DBT  – Dialectical behavioral therapy

Dialectical Behavioral Therapy (DBT) is used for the treatment of borderline personality disorder. In the meantime, the therapy is also a possibility for some other mental disorders. In dialectical behavioral therapy, methods from behavioral therapy, but also from body-oriented treatment approaches, gestalt therapy, hypnosis and other currents of psychotherapy are used. Dialectical Behavioral Therapy emphasizes as a concept the bringing together of opposites that occur in borderline sufferers and other patients. The patient undertakes to comply with certain rules, but can expect a great understanding of the illness from the therapist and receives help to change.

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DBT – When is Dialectical Behavioral Therapy performed?

Dialectical Behavioral Therapy (DBT) is suitable for treating patients with borderline disorder or various other psychological problems.

A mental condition known as borderline personality disorder is characterised by profound changes in behaviour, thinking, feelings, and interpersonal connections. Those affected often have a tendency to harm themselves. Their emotions often express themselves as impulsive actions. Borderline personality disorder mostly affects women. Dialectical Behavioral Therapy is tailored to the treatment of borderline disorder and can even be used in very severe cases (in patients with suicidal tendencies).

In addition to borderline disorders, dialectic behavioral therapy can also be used for a number of other disorders. Eating disorders, addictions, long-term depression, and psychotrauma are currently included in the field of application (reactions to psychologically stressful situations such as rape or the death of a loved one). In this article you will get to know about the uses of dbt therapy in London

DBT – How does Dialectical Behavioral Therapy work?

Dialectical behavioral therapy evolved from behavioral therapy.Yet it was created specifically for treating borderline personality disorder. The founder of Dialectical Behavioral Therapy is the American psychologist Marsha Linehan. She developed the therapy in the 1990s while treating borderline patients with persistent suicidal tendencies. In addition to aspects from behavioral therapy, dialectical behavioral therapy also includes measures from physical forms of treatment, gestalt therapy, hypnosis and other currents of psychotherapy.

The term “dialectic” describes the dichotomy of respecting the patient’s behaviors and emotions by the therapist, while at the same time seeking change. However, “dialectic” can also refer to various other opposites that exist in people with borderline personality disorder happen.

Difficulties often arise, especially with borderline disorders, because the patient shows very severe reactions during therapy or even threatens to break off the treatment. A kind of pact is therefore made between the therapist and the patient. This means that the patient should adhere to certain rules. In return, he can expect the therapist to treat him with respect and understanding and to treat him as well as possible.

The treatment of the problems that the patients may encounter is classified according to their urgency. The following order is found:

  1. suicidal tendencies
  2. Self-injurious behavior (parasuicidal tendencies)
  3. Therapy-threatening behavior
  4. reduction in quality of life
  5. Lack of behavioral skills

If a patient “relapses”, i.e. returns to a level with higher urgency, the therapy is immediately geared back to this.

The therapy itself consists of individual sessions as well as group sessions. Within the group, patients should learn skills to better cope with themselves and others in life. The following main subject areas, called modules, are suggested to those affected during group work:

  • Inner mindfulness:This means that the patient should gain more awareness and calmness in everyday life. He should pay more attention to his perceptions and feelings. Mindfulness can be improved, among other things, by using techniques from Zen Buddhism.
  • Dealing with and relationships with other people: The patient learns social skills. He acquires the ability to enter into and maintain healthy relationships with other people.
  • Dealing with one’s own feelings:The patient should recognize his feelings and become aware of their effects.
  • Stress management:The affected person learns to deal with the stress that almost inevitably occurs. Moments of high stress should be mastered by applying certain techniques.
  • Improvement of self-confidence and self-acceptance: The person concerned should come back into harmony with himself and like himself.

In individual therapy, an intensive examination of the patient’s very own problems takes place. The topics covered in the group are deepened and applied. The skills can be transferred to the life situation of the patient. The therapist carries out measures from behavioral therapy to analyze the patient’s feelings, thoughts and actions. Solutions to the behavioral problems are worked out.Other psychotherapeutic techniques are utilised in addition to behavioural treatment. The therapist even communicates with the patient over the phone so that acute crises (such as suicidal tendencies, self-harm) can be dealt with immediately.

DBTHow does Dialectical Behavioral Therapy work?

There are two ways to practise dialectical behavioural therapy (DBT): inpatiently or outpatiently. A period of two years is usual for outpatient therapy. The length of the treatment is typically cut in half if the patient is kept in a psychotherapeutic facility, and it can then be maintained on an outpatient basis after three months.

Dialectical behavioral therapy usually begins with a behavioral analysis of the patient. This is what happens with the individual therapist. This is followed by the phase of training social skills, which takes place in the group and also with the individual therapist. Acute crises can always occur on the part of the patient, which means that the main focus of treatment is then initially on short-term coping. If the patient is treated as an in-patient, there is a phase at the end of the stay that prepares him for his discharge and further everyday life.

What problems can arise in dialectic behavioral therapy?

As with any therapy, problems can arise. The problems with dialectic behavioral therapy usually arise due to the severe and complicated clinical picture. Borderline disorder can lead to suicide. Pronounced negative effects of the treatment itself are not known.

DBT – What are the chances of success?

Dialectical Behavioral Therapy is generally an effective therapy. In comparison to other behavioral therapies for borderline personality disorder, dialectical behavioral therapy proved to be advantageous. Both the course and the end result are favourable. Almost all psychological parameters that play a role in borderline personality disorders are positively influenced. The rate of suicide attempts, self-injury, therapy discontinuations and hospital stays decreases with dialectic behavioral therapy. After the therapy is over, the benefits last for at least a year (long-term studies are not yet available because the form of therapy is still young).

DBT – Are there alternative or complementary treatments?

There are several approaches to treating borderline personality disorder besides dialectical behavioural therapy. Another approach is mentalization-assisted psychotherapy, which works with patients to associate other people’s behavior with feelings. Transference-focused psychotherapy is also possible, which works with the process of transference (transference of feelings between patient and therapist). If the borderline disorder is based on psychotrauma, i.e. a strong mental stress caused by certain events, trauma therapy can be successful. Many patients require medication.

DBT – Notes for patients

Since dialectic behavioral therapy is still relatively new and only a few treatment centers offer the method, the costs are often not yet covered by health insurance companies. The patient should take care in advance whether and how the treatment can be financed.


Priya Jatoliya

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