Developed in the 1980s by Dr. Marsha Linehan, a psychology researcher at the University of Washington, dialectical behavior therapy is a modified form of Cognitive Behavioral Therapy (CBT) originally created to treat borderline personality disorder and later extended to other mood and behavioral disorders.
Since that time, studies conducted have shown tremendous hope for people who have medicine-resistant mental health challenges.
This approach by therapists at MCS balances teaching acceptance and promoting change.
“The dialectical means two things can be opposite and still co-exist at the same time,” says Cyndi Koch, PsyD. “For instance, you can be doing the best you can, and you still can do better.”
DBT helps people learn and implement four skills to create what they determine to be a life worth living: mindfulness, the ability to tolerate distress, the ability to regulate emotions, and healthy communication skills.
The mindfulness component—in-the-moment awareness of thoughts, feelings and behaviors—is at the core of DBT. It is an acceptance-based skill.
Learning to tolerate distress is about learning to resist impulsive decision making and/or making the situation worse. Emotion regulation and interpersonal effectiveness are change-oriented skills.
Koch says the first “teaches people to more clearly identify their emotions so they can break them down and recognize what’s happening much sooner. Then they can use skills to mitigate that, instead of going from zero to 100—and then being in a manic phase.”
When people see the effects of less impulsive mood management, they feel better about themselves. They’re able to clarify what they need from others and learn how to act in a way that does not damage relationships or compromise themselves.
FINDING THE MIDDLE PATH
MCS therapists who use DBT have seen a significant change in clients. Because the method includes learning several techniques, including mindfulness meditation and cognitive approaches that are somewhat philosophical, it is a psychoeducational approach. Besides practicing mindfulness meditation, occasionally clients are encouraged to use their own DBT workbook in addition to individual sessions with a therapist, to ensure they can easily incorporate these tools in their recovery.
Mindfulness can sound like a trend or a cliché phrase nowadays, but it serves as a readily available way to ground ourselves in the present. MCS Founder, Julie Canterbury says, “It’s more than just paying attention. It’s being acutely aware of everything around you, of being in the present moment and being accepting of it.”
Therapists Rebecca Williams and Kaitlyn Speer utilize DBT regularly with those struggling with “black and white thinking”. Each has a history of helping people who have difficulty with emotional regulation or are exhibit self-destructive behaviors (eating disorders and substance use disorders).
The creator of DBT, Marsha Linehan, was a suicidally depressed person before she combined what she thought might help.
The skill that can increase mood management and even boost confidence is called the DEAR MAN technique, which is an acronym for:
- Describe– Describe the situation using only the facts. For example, “You have asked to borrow money from me for lunch every day this week.”
- Express– Express how you feel about the situation, using “I” statements. Don’t expect the other person to be a mind reader. “I feel like I’m being taken advantage of. I can’t afford to loan you money every day.”
- Assert– Assert your needs and wants. Be clear and say no if necessary. “I want to help you, but I cannot keep loaning you money. I need you to pay back the money you owe me.”
- Reinforce– Reinforce your request by telling the person what they will gain from complying with you. “Please pay back what you owe me. Then you won’t have this debt hanging over your head anymore.”
- Mindful– Be mindful and calm. Keep asserting your position and don’t let the other person distract or attack you.
- Appear confident– Keep your tone steady and assertive, maintain eye contact as appropriate, have good posture, and don’t fidget.
- Negotiate– Be willing to negotiate if necessary. Ask the other person what their solution is; if they are unwilling to agree to yours.
Most people practice, practice, practice DEAR MAN with their therapist or role play with a safe friend. Most important – make it your own – put it in your own words.
TIPS FOR SUCCESS
If you’re considering trying out dialectical behavioral therapy, there are a number of ways to make this therapy as successful as possible for you. The biggest indicator of success: willingness to practice and implement the skills.
“For DBT to be a successful form of treatment, you have to be committed to practicing the skills, not just learning them,” says Gollick, who suggests committing to at least nine months of therapy to start. “When integrated into your personal life, these skills take effect and you will have positive rewards for your commitment. If you just intellectualize the skills but do not practice, they likely will not help to make the changes you set out to make.”
When it comes down to it, you need to be willing to make yourself open to different ways of thinking and of living. It will be uncomfortable, challenging, and even painful at times, but it will be worth it.
Workbooks on DBT include the following:
The Dialectical Behavior Therapy Skills Workbook, Matthew McKay
The Dialectical Behavior Therapy Skills Workbook for Anxiety: Breaking Free from Worry, Panic, PTSD and Other Anxiety Symptoms, Alexander Chapman
Dialectical Behavior Therapy: DBT Becomes Simple, A Self-Help Workbook To Overcome Borderline Cognitive Anxiety Using Dialectical Behavior Therapy, Shawn Arris