Dialectical Behaviour Therapy (DBT)

dbt

Dialectical Behaviour Therapy is a specialized type of talking therapy under the general category of Cognitive Behavioural Therapy (CBT).  This kind of CBT was developed by psychologist, Marsha M. Linehan, in the 1980’s  to especially focus on treating Borderline Personality Disorder (BPD) and has since proven to be a valuable treatment for this particular mental illness.

What does “Dialectic” in DBT mean?

The word dialectic in the term Dialectical Behaviour Therapy refers to the unification or synthesis of two opposing positions, concepts, or realities.  DBT seeks to meld two key concepts that naturally oppose each other:  acceptance and change.

Acceptance refers to coming to terms with who you are—your emotions, experiences, and natural responses.  Change means altering your responses and thoughts toward more positive behaviour and coping strategies in order to reach personal and social goals in becoming a more integrated individual.

People with Borderline Personality Disorder have very heightened negative emotions.  As a result, they are often acutely emotionally unstable and have a tendency toward inflicting self harm and attempting suicide.  DBT seeks to help BPD patients accept their personal liabilities and to help them acquire new behavioural skills to replace their ineffective and damaging responses for achieving emotional stability and personal goals.

Four Stages of Treatment with Dialectic Behaviour Therapy

The end goal of all four stages is to mould the patient toward making their own paradigm shift from feelings of worthlessness to:  I am worth as much as everyone else; life is worth living.

Stage 1:  Achieving Behavioural Control

At the start of therapy, the patient’s condition may be dangerously low—in psychological misery, out of control, and therefore may be self-destructive with drug and alcohol use, sexual promiscuity, or binge eating.  They may also be suicidal with a history of attempts or still at the contemplation stage.  The objective of Stage 1 therapy is to assist the patient into gaining command of his spiralling out-of-control thoughts and behaviour.

Stage 1 is all about setting and achieving three main goals:

  1. Stop suicidal or self-harming behaviour
  1. Rid the patient of obstacles or behaviour that prevent or interfere with therapy — the patient may justify to himself why he does not need to go on with therapy or his family may be embarrassed about his condition and prevent him from getting needed treatment.
  1. Addressing issues that lower patient’s quality of life — Problems like depression, unstable relationships, or being expelled from school may be issues distressing the patient to a volatile degree.

At this stage, the therapist tries to equip the patient with emotion-managing skills so that the patient can disengage from dangerous behaviour and gain some mastery over his negative thought patterns.

Stage 2:  Emotional Experiencing

Although Stage 1 behaviour control has been achieved, the patient continues to suffer quietly.  Their emotional turmoil is usually due to past trauma and invalidated feelings.  For those with Post Traumatic Stress Disorder (PTSD), past trauma is explored and analysed and its accompanying negative beliefs and behaviours, verified.  PTSD is treated at this stage.

The goal of stage 2 is to move the patient past suffering with inhibited emotions and on to a level where they experience their emotions in full.  At this second stage, the therapy involves the following:

  1. The patient is encouraged to remember and accept the traumatic event.
  2. Reduction of stigmatization
  3. Reduction of self-blame
  4. Lowering incidences of negative intrusive and denial syndromes

Stage 2 goals can only be achieved once negative behaviour is under control.

Stage 3:  Learning to Live

Stage 3 focuses on building self-esteem, owning one’s behaviour, creating trust and value for one’s self, and goal setting.  The patient is gradually led toward coming to terms with happy and unhappy events in life, thus enabling him to live life normally.

Stage 4:  Building Capacity for Joy

Some people stop at stage 3 but for others, stage 4 is an important part of recovery.  Stage 4 is all about spiritual fulfilment which helps the patient feel connected to humanity as a whole.  The goal at this stage is to help the patient go beyond just living day to day and be able to incorporate the ability to experience joy and freedom.

DBT-Skills

Scientific evidence has proven Dialectical Behaviour Therapy to be effective in lowering rates of suicides, self-harm, dropouts in treatment, depression, hospitalization, and substance abuse.  DBT has indeed helped many patients to improve functioning and relationships in their personal and social lives.

Depression: When Sadness Becomes More Than Itself

depression

Clinical depression is a growing concern in the Western World.  It has become a common debilitating mental disease with one in five persons in the U.K. having had depression at some point in their lives.  It hits all age groups, income levels, and communities.  Its growth is accelerating to the point that it could become one of the most incapacitating conditions in the developed world by 2020, second only to heart disease.

Normal bouts of sadness are natural occurrences.  Death of a loved one, for instance, may cause one, grief.  In a mentally healthy individual, the intensity may last for a short time and taper off eventually to a steady acceptance.  Grief that spirals into clinical depression however will stay with the individual for the long haul and could disrupt his daily functions.

Depression Is a Real Illness

A person with a depressive disorder is truly sick.  Much like a physical illness in which an organ or its system is weakened, so it is with depression of which its compromised organ is the brain.  Diabetes, for instance, is a physical disease that involves the impaired function of the metabolic system to handle the hormone, insulin.  Likewise, the condition of depression involves an impairment of the nervous system manifesting with the imbalance of certain brain chemicals; low production of neurons and nerve cell connections; and impaired nerve cell growth and nerve circuit functions.

Many factors can trigger depression.  Life events can traumatize people into a depression.  Our biological makeup such as genetics and brain chemistry are major factors as well.  Serious medical illnesses such as cancer and Parkinson’s disease can also lead a person into a depressive state.  Some medications used to treat physical illnesses may have depression as its side effect.

The State of Depression Varies for Each Person

The degree, frequency, and length of depressive symptoms are as individualized as the person afflicted by it.  Symptoms vary from person to person with the variety dependent on age, gender, culture, and other factors.  Some people feel only a few symptoms while others are burdened by many.  In addition, there are people, especially children and adolescents, who do not even recognize the symptoms of depression.  Men feel it differently than women and have different coping strategies as well.

Symptoms of Depression

The tell-tale signs of depression include but are not limited to the following:

  • Sad or anxious mood that does not go away for a long time
  • Chronic empty feeling
  • Thoughts of suicide; attempts at suicide
  • Increased pessimism; hopelessness
  • Restlessness
  • Irritability
  • Insomnia or oversleeping
  • Decreased cognitive functions.  Depressed person has trouble remembering or making sound judgements or decisions.
  • Physical aches, pains, and other symptoms, such as headaches, palpitations, and stomach aches which do not test positive for any physical illness
  • Feelings of very low self-worth, inferiority, and guilt
  • Chronic reduced energy levels; exhaustion; fatigue
  • Fast weight changes and appetite changes
  • Loss of interest in things previously enjoyed; loss of interest in anything and anyone
  • Markedly reduced libido

Some people may not be aware of their depressed state because symptoms can come gradually to them.  They may have kept themselves busy to avoid feeling sad or hurt.  Eventually the strain does catch up to them and they start to exhibit some of the above symptoms.  Physical pains however without any physical cause may also signal that a person has a psychological issue.

Treatment for Depression

The good news is that depression, even severe cases, can be treated; however, diagnosis and treatment is best at the early stages where recovery is faster.  When you suspect yourself of being depressed, seek professional help as soon as possible.  Expect treatment to include talking therapies with your psychiatrist.  Antidepressant medication may also be prescribed if your situation warrants it.

What You Can Do to Help Yourself

Aside from seeking professional help, there are a number of ways by which you can help yourself feel better.  First thing you can do is take charge of your physical health.  As the mind and body are tied together, whatever affects the body affects the mind and vice-versa.  You can start by:

  • Eating a well balanced diet everyday
  • Beginning and sticking seriously to an exercise program
  • Avoid alcohol, caffeine, smoking, and illicit drugs.  These substances just worsen depression.
  • Fixing your sleeping patterns.  Getting a good night’s rest everyday is crucial to your recovery.

Your emotional state needs nurturing as well:

  • Find a trusted friend or family member you can talk to about your issues and emotional condition.
  • Approach depression with a plan.  Write down what you think is causing the problem and the positive ways you can fight your negative state.
  • Join a support group of people with the same problem.
  • Avoid making any major life decisions until you can handle big changes.
  • Avoid piling up more work to perpetually take your mind away from your issue.  You need to set aside time to go over the problem so you can eventually come to terms with it.

stronger than depression

Learn all you can about depression in order to understand the condition better.  The road to recovery may be a shorter path if you simply work positively toward achieving that healing goal.

Cognitive Behavioural Therapy (CBT)

therapist-cbt

Mental problems are varied and individualistic in most and therefore the approaches to addressing these dysfunctions are also diverse and may be tweaked to suit each individual patient.  One such therapy that has proven to it merit through the decades is Cognitive Behavioural Therapy or CBT.

CBT and its History

Cognitive Behavioural Therapy is also known by its shortened name, cognitive therapy, and by its initials, CBT.  Cognitive theory is a type of therapy that focuses on a person’s thinking patterns as the source of his dysfunctional emotions and behaviours.  The aim of CBT is to change how people think for the better so that this positivity may improve how they feel or how they choose to behave.

The Greek philosopher, Epictetus, taught that:  “It’s not things that upset us, it’s our view of things.”  Psychoanalyst and psychiatrist, Aaron Beck drew from this philosophy to develop cognitive therapy in the U.S. in the 1960’s.

Albert Ellis is another proponent of CBT who developed a slightly different approach known as Rational Emotive Behaviour Therapy (REBT).  This therapy looks into a person’s basic irrational assumptions about themselves which often lead them to compromise their chances for happiness and success.  Thoughts like “I can’t be that sexy; I’m not smart enough to make the grade; my parents don’t like me ” reflect a typical negativity that persists even when faced with contrary evidence.

A Case in Point

Some of us do not realize that our thought patterns and behaviour stem from negative assumptions.  Take this case:   Tom thinks of himself as inferior to his colleagues; as such, any small incidents at the workplace may upset him.  If he happens to greet a co-worker who fails to reply in turn, Tom starts to think that:

  1. He has not been deemed worthy of the person’s time for a reply.
  2. He is not liked by this person.

Out of these assumptions, he goes on to infer more negative conclusions:

  1.   My colleagues think I’m not good enough.
  2.   I really am not good enough.
  3.   It’s only a matter of time before I lose my job.

Tom then goes into a low mood without considering that there may be other factors why his greeting was not returned.  His colleague may not have heard him or must have been preoccupied with something that he missed Tom’s greeting.  More incidents like these and Tom begins to solidify his negative thoughts.  These bad thoughts then influence Tom’s behaviour and he:

  1. becomes withdrawn                                                                    cognitive-behavioural-therapy
  2. becomes timid or less assertive
  3. highly sensitive to constructive criticism

All these behaviours work against Tom’s ability to further his career.  Indeed, he may lose his job if his behaviour is not corrected.  This is where cognitive behavioural therapy can help.  CBT sessions with a mental health professional may help Tom realize that his negative thoughts are compromising his workplace situation.

How CBT is Carried Out

Cognitive Behavioural Therapy involves a “talking it out” type of treatment that is concerned with making the patient realize that his inherent tendencies toward negative thoughts have a strong influence on his behaviours and emotional state.

A cognitive-behavioural therapist employs four phases in the treatment:

  • Assessment stage

At the beginning, you and your therapist get to know each other.  This is how your therapist can draft a treatment plan which can include an estimate of how long treatment is likely to take.

  • Cognitive stage

In this stage, your therapist will help you identify what’s causing your negative behaviours.  Expect to delve into past events that helped shape negative thought patterns.  Your therapist       means to help you to understand how your perceptions have brought about your maladjusted behaviours.  Although this stage may prove difficult especially for people who grapple with introspection, patients must fully cooperate at this stage if they are to gain vital insights and make crucial discoveries about their psyche.

  • Behaviour stage

Once the roots of the problem have been fleshed out,  you and your therapist find new patterns of thinking and behaving.  These new skills must be applicable to real life situations.

  • Learning stage

The patient starts to learn and practice new behaviour.  This may include dealing with situations that could contribute to a relapse.  Here, the goal is to establish permanent positive changes so that the psychological problem may be eliminated for good.

It is the goal of CBT to help people come to terms with the fact that while they always cannot control their environment,  they alone can control how they perceive things and react to them. Therapy is a gradual process, one that helps a person take small steps toward thought and behavioural change.

Where CBT is Most Effective

Cognitive Behavioural Therapy has been used to treat patients afflicted with a wide range of problems.  These include anxiety, addiction, phobia, and depression.  In much serious mental health dysfunctions, CBT may only be a component of a main therapy plan.

Cognitive therapy is best suited to people who are comfortable with self-analysis and introspection.  CBT will prove effective especially with those who are truly committed to finding the root cause of the problem and making the necessary behavioural changes.