Dialectical Behavioral Therapy (DBT) is a comprehensive, cognitive behavioral treatment program developed by Marsha Linehan Ph.D. at the University of Washington to address the extreme moodiness, reckless impulsivity, self destructive and suicidal behaviors of persons with Borderline Personality Disorder (BPD) or BPD traits. More recently it has been found effective for treating BPD and substance abuse, bulimia nervosa, and elderly and teenage clients, with treatment resistant depression. Its current use has been supported by the National Institutes of Mental Health, the National Institute of Drug Abuse and various academic centers.
Borderline Personality Disorder (BPD) is a complex disorder. Prominent symptoms include suicidal gestures and attempts, self injury (cutting, burning), aggressive outbursts, impulsivity and emotional reactivity; all of which typically manifest themselves within the context of interpersonal relationships. There has been an ongoing discussion in psychiatry about whether impulsive aggression, mood changes and emotional vulnerability are at the core of the disorder. DBT assumes that BPD stems from emotional dysregulation in the presence of an invalidating (overcritical, judgmental, abusive) environment. When faced with normal emotions like fear, sadness, anger or joy; individuals with BPD are unable to effectively regulate those emotions. Unregulated emotions that do not become manageable within a reasonable amount of time strongly influence the individual’s interpretations of events and color their interactions with people, leading to chaotic interpersonal relationships, impulsivity and self destructive behaviors.
The meaning of the word: “dialectical” derives from modern philosophers like Kant and Hegel, who used the term to describe a process of resolving or synthesizing opposites. Linehan applied it to this form of therapy because a fundamental task in DBT is to promote acceptance while simultaneously encouraging change. If the therapy emphasizes only change or acceptance BPD clients tend to experience it as invalidating their needs and experience. DBT balances the client’s need to avoid pain with a simultaneous effort to accept life as it is.
DBT involves individual, group skills training (that consist of a blend of cognitive-behavioral therapy and Zen inspired meditative techniques) phone availability and consultation with a team that provide ongoing support for the therapists imparting the treatment. The essential goals of the therapy include improving the client’s motivation for change, enhancing the person’s capabilities, generalizing new behaviors and structuring the environment.
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