Dialectical Behavior Therapy: theory, phases and effects
The large number of theories and currents of thought that have existed throughout the history of psychology has led to the generation of a large number of therapeutic techniques that allow different problems and disorders to be dealt with.
One of the most predominant currents at present is the cognitive-behavioral one, which through the modification of behaviors tries to alter the patterns of thought and behavior of the individuals with difficulties to make them more adaptive to the environment and to reduce their suffering. Among the techniques that allow this, especially in the face of self-destructive behaviour and severe personality disorders, is dialectical behaviour therapy .
Dialectical Behavior Therapy: theoretical basis
Experiencing impulses and emotions in an intense way is something most people have done at some point. However, in some cases experiencing overly intense emotions can lead to overly impulsive behavior, including self-injury and attempted suicide, stemming from inadequacy and repression of felt frustration.
In order to treat these problems in numerous patients, Marsha Linehan would try to apply behavior modification techniques typical of the cognitive-behavioral paradigm. However, these techniques would not have the expected effect, and the treated individuals would feel misunderstood, emotionally ignored in their feelings of emptiness and even attacked in the attempt to change their behavior without further ado.
Linehan would become aware of this fact and the feelings of the patients being treated, and in response he would end up mixing these behavior modification techniques with a more dialectical approach, which would end up being the fundamental axis of the treatment to be applied. Linehan would create what is known today as dialectical behavior therapy or dialectical behavior therapy, especially dedicated to the treatment of self-destructive and addictive behaviors.
What’s the point?
It is a technique belonging to the third wave or generation of behavioural therapies, so that it does not focus so much on eliminating the behaviour or characteristic that produces difficulties, but rather on transforming the patient’s relationship with it and guiding him or her in such a way that they can accept it and see reality in a way that is different from the original.
The basic objective of dialectical behaviour therapy is to achieve that the patient learns to correctly manage his emotions and behaviour, so that he is able to control the impulsive behaviours caused by mood disorders while both the subject and the therapist attending him accept his experience of the facts and what they mean for him. A balance is therefore sought between strategies for behavioural change and self-acceptance.
This acceptance and validation of one’s own experience in itself increases the capacity to manage one’s emotions in a more adaptive way, which in turn decreases the impulsiveness that ultimately leads to extreme behaviour. Within this therapy, the figure of the therapist (or therapists, since a team of professionals is usually employed) is of great importance, with the therapeutic relationship and the acceptance by the therapist of those elements that make change difficult being an essential constant for success.
In dialectical behaviour therapy a large number of treatment modalities are used , working in different ways on two basic aspects that this type of treatment tries to solve.
The first of these aspects is mainly based on provoking in the patient the desire to continue and motivate him/her to follow the treatment, by focusing his/her attention on the reasons for improvement and helping him/her to achieve vital objectives to be pursued and those worth living for.
The second component is based on training, training the patient in specific skills so that they are more able to accept and manage themselves in a more adaptive way. This training is based on four main modules.
Among these modules we find training in increasing tolerance to discomfort in order to combat the tendency to carry out impulsive behaviour , another in generating self-awareness skills through techniques such as Mindfulness to treat feelings of emptiness and different cognitive-emotional disorders, a module dedicated to working on emotional regulation and finally a module in which social and interpersonal skills are worked on, making the relationships of these people less chaotic, more stable and lasting.
Psychotherapy is used on an individual level to try to find a solution to the problems experienced by the patient, while group therapy is used to train the client in different skills needed to improve their self-acceptance. When faced with specific problems of daily life, it is possible to establish telephone contact with the therapist so that the situations worked on in the consultation can be applied to daily life.
Phases of therapy
The application of dialectical behaviour therapy is carried out through a series of three phases , after which the patient is guided about the therapy, the need is made clear and the active participation of the treated individual is promoted in order to achieve the objectives established between patient and therapist.
In a first phase, the work is focused on increasing self-awareness and skills both in tolerance to discomfort and in regulation of emotions and personal relationships , together with the control and management of impulsive behaviour, accepting and taking into account all those variables and behaviours that may affect the individual. In general, most of the activities aimed at achieving both self-acceptance and behavioural change are carried out.
In a second moment we proceed to act on the stress that has produced and produces the situation in the individuals.
Finally, the subject is helped to reconstruct and create a more positive and self-validating realistic self-concept , contributing to the setting and orientation towards important life goals for each client.
Clinical Uses and Applications
Dialectical behavior therapy has proven to be useful in a large number of disorders, being especially effective in controlling impulsive behaviors and intense emotions. Some of the disorders in which it is most indicated are the following.
Borderline Personality Disorder
Dialectical behavior therapy is primarily known to be the most empirically supportive type of therapy in the treatment of borderline personality disorder. From the perspective of dialectical behaviour therapy, this disorder is understood as a continuous pattern of emotional dysregulation due to the interaction between biological variables that predispose to emotional vulnerability and a disabling environment that restricts emotions so that they cannot be managed efficiently.
This causes emotions to escalate and get out of control, with extreme emotional lability along with a strong sense of inner emptiness that can lead to self-injurious and even suicidal behavior and dependent and unpredictable attitudes. Thus, in this disorder dialectical behavioral therapy aims to work on the vulnerability and feelings of helplessness of the subject, the vital passivity that they end up showing and the expression of anguish and repressed feelings.
Dialectical behaviour therapy has been successfully applied to a large number of disorders where the main problem was difficulties in regulating emotions. For this reason, the studies carried out indicate that it seems to be of great help in the reduction of symptoms of mood disorders such as major depression.
Eating disorders such as anorexia, bulimia and binge eating disorder often have at their core serious emotional regulation problems linked to the acceptance of one’s body image or an inability to maintain control over one’s eating behaviour.
In this aspect, dialectical behaviour therapy has shown that reduces the symptoms of this type of disorder , especially binge eating disorder and bulimia nervosa in which massive food consumption occurs on the basis of immediate impulses.
It must be taken into account that in a large number of cases, substance abuse is carried out with the intention of facing an existential void, as a mechanism of escape from emotions that are difficult to assume for those who suffer them (such as fear or guilt) or to alleviate the compulsive desire to consume derived from abstinence from the substance to which one is addicted. Thus, in the cases in which there is a problem of regulation of emotions behind consumption, dialectical behaviour therapy has also been shown to be particularly effective .
Although not as successful as in the previous cases, dialectical behavior therapy has been applied frequently in both post-traumatic stress disorder and anxiety disorders such as panic disorder.
- Almond tree, M.T. (2012). Psychotherapies. Manual CEDE de Preparación PIR, 06.
- Aramburu, B. (1996). Dialectical behaviour therapy for borderline personality disorder. Behavioral Psychology, 4, 123-140.
- Linehan, M. M. & Dimeff, L. (2001). Dialectical Behavior Therapy in a nutshell. The California Psychologist, 34, 10-13.
- Soler, J.; Elices, M. and Carmona, C. (2016). Dialectical behaviour therapy: clinical applications and empirical evidence. Analysis and modification of behaviour, vol.42, nº165-166. 35-49.