Dialectical Behavior Therapy: What is it and How to Do It?

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Dialectical Behavior Therapy: What is it and How to Do It?
Dialectical behavior therapy

Dialectical Behavior Therapy or DBT is a psychotherapy approach developed in the early 1990s by psychologist Marsha M. Linehan. DBT was specifically designed to treat patients with borderline personality disorder.

DBT combines principles from standard cognitive behavioral therapy with several additional strategies, including skills training, self-acceptance, and mindfulness. The primary goal of DBT is to help clients develop skills to regulate emotions, improve interpersonal skills, and reduce harmful or self-destructive behavior.

DBT is based on the assumption that clients lack the skills to regulate their own emotions. Therefore, they tend to engage in impulsive and self-destructive behavior as a way of coping with intense emotions. DBT is designed to give clients new skills and help them learn how to manage emotions without hurting themselves or others.

Key concepts of DBT

Diabetic Therapy (DBT) is based on four main concepts:

1. Mindfulness is full awareness of the present moment, without judgment. Mindfulness helps clients focus on the present moment, observing their thoughts and feelings without judgment. With mindfulness, clients learn to accept themselves as they are.

2. Acceptance – means acknowledging the current reality without trying to change it. Acceptance helps clients accept themselves, others, and situations as they are. With radical acceptance, clients learn to live with the current reality instead of fighting it.

3. Change aims to change non-adaptive behavior, thoughts and emotions. DBT uses a problem-based solution approach to identify target behaviors and build new skills. Change allows clients to manage emotions, think rationally, and live functionally.

4. Dialectical balance encourages accepting oneself while still trying to change. Dialectical balance combines radical acceptance with active change. Clients learn to accept the things that cannot be changed while continuing to try to change the things that can be changed.

DBT brings together mindfulness, acceptance, change, and dialectical balance to help clients manage emotions, improve interpersonal skills, and live fully. These four concepts complement each other and form the foundation of DBT.

Components of DBT

DBT consists of 4 main components:

1. Individual therapy

Individual therapy provides an opportunity for patients to discuss their problems in depth with a therapist. Individual therapy usually takes place once a week for 50-60 minutes. The goal of individual therapy is to help patients learn and practice DBT skills, overcome barriers to therapy, and discuss problems that arise between sessions.

2. Group training skills

Skills groups typically consist of 6-8 patients who meet once or twice a week for 2-2.5 hours. These groups are led by trained therapists and are focused on learning and practicing specific DBT skills. Examples of skills trained include awareness, emotional regulation, resilience, and interpersonal skills.

3. Telephone consultation

Patients can contact a DBT therapist outside of scheduled sessions if they need help with skills they have learned or when dealing with a crisis. Telephone consultations are usually brief, solution-focused, and help patients apply DBT skills.

4. Skills classes

Skills classes are additional weekly 2-2.5 hour sessions led by a therapist. These classes cover specific topics in depth, such as self-awareness, emotional regulation, and interpersonal relationships. Skills classes help reinforce patient learning.

Who can be treated with DBT?

Dialectical Behavior Therapy (DBT) is specifically designed to treat borderline personality disorder (BPD). BPD is characterized by instability in emotions, interpersonal relationships, self-image, and impulsive behavior. People with BPD often experience very strong emotions, get angry easily, and have difficulty controlling impulses. DBT helps them learn to regulate emotions, think rationally, and build skills to cope with stress.

In addition to BPD, DBT has also been shown to be effective for other mental health conditions, including:

– Depression
– Eating disorders
– Addiction and substance abuse
– Post-traumatic stress disorder
– Anxiety disorder
– Bipolar disorder

DBT can help anyone who wants to learn healthy coping strategies for managing strong emotions. DBT is also suitable for those who have difficulty building healthy relationships, tend to act impulsively and need support to feel calmer. With DBT skills training, anyone can gain greater self-control.

 Stages of DBT Therapy

DBT therapy is usually carried out in several stages:

Before starting DBT therapy, patients will undergo an initial assessment by a therapist to determine whether DBT is suitable for them. The therapist will assess the patient’s symptoms, history, and goals. Patients are also asked to make a commitment to participate in the full DBT program.

 Level 1

The first stage of DBT therapy focuses on stabilization. The goal is to help patients control problematic behavior and crises, as well as improve skills for managing emotions.

At this stage, the patient will follow:

 

  • Individual therapy – 1 hour per week with a therapist to learn DBT skills
  • Skills group – 2-2.5 hours per week to learn DBT skills in depth
  • Telephone coaching – access to a therapist outside of sessions for crisis support
  • Team consultation – the therapist meets fellow therapists to discuss the case

Stage 1 lasts 3-6 months.

Level 2

Once the patient is relatively stable, they can move on to stage 2. This stage focuses on overcoming past problems and trauma.

Some components of stage 2:

  • Exposure therapy – facing feared situations to overcome trauma
  • Mindset change – challenging irrational beliefs
  • Problem resolution – strategies for solving life problems
  • Interpersonal skills – improving relationships

Stage 2 usually lasts 12 months or more.

 DBT strategies and techniques

Dialectical Behavior Therapy uses several key strategies and techniques to help patients develop skills for controlling strong emotions and self-destructive behavior. This includes:

 – Validation involves accepting the patient’s feelings and experiences as they are without judgment. This helps patients feel heard and understood. DBT therapists actively listen, label, and validate the patient’s feelings.

 – Problem solving helps patients objectively assess problems, generate workable solutions, and act effectively to resolve problems. DBT patients learn problem-solving skills to overcome everyday challenges.

 – Contradictory behavior involves doing the opposite of the impulse that arises. For example, if a patient wants to harm themselves when angry, they may engage in the contradictory behavior of gently hugging themselves. This helps patients change automatic reaction patterns.

– Short-term commitment – DBT therapy uses short-term goals and commitment to help patients build new skills. Patients are asked to make small commitments week after week, such as calling a therapist if they want to harm themselves. This helps them progress towards change.

 Benefits and evidence of effectiveness

DBT has been shown to be effective in treating a number of conditions, especially borderline personality disorder. Some of the main benefits of DBT:

Reduce suicidal and self-destructive behavior

DBT is specifically designed to reduce suicidal and self-destructive behavior often found in borderline personality disorder. Researchers have found that DBT significantly reduces suicide attempts, suicide hospitalizations, and other self-destructive behaviors.

Improve emotional regulation

DBT helps patients develop emotion regulation skills so they can better manage strong emotions. These include skills such as mindfulness, stress tolerance, emotional regulation, and interpersonal effectiveness. DBT has been shown to reduce emotional lability.

Build interpersonal skills

DBT teaches interpersonal skills to help patients relate to others in healthier ways. This includes training in healthy self-boundaries, communicating clearly, and maintaining relationships. DBT can reduce interpersonal conflict.

Improve psychosocial functioning

Overall, DBT can improve quality of life by reducing symptoms of borderline personality disorder and improving psychosocial functioning. Research shows improvements in employment/education, romantic relationships, and life satisfaction.

 

 Preparation before starting DBT

 

Before starting DBT therapy, there are several preparations that need to be made so that the therapy can run optimally:

Setting goals

Setting therapy goals is very important so that clients and therapists have the same understanding of what they want to achieve from DBT therapy. Therapy goals must be specific, measurable, achievable within a certain time period, and realistic. Examples of good therapy goals include reducing self-harm behavior in 3 months or improving emotion management skills in 6 months.

Find a trained therapist

To be able to do DBT, you need a therapist who has been trained and certified in DBT. Make sure the therapist you choose has experience providing DBT, not just knowing the theory. A good DBT therapist will actively train clients in DBT skills and techniques during therapy sessions.

Make a commitment

Clients need to commit to following the full DBT protocol, such as attending regular individual and group sessions. Therapists also need to be committed to implementing DBT according to guidelines, not just integrating some DBT techniques into other therapies. Commitment from both parties is important for the success of therapy.

 

DBT challenges and considerations

 

While DBT has been shown to be effective in treating certain disorders, there are several challenges and considerations to keep in mind:

  • DBT usually requires a very high level of commitment, both from the client and the therapist. Clients must be willing to participate in individual and group therapy, do homework, and practice the skills they learn. This requires strong motivation and self-discipline.
  • DBT is designed as a long-term therapy, and it can take months or years to see significant results. This requires patience and persistence. Change may occur gradually.
  • Because DBT requires highly trained therapists and a comprehensive program, this therapy is not always available everywhere. It may be difficult to find a therapist or DBT program in some areas. The costs can also be expensive if insurance is not covered.

 

Conclusion

Dialectical behavior therapy has been shown to be an effective approach for treating certain mental disorders such as borderline personality disorder. By combining psychotherapy and skills training, DBT helps patients develop emotional regulation skills, self-awareness, stress tolerance, and interpersonal effectiveness.

Through four main components – individual therapy, skills groups, telephone consultations, and teams – DBT provides comprehensive support to patients. This long-term therapy demands commitment and hard work but has been shown to reduce dangerous behavior, hospital admissions, and symptoms of borderline personality disorder.

DBT can be applied in both individual and group settings. Despite its challenges, DBT is worth considering for patients with uncontrolled emotions and behavior. With proper training, team support, and patient involvement, DBT can be a transformative approach that improves self-regulation and quality of life.

Tentang Penulis: Jonathan putra

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dr. Jonathan Putra merupakan Dokter Umum yang berpraktik di RS Umum Royal Prima. Beliau telah mengemban pendidikan Kedokteran Umum di Universitas Sumatera Utara. Adapun layanan yang dapat dr. Jonathan putra bantu yaitu konsultasi kesehatan umum, seperti demam, sakit kepala/ migrain, diare, batuk/ pilek, sariawan, ambeiien, asma, rematik, kolesterol. Selain itu, Beliau terhimpun dengan Ikatan Dokter Indonesia (IDI).

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