Dialectical Behavioral Therapy is a specialized therapy developed by Marsha Linehan, PHD. Marsha Linehan is a psychologist and Professor of Psychology at the University of Washington. She has also served as the Director of Behavioral Research and Therapy Clinics. This kind of psychotherapy was originally designed to treat people diagnosed with Borderline Personality Disorder, however, it has proven to be very effective for people with substance abuse challenges and other personality disorders. Whenever a person is struggling with self-harm behaviors, Dialectical Behavioral Therapy may help them to learn better coping skills and develop a more healthy sense of self. The behavior models are also used to treat people that have suicidal behaviors.

In this post, we will discuss which types of people would benefit from Dialectical Behavioral Therapy, how these disorders and developed, the history and development of Dialectical Behavioral Therapy and an overview of what this treatment includes.

Who Benefits from Dialectical Behavioral Therapy

Did you know that 82% of people that struggle with substance abuse may also have a dual diagnosis including a personality disorder? Clinical trials have found that Dialectical Behavioral Therapy can be very effective for people that have a substance abuse disorder. This therapy can also decrease the probability of relapse and decrease the severity of relapses.

People diagnosed with personality disorders are described as having an extensive past of failed interpersonal relationships, low self esteem and impulsive behaviors that begin in early adulthood. These impulsive behaviors have a variety of contexts and often are a reflection of poor self-image. Borderline Personality Disorder is diagnosed for clients that exhibit unstable emotions, relationships and poor self image. They would describe past relationships as being very intense but unstable. They have chronic feelings of emptiness, intense fears of abandonment, self-harm or suicidal behavior. Many people that are diagnosed with Borderline Personality Disorder also have a co-occurring or dual diagnosis of a substance abuse problem. Because those with Borderline Personality Disorder have a difficult time regulating their emotions, they may experience conflicts, outbursts of anger, violent behaviors and they have a difficult time maintaining a course of action.

For people that exhibit these kinds of behaviors, Dialectical Behavioral Therapy can help them learn more healthy behaviors by teaching the skills needed to address their specific problems. While many people affected by substance use disorders also have personality disorders, 2% of the general population in the US can be diagnosed with Borderline Personality Disorder. Women have been reported as being more affected than men, but the statistics there may be inaccurate.

Development of Borderline Personality Disorder

While there isn’t one prevailing cause of Borderline Personality Disorder, there are a series of environmental and genetic factors that contribute to the development of this disorder. Trauma caused by an attachment disruption, illness, abuse or neglect may result in behaviors often exhibited by those diagnosed with Borderline Personality Disorder. The majority of these people have experienced abuse.

A popular train of thought is psychology is nature versus nurture. Nature referring to what is already existing in our genetic make-up; something that we can’t necessarily change. Nurture refers to the environment affecting us as we grow up; relationships with others and experiences with outside forces that impact mental health.

For Borderline Personality Disorder, the “Nature” includes genetic factors for temperament including aggression and reaction to different situations. The “Nurture” factors include the early parent-child relationship; failure to teach self-object functions and slowed development. As a result, the overwhelming separation stress from the parent-child relationship can cause intense feelings of insecurity, fear of abandonment and what others would describe as an anxious attachment. When someone experiences a more healthy “nurture” environment, they are expected to develop these healthing qualities:

  • Trust
  • Core Sense of Self
  • Independence
  • Ego Control
  • Reality Testing
  • Identity
  • Healthy Repression

For many children, attachment styles are formed as the bond between parent and child is established. There are many attachment styles that children develop. For people with personality disorders, the most common are unresolved, preoccupied and fearful. Each of these attachment styles want intimacy but they have a fear of needing to depend on someone. The fear of rejection results in unhealthy behaviors. Because insecure attachments are so common in those with Borderline Personality Disorder,  the theory is that it affects their ability to maintain healthy relationships.

What is Dialectical Behavioral Therapy?

Dialectical Behavioral Therapy is a type of Cognitive Behavioral Therapy. Cognitive Behavioral Therapy, which is a type of psychotherapy, focuses on changing behavior by changing thoughts. Dialectical Behavioral Therapy takes this one step further by incorporating some Buddhist principles and carefully teaching balance of change and acceptance. By teaching mindfulness and acceptance, clients can focus on regulating their emotions and changing their perspective of situations that may cause them stress or conflict.

The word “Dialectic” describes a particular method of resolution. It was first described by Plato. The process of resolution included the exchange of arguments in a logical and educated fashion intended to bring out the truth. This process was intended to be fair and rational. This problem also included a solving process that is incorporated into therapy by balancing the logical mind with the emotional mind. By clarifying thoughts and separating emotions from logic, a more clear resolution can take place.

Dialectical Behavioral Therapy has been proven to improve the mental health of people that experience suicidal behaviors, are diagnosed with Borderline Personality Disorder, have a substance abuse problem, have an eating disorder or depression. The main theme that is common in these is that they are believed to be a result of a the lack of emotional regulation. This is a key element to the Dialectical Behavioral Therapy which teaches emotional regulation skills.

Acceptance and validation are emphasized in Dialectical Behavioral Therapy, along with the treatment of behaviors that interfere with healthy processes. The skills that are learned in therapy focus on balancing change and acceptance. The goals and targets that are outlined are described as a process and creates the opportunity for compassion and understanding between the therapist and the client. Therapists are to assume that clients are doing the best that they are capable of and that they want to get better. Clients cannot fail in therapy. The skills that are learned in therapy will help clients try harder, do better and be motivated to change.

Five Modes and Four Skill Sets of Dialectical Behavioral Therapy

There five “modes” of Dialectical Behavioral Therapy. Each one incorporates a support team to help promote healthy behaviors and reinforce the skills taught in therapy. These areas are:

  1. Individual Therapy
  2. Skills Training
  3. Ancillary Treatments
  4. Telephone Consultation
  5. Consultation Team

With all of these elements combined, clients are given a great deal of support and guidance as they look to identify goals and make changes in their lives. The skills that are emphasized in treatment help to enhance the ability to change. The four sill sets that are address are:

  • Mindfulness
  • Interpersonal Effectiveness
  • Emotional Regulation
  • Distress Tolerance

Mindfulness includes skills to help clients learn to be in control of their own thoughts instead of letting their thought control their behaviors. This process is intended to limit impulsive behavior and encourage informed decisions.  By doing so they will practice observance, describe what is happening and participate in a healthy way. They stress non-judgment and encourage clients to be more mindful of what is happening around them. This then creates the balance of the emotional mind and the logical mind to help make more informed decisions.

Interpersonal Effectiveness includes the ability to say “no” and mean it. Instead of creating a gray-area, they are taught the skills to be conclusive in their thoughts. They are taught to identify the things that they want and teach them to put themselves in the best place to get what they want. This process also teaches clients how to improve relationships and maintain self respect.

Emotional Regulation means that clients can more logically describe and identify emotions. By labeling what they feel, the client is more aware of what they are experiencing. Part of emotional regulation also include limiting vulnerability. This will help their emotional pain and increase positive thoughts and feelings. They then are able to change how they feel by actions that will balance what they are feeling and what they are trying to accomplish. Learning to take care of their physical needs also creates emotional balance. Eating properly, treating illnesses with medication as necessary, avoiding drugs, sleeping and exercise all contribute to a healthy lifestyle that will make managing emotions more possible.

Distress tolerance skills are taught to help clients cope with a situation that may feel like a crisis. It doesn’t necessarily resolve the problem, but it helps them develop the skills to make it through the hard times when they feel they are not in control. This prevents harmful behaviors and self harm. By learning how to distract themselves, improve the situation, self sooth and accept what is happening, they can better deal with a crisis when it arrives. Some ways they are taught to accept a crisis are to do a strenuous activity (like exercise) that will distract them from the current situation that is causing stress. Another distraction mechanism is to compare the current situation to a past crisis. This helps to increase tolerance and approach the situation with more clear thoughts.

By learning how to problem solve and manage emotions, clients that complete Dialectical Behavioral Therapy are better equipped to maintain healthy lifestyles and form relationships. Through this process they are validated and educated. Finding balance between emotions and logic helps to provide the best outcome for situations that would have been negative before treatment. With behavioral health programs that include Dialectical Behavioral Therapy, those that suffer from substance abuse and co-occurring personality disorders can be supported enough to make changes that will last.

One of the biggest accomplishments of those that go through a behavioral health program that includes Dialectical Behavioral Therapy is that the client can be confident, independent and accepting of the support of loved ones. They have all the skills necessary to maintain a healthy lifestyle and achieve all the goals that before therapy felt impossible. With a little bit of hope and determination, happiness is possible. Recovery can happen. Changes can last a lifetime.

All of the therapists and staff members have been specially trained in Dialectical Behavioral Therapy. Many of the therapists have been trained at the Portland DBT Institute. We invest a great deal into our staff and have a culture by design. This means that we focus on developing meaningful relationships. All of our treatments are evidence based and proven to be effective.