HBH Treatment & Therapies

Dialectical Behavior Therapy (DBT) in Massachusetts

By

life preserver

Dialectical Behavioral Therapy, or DBT for short, has become one of the most viable and respected options for treating mental health problems. Often when we suffer from mental illnesses, we suffer alone. But this doesn’t have to be the case. Seeking an experienced DBT counselor or psychologist is a great way to start getting your mental health back on track.

Handel Behavioral Health has counselors, therapists, and psychiatrists all over Massachusetts in areas such as Franklin, Amherst, West Springfield, and Wilbraham. Contact us today and begin your journey to recovery with a DBT counselor near you!

What is Dialectical behavior therapy (DBT)?

Dialectical behavior therapy is an evidence-based psychotherapy, developed by Psychologist Marsha M. Linehan, and originally designed to treat individuals with personality disorder. However, since its initial success treating personality disorders, DBT has grown in use to treat other behavioral disorders such as substance abuse, self-harm, mood disorders and suicidal ideation.

The DBT approach is based on unconditional acceptance of the client by the therapist who introduces change-oriented strategies into the therapeutic process. The result is to have the individual in treatment to increase their cognitive and emotional self-regulation by identifying environmental triggers to maladaptive responses and rather implement coping skills that serve as replacement behaviors to the undesirable reactions.

In the late 1980’s, Dr. Linehan was a research psychologist at the University of Washington. She wanted to use the principles of Cognitive Behavioral Therapy (CBT) that had been shown to help people self manage their thoughts, feelings and behaviors, but enhance them to specifically address issues faced by people with borderline personality disorders and chronic suicidality.

The new technique was called dialectical behavior therapy and synthesized both unconditional acceptance with behavior change strategies to create a balance that was similar to the philosophical dialectical process of hypothesis and antithesis, followed by synthesis.

Initial randomized clinical trials of DBT resulted in reduced rates of suicidal gestures, psychiatric hospitalizations, and treatment drop-outs when compared to other forms of treatment. Another early study found that DBT was also effective in treating individuals with borderline personality disorder. Since this early research demonstrated the effectiveness of DBT disorder is addressing disorders that had been difficult to treat, it was then used to treat other conditions such as:

  • Depression
  • Substance abuse
  • Post-traumatic stress disorder (PTSD)
  • Traumatic brain injuries (TBI)
  • Binge-eating disorder
  • Mood disorders
  • Self-injury

The outcome of some studies suggests that DBT can be effectiveness in treating survivors of sexual-abuse and chemical dependency.

How does Dialectical behavior therapy (DBT) work?

DBT combines techniques associated with contemplative meditative practices such as: distress tolerance, acceptance and mindfulness, with evidence-based cognitive behavioral approaches of reality testing and emotional self-regulation. Toward this end, the therapist using DBT works to have the individual being treated see the therapist as an ally. This is accomplished, first, by the therapist validating the individual’s feelings at any given point in time. This is down by active listening and repeating back to the client that the therapist understands what the client is going through.

After this connection is made, the therapist will then also identify ways that some of these thoughts, emotions or behaviors may be detrimental to the individual’s self interest. At this point, replacement behaviors can be discussed that can be used as coping skills when triggers to negative thoughts, emotions or behaviors occur. The benefits of these alternative reactions to triggers are also presented. This then is used as an incentive for the individual to acquire new skills and adapt new behaviors that will improve the quality of their lives. However, the ultimate goals of improving the quality of one’s life is defined by the individual being helped.

What are the core components of DBT?

The important components of DBT are: Mindfulness, Acceptance and Change, Distress Tolerance, Emotional Regulation and Interpersonal Effectiveness.

MINDFULNESS

Mindfulness is considered the foundational component of DBT, because it helps the individual accept and tolerate the powerful emotions they experience while recalling upsetting events and confronting detrimental habits.Mindfulness, as used in DBT is not associated with any religious practices or metaphysical concepts. Rather, it involves the non-judgmentally attending to the present moment, being in touch with one’s current emotions, sensing them fully but with proper perspective. It helps the individual to be more aware of their surroundings using all five senses. DBT mindfulness skills rely heavily on the principle of “radical acceptance”, that is, the ability to view situations with no judgment, and to accept situations and their accompanying emotions.

ACCEPTANCE AND CHANGE

The first few sessions of DBT introduce the dialectic of acceptance and change. The patient must first become comfortable with the idea of therapy; once the patient and therapist have established a trusting relationship, then the therapist can introduce change strategies that will help the individual to thrive. Toward this end, it is important for the individual to grasp the concept of radical acceptance which embraces the idea that one should face situations, both positive and negative, without judgment. Acceptance also incorporates mindfulness and emotional regulation skills, which depend on the idea of radical acceptance.

Often, after a patient becomes familiar with the idea of acceptance, they will accompany it with change. DBT has five specific states of change which the therapist will review with the patient:

  1. Pre-contemplation,
  2. Contemplation,
  3. Preparation,
  4. Action, and
  5. Maintenance.

Precontemplation is the first stage, in which the patient is completely unaware of their problem. Contemplation is when the patient realizes the reality of their illness: this is not an action, but a realization. Preparation involves the individual taking action that prepares to move forward. Action is when the client is trained in coping skills that they will implement outside of the treatment setting. Maintenance is when the patient strengthens their change strategies in order to prevent relapse.

DISTRESS TOLERANCE

This component of DBT teaches the individual skills to help them endure emotional pain. This involves helping the individual to replace harmful habits and behavior patterns, which may only have short term soothing results, with those that have healthier, more long lasting effects. These skills can also naturally develop from the client learning to see themselves and their present situation in a nonjudgmental and non-evaluative manner. This helps the individual recognize negative situations and their impact without being overwhelmed and then trying to avoid or escape them. This process enhances the client’s decision making skills.

EMOTION REGULATION

DBT helps individuals learn to regulate their emotions by: identifying and labeling them, obstacles to changing them, increasing the occurrence of positive emotional events, being more mindful of their present emotional state, taking positive action to address a negative emotional state and applying distress tolerance techniques. This approach is based on the idea that intense emotions are a conditioned response to past aversive experiences so they can be altered by training new conditioned responses.

INTERPERSONAL EFFECTIVENESS

The DBT approach focuses on the development of the three interpersonal skills: self-respect, treating others with respect and assertiveness. Self-respect involves having a clear, evidence-based view of ourselves that acknowledges our accomplishments, skills and the ability to have a positive impact on the world around us. Treating others with respect involves interacting with others that expresses a caring attitude, showing interest in their interests, and validating their feelings. Assertiveness is a confident affirmation of one’s point of view without either aggressively threatening the other person’s point of view or submissively permitting another to ignore one’s own point of view.

DBT Treatment at Handel Behavioral Health

DBT can be an effective way to treat a variety of difficult conditions when implemented by a skilled professional therapist. Contacting and working with a DBT therapist can help you to thrive and excel in life in ways that you may not have previously thought possible. Reach out to our compassionate mental health counselors here at HBH and find out more about how Dialectical Behavioral Therapy can benefit you and your mental health.

About The Author

Greg Handel Headshot

Greg has more than 35 years of experience providing positive life supports for individuals, couples and families. He has worked in several different environments including inpatient and outpatient mental health centers, rehabilitation facilities, congregate residential settings and in private practice. More About Author →