What is Dialectical Behaviour Therapy?
Dialectical Behaviour Therapy is principle-based, which means, it is flexible because of its modular construction and its strategies and procedures for treatment are individualized. Dialectical means that two things can be true at the same time. For example: you are right and the other person can be right. It is used, with cognitive behavioural therapy, as a therapeutic exercise and coping strategy when the potential of a high-risk or difficult situation arises. It allows individuals to self-reflect on their thoughts, feelings and situations. It’s about understanding the chain of events that have lead an individual to their present situation and/or feeling. This means looking at self-validation, interpersonal effectiveness, and mindfulness by identifying key actions, consequences, body sensations, events and feelings.
DBT can help treat people with mental health issues such as borderline personality disorder or have behaviours that are harmful to themselves such as suicidal ideations and self-harm. Here are other mental health problems that DBT tries to address:
- Drug addiction.
- Alcohol addiction.
- Eating disorders.
- Anxiety disorder.
- Post-traumatic stress disorder.
- Bipolar disorder.
- And other mood disorders such as depression.
With DBT, the belief is that these issues on mental health emerge because the person is emotionally vulnerable and that they are in environments that invalidate them. What happens in the session in DBT is that the individual receives both acceptance and validation. They are also encouraged to proceed toward directions that will be beneficial for them. In achieving these results, there are specialized treatments being used. Here are some of them: Building skills through group therapy, Individual therapy to address current stressors and past traumas and Phone coaching in between sessions.
Dialectical Behavioural Therapy at Addiction Rehab Toronto
Our clinical team accepts individuals as they are, with unconditional positive regard and empathy during treatment, with the understanding we must work with them to develop goals and how to achieve them. For individuals participating in our treatment plan, the skills and strategies and strategies learned are a balance of acceptance and change.
There are 4 skill sets taught in DBT: mindfulness, distress tolerance, interpersonal effectiveness, and emotion regulation. There’s balance in these skill sets because 2 of them, mindfulness and distress tolerance, are acceptance-oriented skills and the other 2, interpersonal effectiveness and emotion regulation, are change-oriented skills.
A primary focus is creating a validating environment for individuals with emotion dysregulation. Those who sufferer with emotion dysregulation might experience extreme emotion swings, have a black and white view of the world, and bounce from one crisis to another. It’s hard for both the sufferer and the people around them to understand these reactions, so the sufferers don’t have any skills or support group to help cope with the sudden, intense emotional surges that they feel. A central theme in DBT bringing about the “Wise Mind” in individuals: by balancing the minds that influence our behaviour, DBT teaches to live with a “Wise Mind”.
DBT helps with:
- Validation of the self and of others.
- Letting go of the “all or nothing” state of mind.
- Avoiding assumptions.
- Letting go of the ego.
- Finding what is “missing” from a situation.
- Seeing more than what you are seeing.
- Understanding and coping with conflicts and difficult situations.
- Communication skills: flexibility, active listening and approachability.
Life-Threatening Behaviors: These include both suicidal and non-suicidal self-harm, suicidal ideation, and suicide communication as well as other behaviors with the purpose of causing bodily harm. Tackling questions such as: why are these thoughts there, and how to process through them to ensure safety.
Therapy-Interfering Behaviors: These are behaviors that interfere with an individual’s ability to receive effective treatment. What type of learning skills are needed to implement better treatment planning? Does manipulation and control used in therapy? Does an individual avoid certain questions?
Life Behaviors: These are behaviors that interfere with an individual having a reasonable quality of life, like mental disorders, relationship problems, and financial issues. The Primary counselor, Psychotherapist and clinical team, in a collaborative effort, will help individual work through potential barriers of accessibility and resources.
Skills Acquisition: This is the individual’s need to learn new skills to replace the ineffective, unproductive or unhealthy behaviors that are interfering with his/her ability to achieve his/her goal. For example: ineffective communication skills such as fighting with partner all the time – are there other means of listening and boundaries we need to address?
Understanding Dialectical Behavioural Therapy
Rational mind → Rational mind is when you approach with: Approach with knowledge, Rational and logical, Attends only to empirical facts and Largely ignores emotion, empathy, love, or hate.
Emotional mind → Emotional mind is when your thinking and behaviours are dictated by emotional states. Some typical factors of emotional mind are: ‘hot’ cognitions. Logical thinking is difficult and Facts are distorted or amplified to be congruent with your current emotional state.
Wise Mind → Wise mind is seen as the ‘middle ground’ of the emotional and rational mind. In this state we can use both our emotions and our rationality. Wise mind adds intuitive knowledge about emotional experiences, and thus allows us to have a deeper understanding.
Characteristics of Dialectical Behavioural Therapy
Support-oriented: The clinical team will help an individual identify their strengths and build upon them so that they can feel better about both themselves and their lives.
Cognitive: DBT helps individuals identify the thoughts, beliefs, and assumptions that are making their lives more difficult. For example: “I have to be perfect at everything” or “I can’t get upset at someone otherwise I’m a terrible person”. With help with identifying these thoughts, the Primary counsellor or Psychotherapist can help develop a plan to learn alternative, healthier ways of thinking and actions. For example, “I don’t need to be perfect and people will still like me” ← to → “It’s okay to get upset because it’s normal and it happens to everyone at some point.”
Collaborative: Individuals are encouraged to work out any problems they have through their relationships with their Primary counsellor, Psychotherapist and clinical team. As well, individuals are given homework assignments to complete.
Dialectical Behavioural Therapy and the Development Process
(1) Skill Development: Individuals working on behavioural skills, assigning homework, and practicing these skills on a daily basis.
(2) Individual therapy: Increasing an individual’s motivation to apply skills. Primary counsellors meet with individuals two times a week, and a Psychotherapist will meeting one time a week.
(3) Coaching: Providing in-the-moment coaching on how to effectively use skills to cope with challenges.
(4) Clinical Team consultation: Our highly trained and educated clinical team work in a collaborative manner to provide the best programming and treatment plan using core concepts of CBT and DBT.
Dialectical Behavioural Therapy and Addiction
Research has shown that DBT is significantly effective in helping those who suffer from depression, post-traumatic stress disorder, and most importantly, addiction. DBT combines Eastern meditative practices, like Zen, with Western CBT. DBT also considers acceptance and change as conflicting concepts and both the therapist and client combine these seemingly opposite strategies during therapy.
These treatment methods allow the client to go through skill-building systems. Each of these systems may last up to six weeks. The patient may go through it again if needed. Here are the skills that the patient will learn in these systems.
- Mindfulness or being aware as well as engaged at present and in the current situation.
- Distress tolerance or the capacity for acceptance that there will be distressing situations and that extreme measures are not necessary to resolve them.
- Interpersonal effectiveness or the capability to communicate in a clear and concise manner while at the same time building better listening skills.
- Emotional regulation or being able to identify issues that produce undesirable feelings and thoughts, and effectively working toward reducing them using positive coping mechanisms.