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What Is Dialectical Behavior Therapy?

DBT is a type of cognitive-behavioral therapy, also known as "talk therapy," that tries to change negative thinking patterns and pushes for positive behavioral changes. In short, DBT provides teens and young adults with the skills to effectively cope with stress, as well as:

  • Decrease conflict
  • Focus on the present and live in the moment
  • Improve relationships with others
  • Monitor and regulate emotions
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The History of DBT

DBT was developed in the 1980s by Dr. Marsha Linehan, Ph.D., when she discovered that cognitive-behavioral therapy (CBT) alone did not work as well as expected after seeing patients experience extremely intense negative emotions that were difficult to manage due to a lack of acceptance and validation from their therapist, which is essential for change.

Building on CBT principles, Dr. Linehan developed a treatment with added techniques that would meet the unique needs of patients, now known as DBT.

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How Does Dialectical Behavior Therapy Work?

The term “dialectical” refers to the idea that two opposing ideas can be true at the same time. Using this approach to therapy, in DBT, there is always more than one way to approach a situation. The therapist works with seemingly opposing strategies, which are to accept your child exactly the way they are and at the same time, work toward changing negative behaviors.

While CBT and DBT are similar in many ways, DBT adds a focus on acceptance and validation along with efforts to change. The therapist works to balance out acceptance and change while working to gradually teach new skills, such as distress tolerance, emotion regulation strategies, interpersonal effectiveness and mindfulness, all of which will help your child cope more effectively in their everyday life.

DBT Treatment Targets

Preteens, teens and young adults who receive DBT typically have multiple issues that require treatment.

So, DBT uses a hierarchy of treatment targets to help the therapist determine the specific order in which issues or problems should be addressed.

  • 1

    Life-Threatening Behaviors

    First and foremost, behaviors that could lead to your child's death are targeted, including: suicide communications, suicidal ideation and all forms of suicidal or non-suicidal self-injury.

  • 2

    Therapy-Interfering Behaviors

    This includes any behavior that interferes with your child receiving effective treatment such as: canceling appointments or coming late to sessions, or not being open to working toward treatment goals.

  • 3

    Quality of Life Behaviors

    This includes any other type of behavior that interferes with your child having a reasonable quality of life – such as: disorders, financial and housing crises or relationship problems.

  • 4

    Skills Acquisition

    This refers to the need for your child to learn new skillful behaviors to replace ineffective or negative behaviors helping them achieve their goals.

Dialectical Behavior Therapy Skills

Your child learns DBT skills from four behavioral skill modules, with two acceptance-oriented skills (distress tolerance and mindfullness) and two change-oriented skills (emotion regulation and interpersonal effectiveness), defined as follows:

 

Distress Tolerance

How to tolerate pain in difficult situations,
instead of changing it.

Mindfulness

How to be fully aware and present in each moment.

 

Emotion Regulation

How to change emotions and decrease the vulnerability to any painful emotions needing to change.

Interpersonal Effectiveness

How to ask for what is wanted and practice saying “no” while maintaining self-respect and relationships with others.

 

These DBT skills allow your child to effectively cope with and appropriately handle stressful situations rather than responding in a negative or self-destructive way, especially for those who may have a tendency to self-harm or who are suicidal.

 

Types of DBT Settings

DBT Individual Therapy

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Individual therapy consists of one-on-one treatment sessions between your child and a therapist and is focused on enhancing motivation, reviewing and working through issues your child experienced over the prior week, emphasizing problem-solving behavior and the application of DBT skills within their daily life. Additional areas of discussion may include learning how to address obstacles that might arise down the road and working toward ways to improve basic social skills and their life in general.

DBT Phone Coaching

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Phone coaching allows your child to call their therapist in between individual therapy sessions to receive coaching at the times when they need help the most. Phone coaching is focused on providing in-the-moment coaching to assess the situation, identifying effective and feasible goals for coping with the moment, and making a plan on how to utilize the skills they’ve learned to navigate difficult situations that arise in their everyday lives.

DBT Skills Training

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DBT skills training is typically delivered in a group format and is focused on enhancing your child's capabilities by teaching them behavioral skills. The group is run like a class where the group leader teaches the skills and assigns homework to your child to practice using the skills in their everyday lives.

 

These DBT skills allow your child to appropriately cope with and effectively handle stressful situations rather than responding in a negative or self-destructive way, especially for those who may have a tendency to self-harm or are suicidal.

The Effectiveness of Dialectical Behavior Therapy

According to the National Institutes of Health (NIH), DBT has been proven to be an effective treatment in controlled clinical trials and is known as the gold-standard first-line treatment for borderline personality disorder (BPD) today.

While the majority of research to date has focused on the effectiveness and success rates of DBT for people with borderline personality disorder (BPD) who struggle with thoughts of self-harm and suicide, research also suggests that DBT has been successful in the treatment of many different conditions. DBT has successfully treated teens and young adults who have difficulty regulating emotions, have unstable relationships or exhibit impulsive behaviors, including:

  • Anger Issues
  • Anxiety
  • Attention-Deficit / Hyperactivity (ADHD)
  • Depression
  • Hopelessness
  • Post-Traumatic Stress (PTSD)
  • Self-Harm
  • Substance Use

DBT can bring about improvement for preteens, teens and young adults who have complex and severe disorders that may seem hopeless and usually resist treatment.

Evidence that DBT is helpful is seen in reduced self-injury and suicidal behavior, reduced hospital visits and inpatient stays, improved social functioning and in being less likely to drop out of treatment.

How to Tell If DBT Is Right for Your Family

The best way to figure out which type of therapy treatment is best for your family is to talk with one of our mental health professionals. They will consider the symptoms, treatment history, and goals you outline for you and your child, as well as recommend the best next steps specific to your situation.

If you think DBT may be an effective treatment for your family, we'd like to invite you to contact us and speak with one of our DBT therapists at Embark.

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