Dialectical behavior therapy (DBT) is a form of talk therapy that emerged in the 1970s, as a way of addressing mental health that helps patients adjust to change, manage uncomfortable emotions, and handle distress. It utilizes the concept that two seemingly opposing ideas (dialectics) can be true at the same time. At Safe Harbor Recovery Center in Portsmouth, Virginia, DBT is part of the wider spectrum of evidence-based mental health treatment options we offer.
Features of DBT
Every therapy modality looks a bit different from other treatment options. The characteristics of DBT include:
- Greater focus on the current situation than the past
- More emphasis on your views on life, rather than personality traits
- Working to replace habits, thoughts, and behaviors that aren’t working for you with more effective alternatives
- Use of dialectical statements to help people find a middle path instead of behaving in extreme ways
- Validating patient feelings, even if the practitioner doesn’t share their opinion
Dialectical Statements
A key aspect of DBT is the use of dialectics, where two statements that can seem to be in conflict are accepted as true at the same time. Some examples include statements like:
- “I am doing the best that I can, and I want to do better.”
- “I made a mistake, and I am still a good person.”
- “I feel too tired to work, and I can do my work anyway.”
Who Benefits Most from DBT
DBT has similarities with other types of therapy and was developed for the purposes of helping people with borderline personality disorder (sometimes called emotional intensity disorder) to manage self-injury and suicidal behavior, but it has since also been found effective in treating other conditions:
- Depression
- Post-traumatic stress disorder (PTSD)
- Eating disorders
- Substance use disorders
What Patients Gain from DBT
DBT prioritizes four strategies:
- Distress tolerance – because you cannot always avoid stress and pain, it is important to be able to handle them without reacting in non-productive ways, like using substances, hurting yourself, or acting impulsively.
- Emotional regulation – when you recognize your emotions and allow yourself to feel them without judgment, you can learn better ways to handle them.
- Mindfulness – dwelling on the past or worrying about the future excessively takes away from a person’s ability to effectively manage their present situation, so DBT teaches patients ways to stay in the moment.
- Interpersonal effectiveness – managing relationships with other people, by asking for what you want and need, handling conflict effectively, and setting boundaries are all part of this strategy.
How DBT Sessions Work
As with other therapy modalities, DBT allows room for flexibility and customization. However, some characteristics of DBT are consistent, regardless of the practitioner or patients involved:
- Sessions are typically 1-2 hours in length and are led by one or more therapists who are trained and certified in DBT techniques. The duration of treatment is usually six to 12 months.
- DBT may be offered individually or as a group.
- Participants can be any age, but DBT has been shown to be especially effective with adolescents.
- Participants in DBT groups generally also have individual therapy sessions that they can utilize to work on individual goals and behaviors.
- Homework is assigned to reinforce skills between sessions. This often takes the form of:
- Journaling – not just writing down thoughts and feelings, but also making lists and setting goals
- Worksheets – these are often available online and can help a person work on distress tolerance, mindfulness, interpersonal effectiveness, and emotional regulation
- Practicing sensory techniques – such techniques can include focusing on what a person sees, hears, smells, tastes, and physically feels in their environment, bringing them back to the present moment
- Practitioners focus on conveying acceptance of the patient, their emotions, and their thoughts, rather than telling them how they “should” be.
How to Implement DBT Strategies at Home
A patient participating in DBT won’t magically fix their behaviors. Enforcement of DBT concepts at home can be very helpful. Loved ones can try to replace statements that tell the person how to behave or feel with statements that reflect and validate difficult feelings and offer them choices. Some examples might be:
- “You seem upset. Would you like to talk, or do you need some space?”
- “You seem sad. If you want to talk about it, I will be around.”
- “That sounds really stressful. How can I help?”
At Safe Harbor Recovery Center, our experienced staff provides compassionate, trauma-informed treatment for people who are struggling with behavioral health diagnoses, including substance use disorders and mental health conditions. We offer several treatment levels and holistic services to heal the minds, bodies, and spirits of our patients.