DBT skill training sessions, mindfulness skills are categorized into “what” skills and “how” skills. “What” skills represent what the individual is focusing on. It could include the present, their awareness of the present, their emotions, thoughts and sensations, and their effort to separate emotions and sensations from their thoughts. “How” skills answer the question of how to be more mindful.
3. Telephone consultation
Since the clients in DBT are at a high risk of suicide and vulnerable to crises, they require immediate help. However, these individuals do not ask for help fearing invalidation and instead resort to self-harm. At other times, they might ask for help in such a manner that others feel manipulated or abused. This necessitates telephone consultation with the therapist, whenever the client needs it. The clients are more likely to seek help from their therapist because the trust has already been established and they feel validated.
4. Therapist consultation team
Often, DBT is facilitated not by a single therapist but by a team. This team meets up every week and discusses the progress of their clients. This team also provides a platform for professional support and guidance, considering the highly stressful and challenging nature of working with patients, particularly those with borderline personality disorder.
Together, these four components equip the clients with transferable skills to deal better with their destructive thoughts and behaviours. The therapists also feel supported as they work in a team environment. Therefore, DBT is worthwhile and rewarding for both the therapists and clients, despite its challenging nature.
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