DBT For Dummies

Gillian Galen, Blaise Aguirre

• Publisher: For Dummies
• Year: 2021
• ISBN:
  9781119730163
• Edition: 1
• Topic: Psychology
• Subtopic: Movements in Psychology
• Index: Psychology

Keep calm, be skillful—and take control!

Dialectical Behavior Therapy (DBT) is one of the most popular—and most effective—treatments for mental health conditions that result from out-of-control emotions. Combining elements of Cognitive Behavior Therapy with Eastern mindfulness practice, DBT was initially used as a powerful treatment to address the suffering associated with borderline personality disorder. It has since proven to have positive effects on many other mental health conditions and is frequently found in non-clinical settings, such as schools. Whether you struggle with depression, anger, phobias, disordered eating, or want to have a better understanding of emotions and how to focus and calm your mind, DBT practice serves the needs of those facing anything from regular life challenges to severe psychological distress.

Written in a no-jargon, friendly style by two of Harvard Medical School's finest, DBT For Dummies shows how DBT can teach new ways not just to reverse, but to actively take control of self-destructive behaviors and negative thought patterns, allowing you to transform a life of struggle into one full of promise and meaning. Used properly and persistently, the skills and strategies in this book will change your life: when you can better regulate emotions, interact effectively with people, deal with stressful situations, and use mindfulness on a daily basis, it's easier to appreciate what's good in yourself and the world, and then act accordingly. In reading this book, you will:

• Understand DBT theory
• Learn more adaptive ways to control your emotions
• Improve the quality of your relationships
• Deal better with uncertainty

Many of life's problems are not insurmountable even if they appear to be. Life can get better, if you are willing to live it differently. Get DBT For Dummies and discover the proven methods that will let you take back control—and build a brighter, more capable, and promising future!

Part 1

The Nuts and Bolts of DBT

IN THIS PART …

Discover how DBT (dialectical behavior therapy) was developed.

Understand the components of a comprehensive DBT treatment.

Recognize the elements of a contemplative mindfulness practice as a core part of DBT, and figure out how to accept multiple points of view.

Interweave behaviorism into mindfulness practices to develop a complete therapy.

Chapter 1

Entering the World of DBT

IN THIS CHAPTER

Looking at the pillars, modes, and functions of DBT

Getting a handle on the DBT theoretical framework

Stepping through DBT’s stages of treatment

Considering core DBT skills

Seeing the mechanics of DBT

Using DBT to treat specific conditions

Entering the world of DBT (dialectical behavior therapy) is entering into a world that focuses on the philosophical process of dialectics, while also attending to the psychological process of behaviorism and change. Imagine entering into a therapy that tells you that everything is composed of opposites, that these opposites are all true, that everything changes except for change itself, and that the way out of suffering is to start by accepting that all of these things are true. This chapter introduces the basics.

Looking at the Main Pillars of DBT

DBT stands on three big philosophical and scientific pillars. These pillars are specific assumptions that hold the treatment together:

• All things are interconnected. Everything and everyone is interconnected and interdependent. We are all part of the greater tapestry of all things, a community of beings that supports and sustains us. We are also connected to our family, friends, and community. We need others; others need us.
• Change is constant and inevitable. This is not a new idea. The pre-Socratic philosopher Heraclitus said, “The only constant in life is change.” Life is full of suffering, but because change happens, change being the only thing of which you can be certain, your suffering will change as well.
• Opposites can be integrated to form a closer approximation of the truth. This is at the core of dialectics. A dialectical synthesis combines the thesis (an idea) and the antithesis (its opposite). In coming up with the synthesis of the two ideas, the process never introduces a new concept not found in either the thesis or the antithesis. Strictly speaking, the synthesis incorporates one concept from the thesis and one from the antithesis.

Check out Chapter 2 for more about DBT’s main pillars.

Getting an Overview of DBT’s Treatment Modes and Functions

DBT was originally developed by Dr. Marsha Linehan for the treatment of people who struggled with self-destructive and suicidal behavior, and it subsequently became the gold-standard treatment for the condition known as borderline personality disorder (BPD), which we review comprehensively in Chapter 20. The treatment appeals to many therapists and patients, not only because it is very helpful, but because it integrates four essential elements in a comprehensive treatment by addressing the biological, environmental, spiritual, and behavioral elements of a person’s struggle. It’s also unique in its focus on balancing the need for a person to change while being completely accepted for who they are in the present moment.

As you find out in Chapter 2, DBT delivers the treatment through four modes, and these four modes address the five functions of a comprehensive treatment.

The four modes of therapy

There are four modes of therapy, which are detailed completely in Chapter 14:

• Individual therapy: In this mode, a trained therapist works with you to apply newly learned skills to your personal life challenges.
• Group skills training: In this mode, together with a group of other patients, you’re taught new behavioral skills, you complete homework assignments, and you role-play new ways of interacting with others.
• Phone skills coaching: In this mode, you can call your therapist between sessions to receive guidance on coping with difficult situations as they arise.
• Therapist consultation team meetings: In this mode, your individual therapist meets with other therapists who are also providing DBT treatment. These meetings help therapists navigate difficult and complex issues related to providing therapy, and give them new ideas for what to do when they are stuck. Chapter 17 goes into more detail on the consultation team.

The five functions of treatment

As you see in the previous section, DBT is a comprehensive treatment program. In this way, DBT is a collection of treatments, rather than a single treatment method conducted by a single therapist and a single patient. Any program, whichever you choose to do, should address five key functions of treatment (which are fully reviewed in Part 4):

• Increasing your motivation to change: Changing self-destructive and maladaptive behaviors can be very difficult, and it can be easy to become disheartened. Your individual therapist will work with you to make sure you stay on track and reduce any behaviors that are inconsistent with a life worth living. Within individual and group therapy, your therapist will ask you to track your behaviors and use skills coaching in order to achieve this goal.
• Enhancing your capabilities: DBT assumes that people who struggle either lack or need to improve several important life skills, including skills that help you regulate emotions, pay attention to the experience of the present moment, effectively navigate interpersonal situations, and finally, be able to tolerate distress.
• Generalizing what you’ve learned in therapy to the rest of your life: If the skills you’ve learned in group and individual therapy sessions don’t transfer to your daily life, then it’s going to be difficult to say that the therapy was successful for dealing with your problems.
• Structuring your environment in order to reinforce your gains: An important function is to make sure that you don’t slip back into maladaptive or problematic behaviors or, if you do, to make sure that the impact isn’t enduring. Structuring the treatment in a manner that promotes progress toward your goal is a way to do this. Typically, your individual therapist will make sure that all of the elements of effective treatment are in place for you. At times, they may intervene for you if you aren’t yet skilled enough to do so for yourself, with the understanding that such intervention is temporary until you have acquired the skills to manage.
• Increasing your therapist’s motivation and competence: Although helping people who come to therapy with multiple problems can be very rewarding for both patient and therapist, the behaviors that people present with can be very taxing for the therapist, and so the therapist needs help to stay in the game of DBT. This is where the DBT consultation team that you read about in the previous section comes in.

Focusing on the DBT Theoretical Framework

The practice of DBT relies on three central theories:

• The biosocial theory: Dr. Linehan’s biosocial theory essentially states that people who struggle in regulating their emotions do so because of an enduring interaction between that person’s biological makeup — one that makes them more emotionally sensitive, more emotionally reactive, and slower to return to their emotional baseline — and what she termed the invalidating environment.
  An invalidating environment is one where a child’s emotional experiences aren’t recognized as valid or tolerated by significant people in the child’s life. When this happens, and a child’s emotional experiences aren’t validated until the child has escalated emotionally and with high intensity, the child effectively learns that they have to escalate to be heard. When they get punished for expressing high emotions, the child might take their difficulties underground and try to regulate by using maladaptive behaviors such as self-injury. This, in turn, leads to even greater emotionality, as the child experiences shame and guilt. Flip to Chapter 2 for more about the biosocial theory.
• Behavioral theory: The behavioral theory seeks to explain human behavior by analyzing the antecedents of the behavior. Antecedents are the events, situations, circumstances, emotions, and thoughts that preceded the behavior — in other words, the events that were happening before the behavior occurred — and the consequences of the behavior are the actions or responses that follow the behavior. It’s in understanding the elements that are causing behaviors to manifest — and then further understanding what keeps the behaviors going — that the behavioral theory is applied in order to reduce maladaptive behaviors and increase adaptive responses.
  An important element to this theory is that maladaptive behaviors are maintained because a person lacks the skills for more adaptive functioning due to problems in processing emotions and thoughts, which is why there is such an emphasis on teaching helpful emotion regulation skills. We discuss regulating your emotions in Chapter 10.
• The philosophy of dialectics: Essentially, dialectical theory states that reality is the tapestry of interconnected and interwoven forces, many of which are opposing one another. It is the continuing synthesis of opposing forces, ideas, or concepts that defines dialectics. Chapter 15 has more information on dialectics.

Checking Out the DBT Stages of Treatment

DBT consists of five stages of treatment, one of which is pretreatment:

• Pretreatment: This is the period of time when the person is making a direct commitment to themselves and their therapist to do DBT therapy. In this stage of pretreatment, the patient also creates a hierarchical list of problem behaviors that interfere with their living the life they want to live.
• Stage 1: In this stage, the main goal is to reduce the most severe behaviors that greatly impact a person’s life. T...