Dialectical Behavior Therapy

Today I wanted to write about Dialectical Behavior Therapy or DBT for the treatment of anxiety and depression.  DBT was created to address high levels of emotional reactivity through the use of specific emotion regulation skills.

The term “Dialectical” refers to the integration of opposite or divergent points of view.  Some assumptions about reality from a dialectical perspective include the idea that one thing is connected to everything else, that change is both constant and inevitable, and things that seem opposite can in fact be integrated to form a closer approximation of the truth.

DBT combines Western Cognitive Behavior Therapy interventions with Eastern concepts of mindfulness and acceptance.  Mindfulness is a core concept of DBT derived from Buddhism, even though DBT itself does not adhere to specific religious or metaphysical concepts.  Mindfulness refers to the ability to pay attention in a non-judgmental fashion to the present moment while still maintaining perspective.  While this may sound easy in principle, accepting daily life experiences in a calm non-judgmental fashion is in fact quite challenging.

This is what DBT therapists really think about DBT >>

Dialectical Behavior Therapy was developed by Marsha Linehan in 1993.  Originally, she created DBT for people with Borderline Personality Disorder and individuals with self-harm behaviors and suicidal ideation.  At the time clients with Borderline Personality Disorder or BPD were highly stigmatized by people in the mental health profession.  It is not unusual for clients with BPD to struggle with an additional diagnosis such as depression, bipolar disorder, PTSD, eating disorders and alcohol and drug problems.  When Dr. Linehan first tried to use standard cognitive behavioral therapy treatments alone with this challenging population she found that it was insufficient to reduce the emotional reactivity that persisted over time.  Marsha Linehan deserves a lot of credit for coming up with a specific manualized treatment for people with this diagnosis. CBT and DBT are different types of therapy though.

While difficult to accept, negative emotions such as guilt, sadness, fear and anger are a normal part of life.  Even so, certain individuals are more inclined to have intense and frequent emotional reactions to everyday stressors.  Some people are just more inclined to have stronger emotions, just as empaths are more attuned to the feelings of others than the average person.  Standard psychotropic medications may not be enough to adequately deal with the ups and downs of life which leads to emotional vulnerability.  Someone who is emotionally vulnerable may have quick, intense, and out of control emotional reactions that make it hard to function.  When in combination with an invalidating environment, feelings of frustration may build up that increases the potential for violence.  An invalidating environment is one in which someone is unable to be treated in a way that conveys the proper attention, respect and understanding for their needs.  Sadly, much of society remains invalidating or insensitive toward people with mental health problems.

DBT Group Therapy >>

The concepts of DBT are especially applicable during these tumultuous times.  Over 500,000 Americans died in 2020 from the Covid-19 virus.  The recent surge in cases of Covid19 prevented many people from spending time with friends and family over the Christmas and Hanukkah holidays.  Expressions of grief and despair from the loved ones of deceased family members have been enormous.  Calls to suicide hotlines increased 6 times compared to the rate prior to the Covid-19 pandemic.

Years from now people will ask us, “How did you cope with the global pandemic?”.  When applying DBT concepts to the events of 2020, the first and foremost one is mindfulness.  Being aware of the stress and anxiety that is present in such trying circumstances is important.  In DBT the goal is to use coping skills to deal with life changes and stressors while also realizing there are many things that cannot be changed.

Dr. Linehan coined the term “Radical Acceptance” from DBT.  This is the idea that even in the face of great setbacks and personal tragedy we can still learn to stay calm and accept things as they are.  DBT does not invalidate or minimize the importance of grieving.  Instead the goal is on coping with difficult emotions and “weathering the storm” of difficult circumstances.  Has your environment in 2020 been supportive or invalidating?  Have you sought out the comfort of support from others or isolated in response to the global pandemic?  Covid-19 exposed great economic and psychological vulnerability that was present even in more normal times.

Often times people will attempt to comfort others in times of grief by saying in response to the event, “There has to be a reason for it”.  This reflects the Western belief that for every action there is a reaction and for everything that happens there exists a corresponding cause or reason.  For people that are comforted by this belief there is no judgment.  For others, adhering ridgidly to such an idea only results in more anger and frustration.  From an Eastern or Buddhist perspective there does not need to be a cause or reason.  The goal is on acceptance rather than finding a deeper reason or explanation.  This can be a far healthier approach in the face of a pandemic, natural disaster or serious accident.

Various doctors express the need for therapy nearby, here’s more information on finding a DBT therapist near you.

Effective coping skills for this time as well as the future involve maximizing awareness and the use of emotion regulation skills through such things as relaxation training and meditation and TIPP skills.  Recognizing people in life who are supportive and accepting as opposed to critical and judgmental is especially important.  Tough times ultimately reveal character and determine those that are supportive as opposed to those who are not.  It is certainly a challenge to find healthy distractions such as music, reading, art or writing in a journal to alleviate symptoms of depression and anxiety during periods of prolonged isolation.  Finally, limit or minimize exposure to television and social media that can heighten symptoms of anxiety and depression.  In the current polarized political environment it is critical to take breaks and not get swept up in coverage of events that are often sensationalized.

I hope that you have found this article helpful.  Please contact me if you have any questions or comments.

The information on this page is not intended to be a substitution for diagnosis, treatment, or informed professional advice. You should not take any action or avoid taking any action without consulting with a qualified mental health professional. If you are in a crisis or any other person may be in danger,  these resources can provide you with immediate help:
Suicide and Crisis Lifeline 988
24 Hour Suicide Prevention Lifeline 1.800.273.8255
Crisis Text Line Text TALK to 741741