The Influence Of Dialectical Behavior Therapy

Dialectical Behavior Therapy (DBT) is a comprehensive cognitive-behavioral treatment developed by Marsha M. Linehan for the treatment of complex, difficult-to-treat mental disorders. Originally, DBT was developed to treat individuals diagnosed with borderline personality disorder (BPD; Carson-Wong, Rizvi, & Steffel, 2013; Scheel, 2000). However, DBT has evolved into a treatment for multi-disordered individuals with BPD. In addition, DBT has been adapted for the treatment of other behavioral disorders involving emotional dysregulation, for example, substance abuse, binge eating, and for settings, such as inpatient and partial hospitalization. Dimeff and Linehan (2001) described five functions

From the time of the advent of Sigmund Freud’s psychoanalytic theory and therapy until now, psychologists have searched for new and better ways to both understand and treat the human psyche. Many psychologists have spent their lives analyzing the complexities of human thought, behavior, and interactions with societal influences in order to find new ways to guide humans towards a more fulfilling human experience. Throughout time, various theories and models of therapy have emerged, each with their strengths and weaknesses in their efforts to help humanity live more fulfilling lives. Psychoanalytic, Adlerian, existential, person-centered, gestalt, behavior, cognitive, cognitive behavior (CBT), reality, feminist, postmodern, and family systems approaches have all made important contributions towards the evolution of psychological theory and therapy. One of the most widely accepted and practiced forms of theory and therapy in today’s world of psychology is CBT. Cognitive-Behavior Therapy has a rich and storied history, contains more inherent strengths than weaknesses, and provides effective treatment for a variety of psychological conditions.

While using Dialectical Behavior Therapy, it has a couple special theories. The biosocial theory deals with whenever the client is most likely born with a predisposition toward emotional vulnerability. The theory itself deals with how issues from borderline personality develops. When the client lives in an unstable environment, the structure of the home living can affect their mental minds. The client's mind can cause them to become very destructive and affect their relationships with others and most likely diagnose them with personality disorder. (Dialectical Therapy) “DBT draws mindfulness techniques from Zen Buddhism in order to use here-and-now presence of mind to help people in therapy objectively and calmly assess situations” (Dialectical

Marsha Linechan in an attempt to restructure traditional Cognitive Behavioral Therapy (CBT) to better treat female borderline personality disordered clients. This treatment focuses on a subject group that has high levels of emotional reactivity with skills taught that can help manage the emotional response and perception of triggering stimulus. Dr. Linechan’s primary goal was to impart skills into the client so as to manage the stressors of their life outside and without the need of therapy (Bass, Van Nevel, & Swart, 2014). Review of Dr. Linechan’s theory found that within this third wave therapy style there were three constructs built out of CBT framework that allowed the gestation of emotional regulatory and stabilization skills. The three primary goals Dr. Linchan implemented educational dialectics, radical acceptance and validation all rooted within the theoretical and manualized treatment of CBT (Bayles, Blossom, & Apsche, 2014). Currently DBT is considered one of the most frequently investigated therapy styles for the treatment of borderline personality disorder, specifically in its handling of the extreme emotional dysregulation which contribute to the suicidality of those diagnosed with this disorder (Bass, Van Nevel, & Swart, 2014; Kliem, Kröger, & Kosfelder, 2010). Meta-analysis conducted examining DBT’s effectiveness in both randomized, non-randomized, control, and not controlled studies have found that DBT exhibits an overall moderate effect, r=.56 (Kliem, Kröger, & Kosfelder,

(Linehan et. al, 1999; Koons et. al, 2001; & Linehan, Dimeff, Reynolds, Comtois, Welch, Heagerty, et al, 2002). Koons et. al(2001), looked at a sample of twenty women veterans who met the criteria for borderline personality disorder. Half of the women received DBT while the other half received treatment as usual (TAU). According to Koons et. al(2001), "Of the 11 variables patients in DBT changed significantly more than did the patients in TAU on 4 variables(suicidal ideation, hopelessness, Beck depression, and anger out). On 4 others only patients in DBT condition changed significantly..(number of parasuicides, number of hospitalizations, anger in, and dissociation"(p.384). In other words those in DBT showed significant more positive change in 8 of the 11 variables than those patients in TAU. Linehan et. al(1999) did a randomized sample of people diagnosed with BPD and SUD. Half of the sample received DBT while the other half received DBT. 64% of those receiving DBT stayed in treatment while only 27% of patients in TAU stayed. Those in DBT also had significant loss in drug abuse than those who received TAU. Those in DBT compared to those in TAU also had greater increases in social adjustment. Linehan et. al, (2002) did a study on a randomized sample of people diagnosed with BPD and SUD who either

Dialectical Behavior Therapy (DBT) is a comprehensive cognitive-behavioral treatment developed by Marsha M. Linehan for the treatment of complex, difficult-to-treat mental disorders. Originally, DBT was developed to treat individuals diagnosed with borderline personality disorder (BPD; Carson-Wong, Rizvi, & Steffel, 2013; Scheel, 2000). However, DBT has evolved into a treatment for multi-disordered individuals with BPD. In addition, DBT has been adapted for the treatment of other behavioral disorders involving emotional dysregulation, for example, substance abuse, binge eating, and for settings, such as inpatient and partial hospitalization. Dimeff and Linehan (2001) described five functions

According to Waltz (2003), Dialectical Behavior Therapy (DBT) focused is on recognizing accepting and moderating emotional responses in clients. Its main goal is to teach the patient skills to cope with stress, regulate emotions and improve relationships with others. DBT is designed for use by people who have urges to harm themselves, such as those who self-injure or who have suicidal thoughts and

However, an American psychologist, Marcha M. Lenehan develop a treatment called dialectical behavioral therapy, or DBT (Ogden, & Prokott, 2014). The dialectical behavior therapy is committed to helping those to develop tool to solve problems by searching for ways to reduce emotional suffering and build a life worth living. Its main goal is to teach the patient skills to cope with stress, regulate emotions and improve relationships with others. This therapy involves medications, such as antidepressant medications, antianxiety and antipsychotic drugs have also been used in treatment (Ogden, & Prokott,

I also feel there is still much research needed to see if treatment is effective for the disorders it was originally intended for. We can see that clinicians have jumped on DBT, as they have seen that it is a successful treatment option in the few studies they have performed. However, many of these studies were small sized and the ethnicities of them were overall the same. Dialectical Behavior Therapy is a complex treatment that was first intended for individuals with borderline personality disorders.

Though several personality disorders are highly complex and a challenge to treat, there are effective treatments available (“Treating Borderline” 1). The various treatments are broken down by method, the first of which being cognitive behavioral therapy, which attempts to alter the conscious thoughts and behavioral patterns of patients (Daniel); (“Treating Borderline” 2). Cognitive behavior therapy itself is broken down into two therapies, dialectical behavioral therapy and schema-focused therapy (“Treating Borderline” 2). Dialectical behavioral therapy, developed by Dr. Linehan, is centered on the basis that personality disorders are formed when hypersensitive patients are in situations which lack the emotional support they require, therefore leading to their “inability to regulate emotions” (“Treating Borderline” 2). Thus, the treatment serves to help the patient gain control over their emotion and behavior (“Treating Borderline” 2). The treatment itself consists of group and individual sessions and typically lasts approximately one year (“Treating Borderline” 2). During the group sessions, patients learn to become more aware of their behaviors and emotions through sessions pertaining to “problem solving, mindfulness meditation, and breath training“(“Treating Borderline” 2). In personal sessions, referred to as psychotherapy, the psychiatrist explains to the patient how the lessons from the group therapy sessions are applicable

The key concepts of behavior therapy are that it “is grounded on a scientific view of human behavior that accommodates a systematic and structured approach to counseling” (Corey, 2013, p. 250). The attention is focused on the behavior of the person. Behavior therapy is about giving control to the client to expand their freedom. “People have the capacity to choose how they will respond to external events in their environment” (Corey, 2013, p. 250).

First, a little bit about the interviewee - Dr. Young received a Master’s in Advanced Practice Psychiatric Nursing from Husson University in 2005. As a psychiatrist, she prescribes medications to clients, but also does psychotherapy during sessions. My goal for the interview was to determine the population Dr. Young works with, the therapies and techniques she uses, how she views human nature, and her overall philosophy when it comes to therapy. I quickly discovered that Dr. Young uses dialectical behavior therapy (DBT) with clients, most of whom have borderline personality disorder. Dr. Young emphasized that in addition to using empirically supported techniques, developing and maintaining a strong therapeutic relationship with a client is an important aspect of her psychotherapy sessions.

3. Clarkin, J. F., Yeomans, F., & Kernberg, O. F. (1999). Psychotherapy of borderline personality. New York : Wiley.

Since its discovery in the 1930’s, psychologists around the world have been trying to decipher the Borderline’s enigmatic condition. The term “Borderline,” coined by Adolph Stern in 1938 (Optimum Performance Institute), refers to the behavior exhibited by these patients who are on the borderline between neurosis and psychosis. The oscillating nature and unknown concrete cause of this disorder makes it difficult to treat. Due to this, Borderline Personality Disorder, or BPD, has become one of the most controversial disorders to work with in the psychiatric community. Often time Borderline patients are avoided entirely, or written off as hopeless due to their repetitive tendencies and inability to learn from their mistakes (Kreisman, 5).

The third wave of behavioral therapy includes acceptance and commitment therapy, dialectical behavior therapy, and mindfulness-based cognitive therapy. These types of therapies are designed to help people accept difficult life experiences and to persuade individuals to act on their core values. An evolution of cognitive-behavioral therapy, ACT, MBCT, and DBT not only include the thought process within the behavioral network, but mindfulness and acceptance as well. Instead of teaching people to control their thoughts and feelings in the case of CBT, ACT & DBT draws from far eastern philosophies of noticing and accepting the things in life that you cannot change.