Dialectical Behavioral Therapy (DBT): Is it Trendy, or Does it Work?

        Dialectical Behavioral Therapy, or DBT, is a relatively new theory of psychodynamic treatment in which the treatment focus is aimed at the emotions that are currently being experienced by the individual, rather than any past history. This change from the traditional focus allows for effectiveness in a wide range of clinical situations, although it was originally developed for the treatment of Borderline Personality Disorder. Once thought of primarily as a means of increasing the stability and safety of chronically suicidal patients, it has spread to have treatment implications for a wide range of mood disorders, personality disorders, addictions, and anxiety as well as other mental illnesses.

       DBT is based on the premise that individuals develop avoidant behaviors as a means of emotional escape from emotional pain .DBT also presumes that the intensity of the pain has a dialectical conflict between the self and the environment.

      The effectiveness of DBT requires the accurate reporting of experiences and emotions by the individual client, and that the emotional pain experienced is not due to misunderstanding on the part of the client. The emotional pain experienced must be acknowledged and validated by the treating clinician.

       Consider the following example of emotional distress causing avoidant behavior by the individual experiencing the pain. For instance, if an experience results in anxiety, in the future the client will anticipate the sensation of anxiety and avoid interactions or life experiences of a similar nature to the original precipitant.

     DBT is an acceptance-based therapy in that rather than attempting to solve problems, it teaches the client to be mindfully aware of the situation, and to accept it without expecting to change. It is important to note that this is not a suggestion that abuse, or other such inappropriate behavior towards the client is encouraged to be tolerated, but rather that emotions that interfere with the client’s daily life be accepted and dealt with in the here and now.

    Emotional sensitivity, or increased emotionality, is often the end result of childhood attachment disorders, trauma, prolonged invalidation of displayed affect or mood, and loss.  Clearly, these precipitating factors are outside of the control of the individual. This sensitivity or high emotional arousal leads to an increased perception of environmental threats, and eventually the diminished capability to process information. Finally, avoidance almost completely replaces appropriate adaptive behaviors.

   Rather than discouraging the client from the negative thoughts they experience, the cognitive reframing of DBT teaches the individual to modify the thoughts in order to decrease the emotional pain that they experience. The goal in DBT is not to agree with the client, but to assist the client to the realization that their strong emotionality is the basis of their avoidant and other ineffective strategies that have increased, rather than alleviated, their suffering, thus learning to balance acceptance with change.