Dialectical Behavior Therapy

Tony
23 min readJul 4, 2022

In DBT, there are concrete skills and exercises you can use in your daily life. It is easy to understand, and you can apply it to your life in distressful situations.

Also, the exercises in DBT put mindfulness principles into concrete steps. Therefore, you will be able to see how the ideas of mindfulness can come to counter various problems.

In this post, you will learn the following:

  • What is DBT
  • How does it benefit your wellbeing
  • Essential skills that are part of DBT

What Is Dialectical Behavior Therapy?

Dialectic behavior therapy is psychotherapy for people with mental disorders. But it is also helpful for people that want to be better at reducing interpersonal conflicts. And valuable for people who experience:

  • Borderline personality disorder (BPD)
  • Suicidal ideation
  • Self-harming or substance use behaviors
  • Eating disorders
  • Mood disorders

Dialectic is the synthesis of opposites. It is the idea that integrating the opposite viewpoints improves understanding. A dialectical mindset that integrates polarities is a means of replacing rigid thinking.

The psychologist Marsha M. Linehan developed DBT in the 1970s. She created the technique because cognitive-behavioral therapy wasn’t as successful for BPD clients. DBT was also significant for Marsha because she struggled with mental health. She had problems with suicide and borderline personality disorder (BPD).

Advantages and Disadvantages of Dialectical Behavior Therapy

Advantages of Dialectical Behavior Therapy:

  • It helps people who have problems with mental issues. And it for providing a solution to people with borderline personality disorder (BPD).
  • It focuses on improving the patient’s life and teaches skills to cope with challenges.
  • The client will learn to set clear goals in their lives. Also, they will learn how to manage intense emotions. And as well as skills to be better at interpersonal relationships.
  • Controlling suicidal and self-harming behaviors is the priority in BDP.

Disadvantages of Dialectical Behavior Therapy:

  • It may not work for people who don’t believe they need to change. It will also be hard for them to accept therapy without motivation for change.
  • It needs a time investment from clients: The weekly group skills training sessions are 1.5–2.5 hours long. The weekly individual therapy sessions are one hour long. And you will get homework as well.
  • There are also a lot of skills that the therapist teaches in the classes.

Forms of Dialectical Behavior Therapy

There aren’t any specific forms of DBT, but there are different components of DBT:

  • Individual or groups skill training for enhancing capability.
  • Individual psychotherapy. It is for addressing motivation and skill strengthening.
  • Telephone contact with the individual therapist for handling the application of coping skills.
  • Consultation/team meeting to help therapists to provide effective treatments.

The skills training is like a weekly workshop that runs like a classroom. And it is to teach each of the four topics:

  • Mindfulness
  • Interpersonal effectiveness
  • Emotion regulation
  • Distress tolerance skills

How Do You Do Dialectical Behavior Therapy?

In dialectic behavior therapy, there are four modules and skills with each module. But there are also a ton of other exercises that it includes as well besides the skills. The four modules are mindfulness, distress tolerance, emotional regulation, and interpersonal effectiveness.

I’ll be summarizing some details for each component. And I also include resources at the end for learning more.

Mindfulness

The mindfulness component teaches the user to be more at the moment with their attention. And it gives concrete to participants to use the skill daily. Here are the skills that belong to this module:

And the What Skills and the How Skills connect. What Skills are what you do to practice mindfulness. In contrast, the How Skills are how you practice mindfulness to be effective.

What Skills: 1) Observe, 2) Describe, 3) Participate.

  • Observe: Take note of your surrounding without thought commentary. Open your senses to thoughts and emotions as they arise.
  • Describe: This part is about describing what you feel and observe. Describe out loud or write it down what you watch or feel. But make sure not to let self-judgment get in the way of your description.
  • Participate:
  1. Take what you’re doing right now, whether reading or writing.
  2. Put your full attention on the action without letting any rumination be in your mind.
  3. Let the focus be on the here and now. An example would be driving, where it is easy to let thoughts take over. And by the time you get to a destination, you are not even sure you remember driving here. So instead, focus on driving without the thoughts getting in the way.

How Skills: One-Mindfully, non-judgementally, effectively.

  • One-Mindfully: The core here is to do one thing at one time. So when you’re watching tv, don’t be eating. When you’re supposed to be writing, don’t be multi-tasking on several tasks at once. The purpose is to sustain activity without fragmented attention.
  • Non-judgementally: Whether realizing it or not, we judge others and ourselves constantly. The purpose of this step is to let go of judgment towards observations. So instead, going back to the awareness without passing thoughts on the experience.
  • Effectively: Often, the mind likes to force judgment on experiences. It tries to justify actions or results as right or wrong, which takes energy. Do the exercises or practice the skills without worrying about right or wrong.

Wise Mind:

It is a term that describes a state that integrates emotion with logic. When we react emotionally to a situation, that is the emotional mind. And when we operate with logic towards a situation, it is the rational mind. The wise mind is in the middle between the emotional mind and the rational mind.

In the emotional mind, the person reacts with anger or frustration towards problems. Leashing out emotions with impulsive will cause havoc in relationships and at work. While in the rational mind, the person only considers goals, logic, and facts. In that state, they will neglect their emotions and feelings.

When the rational mind and emotional balance together, it becomes the wise mind. It is the state of intuition and focusing attention on experiences as in a state of mindfulness. Instead of thinking of answers step by step, in the wise mind, you wait for an answer to come to you. It is also okay if no answers come to you while you wait.

Distress Tolerance

The skills in distress tolerance are to help proceed through moments of distress. And these skills help make the problems more manageable to deal with at the moment.

Accepts: It is a set of things you can use when you have difficulty with distress. It is more focused on handling thoughts of the problem disturbing you. Using the ACCEPT exercise helps move your attention away from the thought.

  • Activities: complete activities or a single activity when you feel distressed. Exercise, gardening, walking, journalizing, cooking, or hiking. It can be anything. The activity is for moving the attention from the problem to the action. Do the exercise with mindfulness.
  • Contributing: Help someone out, a friend, family, or stranger. For example, give compliments, make a gift, write a meaningful letter, or create a poem for your loved one. Making someone’s day better would help make your distress go away a little.
  • Comparisons: To compare your current distress with someone elses’. Doing this mental task will lead you to look anew at experiences. So many others have it worst than we do in the world. If they can have the strength to stand back up, I’m sure we can find that same strength.
  • Emotions: This part is about finding things opposite to your current feelings. If you feel super anxious, go for a walk while practicing mindfulness. If you feel depressed, you can watch some happy youtube videos.
  • Push away: Some stressful situations are impossible to deal with except through distraction. You can try to find tasks to do around the home. Eat comfort food (ensure not to overeat ice cream or spaghetti). Worst case, you can count back by 7s from a thousand in your head. Try to block the thought from coming up in your mind. Push it away whenever it arises.
  • Thoughts: Your mind can only focus on a single thought at a time. So, thinking of something else can help avoid the original thought. For example, you can try counting numbers backward or alphabets backward. If it isn’t too bad, you can do some crossword puzzles or sudokus.
  • Sensation: Do activities that appeal to the senses. It is where your attention is on the sensations. Some simple recommendations are taking a warm shower or watching movies. You can also listen to soothing music and keep a playlist of happy songs.

TIPP: It is four steps of activities you can do when feeling distressed. The exercise can for in a public setting, and you need an effective release from the stress.

  • Temperature: Use cold temperature to help regain control of your emotions during distress. You can use cold water or ice on your body. If you’re in a car, you could also turn on the AC so it would be colder. You can splash your face with cold water in the bathroom if you’re in a public setting. The point is that changing the temperature could help change the impulse of emotions.
  • Intense exercise: Doing intense activity may be useful when there are suicidal thoughts. You can go for a fast lap in the street, swim in a pool, or do pushups. The point is so that you will run out of energy to help distract yourself from the distressing emotions.
  • Paced breathing: Try to control your emotions by doing breathing exercises. For starters, you can start by breathing slower than your present pace. Or you can do a simple activity of breathing inward for a count of 4, holding it, and counting for 7. And breath out on the count of 8. It’s a technique used by people with insomnia called the 4–7–8 breathing method.
  • Progressive muscle relaxation: In step four, tense your muscles from the head to toe or vice versa. You don’t need to hold the tension for far too long. Hold the tightening on a muscle for like the count of 5.

Self-Soothe: Doing the steps in this exercise can help promote a sense of calmness. The good thing about the steps is that it doesn’t have to be with specific materials. You can apply it when you’re in a room or standing.

  • Vision: Find something that soothes you from looking with the eyes. You can find a nature documentary to watch, look at flowers, and go through old photos. You can also focus on particular objects in a room or the colors of the wall. The point is using your sight to focus on something other than your distress.
  • Hearing: Listen to the sound, any sound, with mindfulness. It can be your favorite music or song. It can also be the sound of someone you like if it helps soothe your anxiety and distress. Other things that might work are the sound of the ocean or nature.
  • Taste: Give yourself a special treat. You deserve to eat something nice. Enjoy with a sense of mindfulness. Let the food taste help you move past the distress you feel in the moment. If you don’t have availability of a full course meal right now, it can be some mint gum or some sweet or sour candy. You can also try some other ideas like green tea or hot chocolate. Or, with more time on your hand, you can cook yourself your favorite food or snack.
  • Smell: When experiencing emotions in the present, try to use your sense of smell. Pick up the scent in the air, whether they smell good or not. Don’t put judgment on the scent. You can also go to a place with a smell you like, such as a garden or a coffee shop. Try wearing the cologne or perfume that you want. Scented candles or a nice bath with your favorite shampoo also work.
  • Touch: Try combing your pet’s fur or playing with a fidget toy. Do something where you can feel yourself enjoying. A common suggestion includes being in a warm blanket. If you have access to water now, try to feel the sensation of moving water on your fingers. Notice how it feels as you glide your fingers on your skin softly.

IMPROVE: The point of this exercise is to help you relax from distress or a problem. It works better if you are alone and are in a comfortable setting. It is helpful when you’re feeling low-energy or upset about an issue.

  • Imagery: Envision in your mind a different situation than the one you’re in now. It could be on a warm beach or watching the green grass field in the countryside. Take your imagination somewhere to distance yourself from the current distress or present. If there are worries about the result, imagine a situation where you succeed with your tasks.
  • Meaning: Is there a different way to look and see the painful experience? Or any lessons that you can take away from what happened. Things can happen to you, or they can happen for you. You don’t have control when things happen to you. You feel hopeless. When it happens for you, you can grasp something from experiences. Finding meaning is difficult, but you can start by asking yourself to look for them.
  • Prayer: At times, problems are too overwhelming. We have tried to reason with the problems with all our human strength. You tried and fell countless times. It is time to accept that our limited strength can’t overcome the issue. Pray to a Higher Power to surrender and ask for help. Some things are beyond your control and power to deal with in life. It is okay to ask for help. Admitting your limitations is not a weakness because humility is a strength.
  • Relaxation: You can use what you learned from the activities like self-soothe exercise. The pace of life can go so fast that it can be hectic juggling expenses and responsibilities. But remember to slow down by having time for hobbies or people you care about in life. You can pick up those old hobbies you had forgotten about since you were so busy. Watch some old movies that you used to enjoy or read your favorite books you liked as a kid.
  • One thing at a time: It is hard to enjoy the present when your mind is running on two tracks. When your mind is ruminating on the past, you will forget that the present is the present because it is a gift. When your mind is anxious about an unknown future, you will forget that the next minute is not here yet. Nothing in the future is preset in stone. So do whatever is at your hand right now. Pay attention when you’re eating dinner with your family. Be mindful when having conversations with a loved one. The opportunities will not come back.
  • Vacation: Walking away from a problem might bring back an idea or solution. When encountering stress, you might lack the strength to eat or take care of yourself. If you can, try to put the problem away. Walking afar, you will find the pieces of who you were before the trauma or distress happened. Take a small break to hike to a quiet or somewhere where you can be alone if that helps.
  • Encouragement: Imagine your future self who went through the distress, encouraging you. You can also imagine saying words of encouragement to a friend. Whatever works for you. For some people, the simple act of repeating a phrase of encouragement works for them. It can be a simple phrase like, “Take it slow”/“I will be alright”/“It will be okay” to yourself.

Emotional Regulation

This module teaches how to deal with challenging emotions. Emotions come and go. They are a part of you, but not all of you. Don’t let the feelings come to define you because you are not the emotions. When these emotions arise, there’s no need to judge them for right or wrong. Emotions are emotions.

ABC PLEASE

  • Accumulate Positive Experiences: Keep a list of activities you want to do that would bring you up. Also, remember to bring your attention when doing your hobbies and not let your problem take you away. And whether it is watching a good show or reading an exciting book. If you love yourself, then make time for yourself for what you enjoy.
  • Build Mastery: It seeks activities that give you the feeling of accomplishment. It can also be a hobby that makes you feel confident because you’re making progress. If you had neglected certain tasks, it could be as simple as getting your laundry done. Or it is a task like running, where you plan on running for a longer distance. If you’re at home, it can be doing calisthenics like the number of pushups. But the activity is for gaining the feeling of accomplishment or sense of progress.
  • Cope ahead of time: Plan for what you must do when facing future distress. For example, what exercises will help when you a problem shows up? Are there specific phrases of encouragement you could tell yourself when it happens? You can start by writing yourself a little letter to read for when you have difficulties in the future. Also, creating a playlist of upbeat songs you would enjoy can help.
  • Physical illness: Poor health can exacerbate the symptoms of mental problems. If you have any medications, remember to take those medications on time. And bring a bottle of drink water when you are going to be thirty on a trip.
  • Balance eating: Use your judgment when deciding what food to ingest. Don’t eat food you know will cause a stomach issue or overeat.
  • Avoid mood-altering substances: Avoid taking drugs or alcohol. They will make it harder to cope with problems that may arise. If drugs or alcohol presents a problem in your life, can you get some help to cope with it?
  • Balance Sleep: It is hard to get by and work to your best on insufficient sleep. It reduces your effectiveness in handling emotions and issues that come up.
  • Get exercise: You don’t have to do strenuous activities to start. You can do something simple like walking in your neighborhood. Enough exercise that helps you stretch your body from all the sitting.

Opposite to Emotion Action: Take actions opposite to your distress emotions. For example, if you’re feeling depressed, you can try reading a book instead of sleeping it through. And when you’re sad, you can try listening to soothing music instead of crying and being in your head. Don’t take the most immediate reaction to an emotion. Instead, slow down and do something opposite to the feeling to counteract it.

Interpersonal Effectiveness

DEAR MAN: The DEAR MAN exercise helps you better communicate your needs to another person. So often assume that people know what we want in a conversation. But many confusions arise from a misunderstanding between two people.

  • Describe: Explain the situation to the other person without blaming any involved party. Tell the person the facts of the case.
  • Express: Express how you feel about what happened or your thoughts on the case. In DBT, they teach people that, in most cases, the person doesn’t know how you feel. So in this step, you can tell them openly how you feel.
  • Assert: Assert yourself by describing what you want straightforwardly. Don’t let there be any room for any other interpretations. Don’t be afraid to say no. It makes understanding what is going through each other’s minds more straightforward.
  • Reinforce: Explain to the other person what will come from accomplishing your demand. You state clearly the results of doing what you ask of them.
  • Mindful: Mindfulness in this step means keeping the goal of your conversation in mind. Don’t let the other person’s words become a distraction from stating what you want. Instead, keep repeating what you’re asking for from them. Persist in what you’re asking for from them.
  • Appear confident: Asking for what you want can be challenging for some people. You can start by straightening your back and having a confident posture. Even if you don’t feel confident, you will at least look optimistic with a good posture. And also, make sure to slow down the rate at which you speak. There’s no need to hurry. People hurry their pace of speaking when they are feeling nervous.
  • Negotiate: If the other person disagrees with your request, try negotiating with them. Then, you can see if there is a way to create a win-win situation for both parties. You can listen to their answers if the other person disagrees with your solutions.

GIVE: The steps help you interact with people more smoothly. Essentially, the core of the exercise is about taking empathy when being with others. When you have empathy in your interactions, it helps you connect with others and shows them you care.

  • Gentle: Whether you’re with a stranger or a coworker, try to be gentle in your approach. Avoid words that appear threatening or provide harsh criticism. And remember, it is more than words, the tone of your questions and conversations matters. For example, saying something with a straight face is different than with a smile. It gives people a different feeling. Also, don’t be manipulative or guilt-trip people to do things for you. Even behind a screen, you’re conversing with a human being.
  • Interested: Staying interested is tough, and often we can lose attention when having conversations. So the first thing is to be mindful when having a conversation. Don’t let your attention be all over the place or how much you pay for rent. Nobody wants to talk with a neighbor who rants about their life for 40 minutes straight. Instead, please pay attention to the person and be curious about their life.
  • Validate: It means having empathy by putting yourself in another person’s spot. Sometimes, the advice given might not be correct or to your incentive. But restating with validation lets the other person know that you understand. It also shows them that you appreciate them for their advice even if it isn’t helpful. And it is a form of politeness.
  • Easy manner: Friendliness means smiling and having an easy-going attitude. It makes the other person feel more relaxed when talking with you. For example, it is hard to talk to someone who is always critical and judgemental. In comparison, most people would like to speak with someone who can make jokes. Easy manner means you can take yourself lightly when being with other people.

FAST: This exercise guides you on how to accept and view yourself. Also, it gives tips on how to maintain a sense of self-respect for your actions and interactions.

  • Fair: Fairness in this sense is for you to be fair to others and yourself. So in your negotiation, consider the other person’s wants and needs along with your own. And also, be honest with yourself, give yourself some slack, and don’t put yourself down. In your worst moment, you might look down on yourself. But remember, sometimes there are things beyond your control. There’s no reason to get upset at yourself for something you can’t control.
  • Apology free: Don’t over-apologize when you haven’t made a mistake or hurt another person. You don’t need to say sorry to the past when it is in the past. And for some things that have already happened, saying sorry once is enough. Likewise, there’s no point in apologizing for having an opinion.
  • Stick to values: It is easy to want to compromise on values or morals to please another person. In the face of fear or loss or chase after a desire, people often select to abandon principles. But please don’t be afraid to stick to your principles and beliefs in the face of conflict. Remember to ask your heart for the answer when confronting a difficult question.
  • Truthfulness: In the short term, you may worry that the truth will hurt how you appear to others. But in the long term, dishonesty will hurt your self-respect. And your fading self-respect will make you ask yourself one day, “Why did I tell that lie at that time?” When you accept the fact as they are, you can start making changes. Avoiding the truth of the matter never helps anybody grow stronger and better.

Resources:

Why Is Dialectical Behavior Therapy Effective?

The result of DBT may come from the skills and lessons that clients learn. It teaches patients skills that deals with many facets of their life. The exercises that you will learn can help in a range of situations.

There’s a difference between CBT (cognitive-behavioral therapy) and DBT. The first difference is the radical acceptance of the client’s capabilities and functioning. The focus on procedures of change made clients feel invalidated in CBT. With DBT, there is a focus on combing change and acceptance into client interactions.

And the different components of DBT also make the therapy more structured. Instead of doing everything, for example, teaching new skills and targeting suicidal behaviors. DBT separates individual therapy apart from skills training. Hence, in DBT, each step has different stages and goals.

What Are the Stages of DBT?

Stage 1: In this stage, addressing life-threatening or problem behaviors is essential. Patients in this stage feel like they are at the lowest point and feel hopeless about issues. It feels depressing or like being in ‘hell’ in their minds.

At this stage, it is about achieving control over behaviors. Taking control of behaviors can help patients go forward with the intervention. Also, it is hard for treatment to be effective when behaviors are interfering. So the patient needs to learn skills to manage emotions and behaviors.

  • Self-harming
  • Suicidal thoughts
  • Destructive behaviors
  • Treatment-interfering behaviors
  • Cutting themselves
  • Compulsive drinking
  • Skipping therapy sessions

Stage 2: In this stage, the patient is more stable but needs help processing emotions. It is about healing the pain from traumas or dysfunctional attitudes. It moves the patient from living with quiet desperation to a healthy space.

In this stage, the therapist might help invalidate negative self-attitudes from traumas. From traumatic experiences, patients collect and bury these challenging emotions. So the patient must remove any emotional or mental blockages to move to the next stage. And the patient needs to learn to accept and process emotional and traumatic responses.

  • Changing self-defeating thoughts
  • Removing self-blame
  • Invalidating stigmatization
  • Exploring maladaptive thoughts
  • Decreasing traumatic stress
  • Healing from trauma

Stage 3: In this stage, the patient will use the skill they learn and apply them to their everyday life. It focuses on setting reachable goals, learning self-respect, and approaching happiness. The patient learns to trust themselves as they use the lessons on the challenges in life. This stage is about improvement now that their life is under control.

  • Building self-confidence
  • Reaching individual goals
  • Learning to value yourself
  • Owning your actions
  • Creating joy in life
  • Live a functioning life
  • Managing emotions healthily

Stage 4: In this last stage, the focus is on discovering greater meaning in life. The method could be from improving on specific skills or through spirituality. But it is about transcendence and creating a greater capacity for joy. It doesn’t have to be a spiritual path to finding purpose. But it is about finding deeper purpose and meaning in life.

  • Discovering greater meaning
  • Having a purpose
  • Ongoing capacity for joy
  • Improving on skills
  • Deeper meaning

What Is Radical Acceptance in DBT?

Radical acceptance in DBT is accepting the facts and terms of reality. It doesn’t mean being happy about what happened. It means taking things as they are.

And there will be things that don’t go your way, and getting angry won’t solve it. Radical acceptance means letting go instead of letting yourself become trapped in the situation.

Accept that it is what it is. There’s no reason to contemplate or get depressed. Instead, there is the choice of staying miserable or accepting the pain when you can’t solve it.

When you can’t change the past or a situation, you can still change how you feel about it. People are not at fault for many of their painful experiences that have nothing to do with them. There’s nothing they had done wrong to deserve the pain.

It is the unfortunate responsibility of having to live through it. But it doesn’t mean you have to accept the story, and you can still build a new story and a new life. Rejecting the pain will only bring further suffering. Acceptance doesn’t mean you have to approve. It means it is what it is, and you can move on from the pain.

Does DBT Help with ADHD?

College students with ADHD participating in the DBT program show improvement in their symptoms. After their 8-week intervention, the students show a greater response and recovery rate. Besides decreasing symptoms, their quality of life improves in the 3-month follow-up.

https://link.springer.com/article/10.1007/s00406-002-0379-0

The patients found the lessons practical and could use the skills they learned in their lives. The DBT treatment teaches skills that make them feel like they can better cope with ADHD. It gives the patients acceptance and validation for the ADHD symptoms. Also, it educates them on self-management and skills for change.

Is DBT Good for Anxiety?

The What and How skill in DBT can help students feel less anxious before taking tests. And it also reduces the general anxiety of college students and increases mindfulness. The exercises help the students by bringing their attention away from the anxiety. Also, mindfulness helps decrease their worries over their performance for the test.

Dialectical Behavior Therapy and Cognitive-Behavioral Therapy

Dialectic Behavior Therapy is a form of Cognitive Behavioral Therapy. Marsha M. Linehan created it to treat patients with suicidal behaviors better. And it is also to help patients with borderline personality disorder.

Cognitive Behavioral Therapy orients toward adjusting maladaptive patterns of thoughts. It assumes that thought patterns are the cause of problem behaviors or emotions. Hence, in CBT, there is a focus on identifying and changing unhealthy thoughts in people.

In comparison, DBT is more geared towards helping patients regulate emotions. The skills it teaches do combine the building blocks of mindfulness for distress. But there are also other skills for educating clients on handling challenging emotions. Also, there are skills for communication in interpersonal interactions.

DBT also takes more time than CBT since, in CBT, there’s only a weekly therapy session. But in dialectic behavior therapy, there are these skills the patients must learn also. DBT focuses more on educating the clients to help them understand their emotions.

In DBT, there are many different components besides individual therapy. It separates the process of treatment into various parts to treat patients. For example, the client will have skills training besides talk therapy.

Dialectical Behavior Therapy for Binge Eating and Bulimia

The studies for treating binge-eating with DBT show no long-term impact. At the end of the treatment, 89% of the women receiving DBT stopped binge-eating. But the abstinence rate went down to 56% during a 6-month follow-up with the clients. But, the studies don’t seem to say if it is because the patients had stopped practicing.

Other studies show that DBT helps reduce binging/purging episodes. Most of these studies focus on teaching them emotional regulation skills. And the studies seem promising. Most patients improve after learning DBT. But some patients still have symptoms of bulimia or binge eating.

Dialectical Behavior Therapy for Borderline Personality Disorder

Through DBT, patients with BPD may find a way to deal with emotional distress. In DBT, there’s the assumption that remediating skill deficits can reduce maladaptive behaviors. And this is true in a study where DBT minimizes the likelihood of suicide attempts in BPD patients. So there is an association between skill deficit and problematic behaviors.

https://doi.org/10.1016/S1077-7229(00)80052-8

And that is not the first study to show that DBT skills are helpful for patients with BPD. Also, in the table above, you can see the significant improvement in patient behaviors. And with considerable changes in parasuicide, the number of suicide and self-harm attempts. So it suggests that BPD patients can achieve better outcomes from DBT-oriented therapy.

Dialectical Behavior Therapy for Depression

DBT seems to be a promising treatment when combined with antidepressant medications. And 75% of adults who use both MED and DBT show no significant symptoms of depression in a six-month follow-up. But only 31% of MED patients show no significant signs of depression after six months.

It seems that the decrease in depression symptoms may come from processing emotions. Patients with an increase in emotional processing had reduced depression symptoms. So the DBT skills related to emotional processing can reduce depression.

Dialectical Behavior Therapy for PTSD

For PTSD patients, it is more effective when DBT combines with DBT PE. DBT Prolonged Exposure (DBT PE) protocol is a method to treat PTSD patients. Prolonged exposure therapy teaches patients to approach trauma-related memories, feelings, and situations. Gradual exposure is helpful for PTSD patients because avoiding them reinforces the fear. And by approaching the fears, the clients will learn that the fears are not real.

And with DBT + DBT PE is two times more effective than having DBT alone for PTSD patients. With DBT alone, 40% of patients had a reduction or disappearance of PTSD symptoms. But when combined with DBT Prolonged Exposure, the rate is 80%. Also, with DBT Prolonged Exposure, patients were 2.4 times less likely to attempt suicide. Also, they were 1.5 times less likely to self-injury than DBT alone.

Dialectical Behavior Therapy vs. Acceptance and Commitment Therapy

Both Acceptance and Commitment Therapy (ACT) and DBT teach the value of being in the present. In both therapies, the client learns mindfulness and not to judge feelings and thoughts. And both ACT and DBT advocate for the client to take steps toward positive change.

But as its name suggest, ACT focuses more on the experiential approach to acceptance. It teaches the practice of accepting experiences rather than denying or altering them. And invite clients to be open to unpleasant emotions and not avoid situations. In contrast, DBT appears more educative in its approach. In DBT, the clients will learn skills and exercises to cope with experiences.

Another difference is that DBT and ACT are from different philosophies. ACT is from the perspective of functional contextualism. It is an idea that events should be part of an ongoing whole in a certain context. Meanwhile, DBT is from the idea of dialectic. And it is the belief that combining opposing viewpoints leads to better understanding.

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