John Condron is proud to be certified as a Dialectical Behavior Therapist by the Dialectic Behavior Therapy National Certification and Accreditation Association. The DBTNCAA is unique in that it is the only certification organization to require practice-based evidence to ensure quality one patient at a time. It was the first organization to offer certification in DBT.
What is DBT?
Dialectical behavior therapy (DBT) is a cognitive-behavioral approach that emphasizes the interaction between social and psychological aspects of treatment. Some people are prone to react more strongly to certain emotional situations than most people. This is especially likely in close or intimate relationships. DBT theory suggests that some people become upset faster and more intensely, and take a long time to calm down.
People who are sometimes diagnosed with borderline personality disorder experience extreme swings in their emotions, see the world in black-and-white, and seem to always be jumping from one crisis to another. Because few people understand such reactions — most of all their own family and a childhood that emphasized invalidation — they don’t have any methods for coping with these sudden, intense surges of emotion. DBT is a method for teaching skills that will help in this task.
Characteristics of DBT
Support-oriented: It helps a person identify their strengths and build on them so that the person can feel better about him/herself and their life.
Cognitive-based: DBT helps identify thoughts, beliefs, and assumptions that make life harder, such as “I have to be perfect at everything” or “If I get angry, I’m a terrible person.” It helps people to learn different ways of thinking that will make life more bearable, such as “I don’t need to be perfect at things for people to care about me” or “Everyone gets angry; it’s a normal emotion.”
Collaborative: It requires constant attention to relationships, including between patients and therapists. In DBT people are encouraged to work out problems in their relationships with their therapist and the therapists to do the same with them. DBT asks people to complete homework assignments, to role-play new ways of interacting with others, and to practice skills such as soothing one’s self when upset. These skills, a crucial part of DBT, are taught in weekly skills session, reviewed in weekly homework groups, and referred to in nearly every group. The individual therapist helps the person to learn, apply and master the DBT skills.
Components of DBT
1. Individual weekly psychotherapy sessions that emphasize problem-solving for the past week’s issues and troubles that arose in the person’s life. Self-injurious and suicidal behaviors take first priority, followed by behaviors that may interfere with the therapy process. Quality of life issues and working toward improving life in general may also be discussed. Individual sessions in DBT also focus on decreasing and dealing with post-traumatic stress responses (from previous trauma in the person’s life) and helping enhance the patient’s self-respect and self-image. Between and during sessions, the therapist actively teaches and reinforces adaptive behaviors, especially as they occur within the therapeutic relationship. The emphasis is on teaching patients how to manage emotional trauma rather than reducing or taking them out of crises. Telephone contact with the individual therapist between sessions is part of DBT procedures. During individual therapy sessions, the therapist and client work toward learning and improving many basic social skills.
2. Weekly group therapy sessions, generally 1 1/2 to 2 1/2 hours a session and led by a trained DBT therapist, where people learn skills from one of four different modules: interpersonal effectiveness, distress tolerance/reality acceptance, emotion regulation, and mindfulness skills.
The Four Modules of Dialectical Behavior Therapy
Mindfulness: The essential part of all skills taught in skills group are the core mindfulness skills. Observe, Describe, and Participate are the core mindfulness “what” skills. They answer the question, “What do I do to practice core mindfulness skills?” Non-judgmentally, One-mindfully, and Effectively are the “how” skills and answer the question, “How do I practice core mindfulness skills?”
Interpersonal Effectiveness: Interpersonal response patterns taught in DBT skills training are very similar to those taught in many assertiveness and interpersonal problem-solving classes. They include effective strategies for asking for what one needs, saying no, and coping with interpersonal conflict. This module focuses on situations where the objective is to change something (e.g., requesting someone to do something) or to resist changes someone else is trying to make (e.g., saying no). The skills taught are intended to maximize the chances that a person’s goals in a specific situation will be met, while at the same time not damaging either the relationship or the person’s self-respect.
Distress Tolerance: Distress tolerance skills are concerned with tolerating and surviving crises and with accepting life as it is in the moment. Most people learn Distress Tolerance in childhood; but what if one’s parents lack these skills? Four sets of crisis survival strategies are taught: distracting, self-soothing, improving the moment, and thinking of pros and cons. Acceptance skills include radical acceptance, turning the mind toward acceptance, and willingness versus willfulness.
Emotion Regulation: Borderline and suicidal individuals are emotionally intense and labile – frequently angry, intensely frustrated, depressed, and anxious. Such patients might benefit from help in learning to regulate their emotions. Dialectical behavior therapy skills for emotion regulation include:
- Identifying and labeling emotions
- Identifying obstacles to changing emotions
- Reducing vulnerability to “emotion mind”
- Increasing positive emotional events
- Increasing mindfulness to current emotions
- Taking opposite action
- Applying distress tolerance techniques