East meets West in dialectical behavior therapy
Monday, May 08, 2017
Back in the 1980s, psychologist Marsha M. Linehan struggled with her borderline personality disorder patients. They are some of the hardest clients to gain behavioral control and improve their quality of life.
Traditional cognitive and behavioral therapies failed repeatedly, so Linehan decided to combine aspects of both, and she weaved in an Eastern mindfulness component to help bring resolution to the challenges that were being faced. With these new combined therapies, she created dialectical behavior therapy (DBT).
The term "dialectical" stems from the basis that opposites are working together. The therapist accepts the patient's current behavior and abilities, but in the same manner tries to teach new behavioral skills.
DBT focuses on enhancing capabilities, building motivation and skills, and teaching and strengthening coping skills. Four behavioral skills are taught:
- mindfulness (living in the moment)
- distress tolerance (not changing the situation but learning to tolerate it)
- interpersonal effectiveness (asking what you want and learning to say "no" with self-respect)
- emotional regulation (learning to change the emotions you can)
DBT also features four stages of treatment.
In the first stage of DBT, the client is stabilized, changing suicidal risk and life-threatening behavior into control, and dealing with behaviors that interfere with the quality of life.
Several modes of therapy are utilized in this stage:
- individual (to work through obstacles that arise)
- group (to learn new behavior and communication skills)
- telephone ( to deal with in-the-moment coping skills for difficult situations)
- therapist support (to motivate and support the provider in the patient's treatment).
The first stage lays the foundation work for the success of the other stages; the patient can only move into Stage 2 when Stage 1 is complete, and behavior issues are in control.
The second stage deals with experiencing emotions and reducing the trauma associated with them. Past traumas may be explored, which is one reason the first stage is crucial. Dysfunctional and negative behaviors, thoughts and concepts are recognized and discussed.
In Stage 3, the patient learns problem-solving in the real world and how to work on changes that improve the quality of life by achieving self-worth, self-respect and trust in self. Patients also become accountable for the actions they take in life and how that affects the quality of their life.
The final stage is to get rid of the feeling of incompleteness and achieve joy; gaining a sense of achievement and feeling connected and worthy.
Linehan's use for DBT may have started with borderline personality disorders, but DBT is now used as a form of treatment regime for other mental health disorders — traumatic brain injury (TBI), eating disorders, certain mood disorders and even sexual abuse survivors and addiction recovery.
The skills and mechanisms for coping are beneficial to the whole population. When we learn to recognize negative behaviors and how those behaviors affect our lives, we learn how to flow through life with the knowledge of these behaviors and how to cope successfully with them. This results in a healthier population of people.
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