Understanding DBT (Dialectical Behavioral Therapy)

Dialectical Behavior Therapy (DBT)

Dialectical Behavior Therapy (DBT) is a treatment track in Restore, FHE Health’s dedicated program for those with a primary mental health diagnosis. While patients in the Restore program may be introduced to DBT informed skills, not everyone is appropriate for the more specialized and specific DBT track. If our consultation team recommends DBT, it is because they believe you could benefit from this intervention based on your individual treatment needs. For more information about the therapeutic benefits of DBT, how it works at FHE Health, and other common questions, we invite you to read on.

The Benefits of DBT

DBT is effective at treating certain mental health symptoms in particular—more specifically, difficulties in managing emotions, interpersonal and relationship challenges, maladaptive coping behaviors like disordered eating, and suicidal thoughts. Our consultation team of DBT therapists will determine whether you could benefit from this type of therapy. It aims to increase skills and aptitude in the following areas or “modules” (in DBT vocabulary):

• Mindfulness – Mindfulness is the act of being present with all one’s senses to what is happening in the here and now. Mindfulness-based exercises teach how to non-judgmentally observe and attend to your thoughts, emotions, and behaviors in the moment, so that over time you can increase self-awareness and improve decision-making abilities.
• Distress tolerance – This term refers to one’s capacity to weather a crisis without making it worse through self-harm or other negative behaviors. The premise is that while you may not be able to control many of the stressful things that happen to you, you can learn to manage your response to these things in healthier ways, using the various techniques of this module.
• Emotion regulation – The skills and education in this area are intended to help you manage your emotional triggers in healthier ways, through positive self-talk, constructive behaviors, and other coping mechanisms.
• Interpersonal effectiveness – In this module, patients learn how to express their needs in appropriate ways, set healthy boundaries, and manage conflict, among other relational skills.

These four areas of focus in DBT might also be thought of as its core benefits. With practice and eventual mastery, they can improve quality of life for those who struggle with managing emotions, maintaining relationships, and/or thoughts of suicide or self-harm.

How DBT Works at FHE Health

There are four components to the DBT track at FHE Health. They are as follows:

1. A Skills Group – As its name suggests, this weekly group meets to learn and practice the skills taught in each of the four modules (interpersonal relations, acceptance skills, emotional regulation, and mindfulness). Patients come together in a group setting to discuss current issues and solutions with a trained DBT therapist who can help to facilitate the discussion, teach tools and techniques from the modules, and make sure the group stays on track.
2. Structured Individual Therapy Sessions – These sessions, which take place with your primary therapist or a member of the DBT team, are not free-form talk therapy. They adhere to a very specific, structured format that focuses on increasing behavioral competency with the DBT skills you’re learning while decreasing any maladaptive coping skills. First, you’ll discuss any behavioral issues that may have occurred since the last session. Second, you’ll review the weekly “diary card” that DBT patients use to track their behaviors, emotions, and skills. Third, you’ll spend some time on the latest new skill and discuss how group therapy is going.
3. Coaching – This component is for when a patient may be in crisis and needs support outside of group or individual therapy. A DBT-trained nurse or tech can help coach the patient through whatever is going on (for example, thoughts of self-harm). The goal is positive behavior modification: It’s about reinforcing what the patient is learning and helping them apply it to real-life situations and emergencies.
4. Consultation for DBT therapists – This component is not something that patients will necessarily see, but that doesn’t make it any less important. In fact, if a DBT program doesn’t have a consultation team, it’s not considered DBT. During this weekly check-in with the DBT team supervisor, our therapists review cases, offer support to one another, and discuss what skills are being taught. A key element of this time is the consistent, structured supervision that our DBT therapists receive, with the goal of improving patient care.

What Is DBT?

DBT is a mindfulness-based type of cognitive-behavioral therapy developed by the psychologist Marsha M. Linehan in the late 1980s. It was originally developed to treat borderline personality disorder (BPD). Over the years, it has also found wider application as a treatment for mental health conditions that share some of the same symptoms as BPD.

DBT emphasizes the psychosocial aspects of treatment and focuses on social factors and individual thoughts and behaviors. It is believed that certain people are predisposed to experiencing more intense emotional reactions to life situations. DBT is oriented around practical skills that can help them manage their emotions more effectively and identify negative self-talk and self-defeating behaviors. Together, the patient and therapist work as a team to identify and change these mental, emotional, and behavioral patterns, via healthy coping skills.

Individual and Group Therapy Sessions in DBT

Individual and group therapy play a very important role in DBT but are not what many people have in mind when they think of psychotherapy. Unlike talk therapy, for example, individual DBT sessions are highly structured with the goal of reviewing and reinforcing the DBT tools and techniques introduced in group therapy.

These one-on-one interactions with an individual therapist also allow patients to address sensitive issues like self-harm or suicidal thoughts and evaluate their progress in making positive changes. They can practice and reinforce mindfulness exercises and other stress coping techniques and process and reflect on the application of these tools in real-life situations.

Group therapy functions much like a small, supportive class, where patients get to learn about the four modules and related tools and techniques. They will be assigned a homework assignment for the week that encourages them to apply one of these tools and techniques to a real-life situation and then reflect on how it goes.

More About DBT and DBT Outcomes

Research has shown that DBT is effective at reducing negative behaviors and eliciting positive change. Through the acquisition of life skills that increase mindfulness, distress tolerance, emotional regulation, and interpersonal effectiveness, many people have been successful at managing even more serious mental health conditions. For more information about our DBT track and to explore whether you may be eligible, contact us today.