Dialectic behavioral therapy (DBT) is utilized to treat those who are afflicted with conditions such as borderline personality disorder (BPD), bipolar disorder, post-traumatic stress disorder (PTSD), obsessive compulsive disorder (OCD), suicidal tendencies, and substance abuse. Psychologists are understanding how to help treat some of these more difficult mental problems, as affected people are learning that they can be helped and are seeking out therapy in growing numbers.
People with BPD, bipolar disorder, PTSD or OCD will usually have other psychological problems, like suicidal tendencies, drug abuse, depression and anxiety episodes. One challenge these individuals seem to share is a lack of adequate coping mechanisms to allow them to handle the daily pressures of everyday life. This unique challenge for all these individuals sometimes also prevents them from responding to more conventional approaches of psychological counseling, or cognitive behavior therapy (CBT). Modifications have been incorporated into DBT that have been shown to be much more powerful with these patients, giving them coping skills for specific problems.
Marsha Linehan, Ph.D., first came up with dialectic behavioral therapy after recognizing the minimal success rate of CBT with adult women suffering from BPD. Her studies showed that clients were frequently withdrawing from treatment or growing irritated and unengaged. She also found that professionals quite often backed off when pushing for a behavioral change if patients grew upset or emotionally withdrawn. On the other hand, patients would reward counselors with warmth or engagement if they were permitted to change the topic to one they wanted to discuss.
To address this inability to promote change, acceptance techniques were added so clients could feel better understood by their therapists. As opposed to pushing a patient to change all their actions, making them feel invalidated, several behaviors were acknowledged as very appropriate, enabling the individual to understand that not every action or response was inappropriate. They were also helped to recognize that the existing behavior was normal for their psychological condition, but was also treatable through cooperation between therapist and patient.
This not only keeps people from feeling alienated by their therapist and choosing to quit treatment, but it also significantly improves their relationship. It helps clients understand they have good judgment and prepares them to know how and when to believe in themselves. Rather than focusing on the need for change, DBT reinforces when patients make decisions that will result in change.
In order to weave in acceptance with change, Linehan also included a third set of strategies known as dialectics. In DBT, therapists and clients attempt to equalize change with acceptance, two factors that may at first seem to compete with one another. But by maintaining and combining them, both parties avoid becoming caught inside rigid thoughts and habits.
Obsessive compulsive disorder and bipolar individuals learn priceless coping skills in the course of three components of DBT: individual therapy, skills groups and phone coaching. During individual therapy, patients get a one-hour weekly appointment with the psychologist. They also go to a two-hour weekly skills group to develop the four major skill sets: mindfulness, interpersonal effectiveness, emotion regulation and stress tolerance. And unlike some other treatment options, DBT retains the presence of the therapist. Patients are asked to call their individual therapists for skills instruction prior to potentially harming themselves. The therapist then emphasizes alternatives to self-harm or suicidal behaviors.
It is not unusual for DBT to be applied in conjunction with medication. This is especially true for people with bipolar disorder, who might depend on such medicines to handle serious depression, and to help stop the extremes in mood shifts.
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