Dialectical Behavior Therapy (DBT) in Brooklyn

Understanding DBT: Applications and Effectiveness

Dialectical Behavior Therapy (DBT) is a comprehensive, evidence-based treatment developed by Dr. Marsha Linehan in the late 1980s. Originally created to treat borderline personality disorder (BPD), DBT has since been adapted to address a wide range of mental health issues characterized by emotional dysregulation and impulsive behaviors.

At its core, DBT is based on a dialectical worldview, which emphasizes the synthesis of opposites. In therapy, this often manifests as balancing acceptance (of oneself and one’s current situation) with change (working towards improvement). This balance is crucial for individuals who struggle with intense emotions and maladaptive coping mechanisms.

DBT typically consists of four main components:

1. Individual therapy sessions
2. Group skills training
3. Phone coaching (for crisis situations)
4. Consultation team meetings for therapists

The skills taught in DBT fall into four modules:

1. Mindfulness: Focusing on the present moment non-judgmentally
2. Distress Tolerance: Coping with crisis situations without making them worse
3. Emotion Regulation: Understanding and managing intense emotions
4. Interpersonal Effectiveness: Navigating relationships assertively and effectively

While originally developed for BPD, DBT has shown effectiveness in treating a variety of mental health issues beyond the six mentioned above:

1. Bipolar Disorder: DBT can help manage mood swings and impulsive behaviors associated with bipolar disorder.
2. Attention-Deficit/Hyperactivity Disorder (ADHD): DBT skills can assist with impulse control and emotional regulation in ADHD.
3. Generalized Anxiety Disorder: DBT’s mindfulness and distress tolerance skills can be particularly helpful for managing anxiety.
4. Obsessive-Compulsive Disorder (OCD): DBT can complement exposure therapy for OCD by providing emotion regulation and distress tolerance skills.
5. Anger Management: DBT’s focus on emotional regulation and interpersonal effectiveness can be beneficial for individuals struggling with anger issues.
6. Adolescent Mental Health Issues: DBT has been adapted for adolescents (DBT-A) and has shown effectiveness in treating various mental health issues in this population.

The effectiveness of DBT has been well-documented in numerous studies. For Borderline Personality Disorder, DBT has shown remarkable results. A seminal study by Linehan et al. (2006) found that DBT was significantly more effective than treatment by expert therapists in reducing suicide attempts, self-injurious behaviors, and use of crisis services.

In treating substance use disorders, a study by Linehan et al. (1999) found that DBT was superior to treatment as usual in reducing drug abuse in individuals with BPD and substance dependence. Participants in the DBT group showed greater reductions in drug use and achieved higher rates of abstinence.

For eating disorders, Safer et al. (2001) demonstrated the effectiveness of DBT in treating bulimia nervosa. The study found that 89% of participants receiving DBT had stopped binge-eating and purging by the end of treatment, compared to 12.5% in the control group.

In addressing PTSD, particularly in individuals with BPD, Harned et al. (2012) found that DBT with the DBT Prolonged Exposure protocol led to significant reductions in PTSD symptoms, with 80% of participants no longer meeting criteria for PTSD at follow-up.

For depression, particularly treatment-resistant depression, Lynch et al. (2007) found that adding DBT to medication treatment led to significantly better outcomes compared to medication alone in older adults with depression.

Regarding self-harm and suicidal behaviors, a meta-analysis by DeCou et al. (2019) found that DBT was associated with moderate to large reductions in self-harm and suicidal behaviors across various populations.

One of the key strengths of DBT is its comprehensive nature. By combining individual therapy, group skills training, and phone coaching, DBT provides multiple avenues for learning and applying new skills. The focus on both acceptance and change helps individuals validate their experiences while working towards improvement.

DBT’s structured approach to teaching specific skills makes it a practical and accessible treatment option. Patients learn concrete strategies they can apply in their daily lives, which can lead to a sense of empowerment and self-efficacy.

While DBT has shown impressive results, it’s important to note that it requires a significant time commitment and engagement from both the therapist and the patient. The full DBT program typically lasts for at least six months to a year. However, elements of DBT can be incorporated into other treatment approaches for those unable to commit to a full DBT program.

In conclusion, Dialectical Behavior Therapy has proven to be a powerful and versatile treatment approach for a wide range of mental health issues. Its focus on skill-building, emotional regulation, and balancing acceptance with change makes it particularly effective for individuals struggling with intense emotions and impulsive behaviors. As research continues, DBT is likely to be further refined and adapted to address an even broader range of mental health concerns.

References:

1. Linehan, M. M., Comtois, K. A., Murray, A. M., Brown, M. Z., Gallop, R. J., Heard, H. L., … & Lindenboim, N. (2006). Two-year randomized controlled trial and follow-up of dialectical behavior therapy vs therapy by experts for suicidal behaviors and borderline personality disorder. Archives of General Psychiatry, 63(7), 757-766. https://doi.org/10.1001/archpsyc.63.7.757
2. Linehan, M. M., Schmidt, H., Dimeff, L. A., Craft, J. C., Kanter, J., & Comtois, K. A. (1999). Dialectical behavior therapy for patients with borderline personality disorder and drug‐dependence. The American Journal on Addictions, 8(4), 279-292. https://doi.org/10.1080/105504999305686
3. Safer, D. L., Telch, C. F., & Agras, W. S. (2001). Dialectical behavior therapy for bulimia nervosa. American Journal of Psychiatry, 158(4), 632-634. https://doi.org/10.1176/appi.ajp.158.4.632
4. Harned, M. S., Korslund, K. E., & Linehan, M. M. (2014). A pilot randomized controlled trial of Dialectical Behavior Therapy with and without the Dialectical Behavior Therapy Prolonged Exposure protocol for suicidal and self-injuring women with borderline personality disorder and PTSD. Behaviour Research and Therapy, 55, 7-17. https://doi.org/10.1016/j.brat.2014.01.008
5. Lynch, T. R., Cheavens, J. S., Cukrowicz, K. C., Thorp, S. R., Bronner, L., & Beyer, J. (2007). Treatment of older adults with co‐morbid personality disorder and depression: A dialectical behavior therapy approach. International Journal of Geriatric Psychiatry, 22(2), 131-143. https://doi.org/10.1002/gps.1703
6. DeCou, C. R., Comtois, K. A., & Landes, S. J. (2019). Dialectical behavior therapy is effective for the treatment of suicidal behavior: A meta-analysis. Behavior Therapy, 50(1), 60-72. https://doi.org/10.1016/j.beth.2018.03.009