Dialectical Behavior Therapy: History and Development, Use for Borderline Personality Disorder, Controversies
16th October 2023
Dialectical Behavior Therapy (DBT) was developed by Dr. Marsha Linehan, a psychology researcher at the University of Washington, and was originally created to help people struggling with suicidal ideation. It is a useful therapy for persons who are struggling with handling their emotions. The National Association of Cognitive Behavioral Therapists includes DBT as a subset of the more general classification of Cognitive Behavioral Therapy. Other therapies under the heading of Cognitive Behavioral Therapy are, Rational Emotive Behavior Therapy, Cognitive Therapy, Rational Behavior Therapy, Rational Living Therapy, Schema Focused Therapy.
DBT combines several approaches, including standard cognitive-behavioral techniques for emotion regulation, as well as mindful awareness and distress tolerance. Some of the approaches incorporated in DBT are derived from Eastern meditative practice. DBT is used primarily in the treatment of Borderline Personality Disorder (BPD), but, as The American Institute for Cognitive Therapy explains, it has also been adapted and found useful for a wide range of psychological difficulties, including persons who struggle with emotions but who do not meet the criteria for BPD, as well as those with eating disorders.
DBT combines standard cognitive-behavioral techniques for emotion regulation and reality-testing with concepts of mindful awareness, distress tolerance, and acceptance largely derived from Buddhist meditative practice. DBT is the first therapy that has been experimentally demonstrated to be effective for treating BPD.
Research indicates that DBT is also effective in treating patients who represent varied symptoms and behaviors associated with spectrum mood disorders, including self-injury.
DBT treatment usually entails a weekly one and one-half to two and one-half hour skills training group, as well as weekly individual DBT therapy.
Skills training in DBT includes lessons in,
Part of the purpose is to help you learn to be in tune fully with the moment, as an effective means of managing emotions. In this way, as crises arise, rather than interpreting them as being worse than they are, individuals learn to deal with the crisis at hand, rather than an imagined worse-case scenario. DBT endeavors to help individuals meet objectives in relationships positively and pro-actively.
Linehan created DBT in response to her observation of therapist burnout from difficulties with patient motivation and cooperation with standard therapies. She started to develop her concepts when recognizing that those patients who struggled with suicidal ideation often had been raised in oppressive and invalidating environments. Unconditional acceptance was of necessity.
Her version of unconditional acceptance derived from Thich Nhat Hanh's metaphysically neutral version rather than Carl Rogers' humanistically "positive" version. Thich Nhat Hanh was a Vietnamese Zen Master, poet, peace and human rights activist. "Mindfulness," in particular, is associated with the Zen philosophy of Thich Nhat Hanh. Along with that was the necessity of enlisting the support of her patients, that is, their willingness to commit to change and participate in therapy.
Elements of Eastern religion and Zen Buddhism are incorporated into Dialectical Behavioral Therapy. Photo: Buddhist monk. Tevaprapas MakklayLinehan united commitment to the core conditions of acceptance and change through the Hegelian principle of dialectical progress, in which thesis and antithesis - synthesis, and proceeded to assemble a modular array of skills for emotional self-regulation. Hegel was a 19th century philosopher who focused upon history and logic, a history in which it sees, in various perspectives, that "the rational is the real" and a logic in which it sees that "the truth is the Whole."
Therefore, the philosophy behind DBT derived from both modern Western psychology, such as Cognitive Behavioral Therapy and what is commonly referred to as "assertiveness training," as well as Eastern philosophical influences, such as Zen Buddhist mindfulness meditation. Add to this a dash of tough love, and this amalgamation of practicality, modern psychological practice, and Eastern meditation and philosophy, produced a form of treatment, that is effective for many.
The individual component is considered necessary to keep suicidal urges or uncontrolled emotional issues from disrupting group sessions
Group therapy with DBT
Skill Training Components of DBT
Four sets of crisis survival strategies are incorporated in DBT: distracting, self-soothing, improving the moment, and thinking of pros and cons. Acceptance skills include radical acceptance, turning the mind toward acceptance, and willingness, which signifies working within one's present situation, as opposed to willfulness, which is interpreted as meaning, trying to impose one's will regardless of reality.
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Possible Controversies with Dialectic Behavior Therapy - Please Note:
It has been noted that DBT has been effective for many, more effective than standard treatments, probably in large part, because of the specific training of therapists, and the intensity, specific and regularity of the treatment schedule. Also of note is the DBT treatment for Borderline Personality Disorder, does generally not include use of prescription drugs, which have not been found to increase effectiveness of the treatment.