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What is Dialectical Behavior Therapy?

Dialectical Behavioral Therapy (DBT) is a treatment designed specifically for individuals with self-harming behaviors such as cutting, suicidal ideation and past suicide attempts. DBT also treats depression, bipolar disorder, post-traumatic stress disorder, anxiety disorders, eating disorders and substance abuse. Usually, patients that are unsuccessful in previous forms of therapy will find success and a reduction of symptoms from participating in DBT. DBT is an empirically supported and action-oriented treatment.


What kind of therapy is involved in DBT?

Patients in outpatient DBT received three main modes of treatment: Individual therapy, DBT skills group and phone skills coaching. Patients receive one individual session of therapy a week and a weekly DBT skills group for at least one year. Skills group is not a process psychotherapy group, it is a group for patients to learn new skills that will assist them in getting their needs handled and reaching their desired goals.

The patient’s primary individual licensed mental health provider is the professional in charge of treatment. This means they coordinate treatment with other treatment providers (skills group leaders, psychiatrists, dieticians, and vocational counselors) and make sure the patient remains on task to obtain their goals.


Is phone coaching free?

Yes, phone coaching is free but phone coaching is not phone therapy. Phone coaching is about assisting with DBT skills in order to create the best plan of action for the patient between sessions or during crises. Phone coaching is earned by the patient and each provider has limits surrounding phone coaching.


Why does my loved one engage in self-destructive behavior?

Self-destructive behaviors are learned coping techniques for excruciatingly intense and negative emotions. Usually, individuals that utilize self-harm experience negative emotions such as anger, guilt, fear, and sadness at a higher degree than their peers. This emotional vulnerability is often a result of several factors and is not the sole cause of psychological difficulties. Individuals with emotional vulnerability may have been a victim of trauma or involved in an invalidating environment. Individuals that self-harm do so as a result of not being in a validating environment, or do so in an attempt to relieve negative emotions.


What are the targets and goals of DBT treatment?

The overall goal of DBT is to help patients create a “life worth living.” What makes a life worth living depends on the hopes and dreams of each patient. While these specific goals will differ from person to person, all patients have the task of bringing problem behaviors under control. Because of this expectation, DBT organizes treatment into four stages of targets.

Stage 1: Moving from out of control of one’s behavior to in control of one’s behavior

Target 1: Eliminate life-threatening behaviors

Target 2: Reduce and/or eliminate behaviors that interfere with treatment

Target 3: Decreasing behaviors that diminish the quality of life

Target 4: Learn Skills:

  1. Increase attention to the present moment and reduce rumination about past and future events.

  2. Terminate harmful relationships, start new relationships and improve current relationships

  3. Understand the function of emotions and the benefit of emotions. Learning a way to experience emotions without becoming overwhelmed.

  4. Tolerate emotional pain without self-harm or self-destructive behaviors


Stage II: Moving from being emotionally shut-down to being emotionally engaged

Target: Experience feelings without shutting down, dissociating, avoiding life or having symptoms of post-traumatic stress disorder (PTSD). If necessary, the patient will complete prolonged exposure therapy at this time to eliminate symptoms of trauma.


Stage III: Building an ordinary life, solving ordinary life problems

Target: Patients work on ordinary problems such as marital or partner conflict, career goals and academic development.


Stage IV: Moving from incompleteness to completeness and connection

Target: Finding answers to existential problems. Often this is a stage that even though the patient has resolved many difficult issues, they may still experience feelings of emptiness. Many patients move forward to seek further meaning through spiritual, career, political and relationship paths.


How is DBT different from Cognitive Behavioral Therapy (CBT) ?

DBT is a behavioral treatment. DBT is not only focused on change, as CBT is, but is also founded on acceptance of what currently is in-the-moment for the patient. Acceptance strategies were added to the change strategies to create a deeper and authentic relationship between patient and DBT provider. DBT is also founded on dialectical dilemmas that are not identified or trained in CBT.

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