Dialectical Behavior Therapy also known as DBT, is a therapy originally developed by Marsha M. Linehan, Ph.D., a psychology researcher at the University of Washington. In DBT therapy, the client and therapist work together collaboratively. The therapist accepts and validates the client’s feelings while at the same time, discussing behaviors that need to change and providing healthier alternatives. DBT combines the standard cognitive-behavioral techniques for emotion regulation and reality-testing with concepts of distress tolerance, acceptance, and mindful awareness. Research has shown that DBT is effective in treating clients who present with varied symptoms and behaviors associated with mood disorders such as depression and anxiety as well as self-injury, impulsiveness, and anger management issues. Recent work suggests DBT’s effectiveness with survivors of traumatic experiences and chemical dependency.
One of Dr. Mestemaker’s specialties is in the area of treating trauma and she finds DBT to be an effective treatment. People can experience trauma symptoms from a variety of situations. Traditionally, when we think of the experience of trauma, we usually think of emotional, physical, or sexual abuse, and neglect that may occur in childhood. However, individuals can experience the symptoms of trauma for example from a hostile work environment, medical procedures, illnesses, bullying, and witnessing accidents. Individuals who have been traumatized may organize their lives around ways to relieve and ward off traumatic memories and reminders. DBT is a way to address these old memories and learn more adaptive ways of coping.
DBT is composed of four skills training modules that are learned during therapy: mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness.
Mindfulness is one of the core concepts behind all elements of DBT. It helps individuals accept and tolerate powerful emotions in the face of upsetting situations rather than using avoidance. Mindfulness teaches the capacity to pay attention, non-judgmentally, to the present moment, live in the moment, experience emotions and senses fully, but yet with perspective.
Distress tolerance teaches the ability to bear pain skillfully through acceptance and finding meaning for upsetting events. The goal is to learn how to recognize negative situations calmly rather than becoming overwhelmed or by using avoidance. Clients learn how to make wise decisions about whether and how to take action.
Emotion regulation helps clients decrease the frequency of intense emotions and lability while increasing overall emotional stability. Clients learn to identify and label emotions, identify obstacles to changing emotions, reduce vulnerability to emotions, increase positive emotional experiences in a way that is healthy, and learn to apply distress tolerance techniques.
Interpersonal effectiveness focuses on effective strategies for asking for what one needs, saying no, and coping with interpersonal conflict through assertiveness training and interpersonal problem solving. This module addresses situations where the objective is to create change or to resist the changes someone else is trying to achieve. The skills taught are intended to maximize the chances that the client’s goals are met while at the same time maintaining self-respect and a positive relationship with the other person.
