As its name suggests, DBT emphasizes dialectics — the reconciliation of opposites in a continual process of synthesis. DBT emphasizes the dialectic of acceptance and change in improving the quality of participants’ lives.
Developed in 1993 by Marsha M.Linehan, and outlined in her book titled “Cognitive Behavioral Treatment of Borderline Personality Disorder “, DBT has received attention as an innovative and effective therapy for difficult-to-treat conditions. It is one of the few empirically validated treatments for persons with Borderline Personality Disorder, and is currently being studied in the treatment of several other psychiatric disorders such as substance abuse, eating disorders, major depression, and anxiety disorders. It has received recent attention in the media, including the New York Times and National Public Radio.
The Emotion Management Program, LLC (EMP) specializes in DBT. EMP’s approach differs from traditional DBT in that rather than operating from a cognitive behavior perspective, it is best understood as a contextual behavior approach. A cognitive behavior approach emphasizes change and control of private experience and rationality as the important outcome criteria. In contrast, a contextual behavior approach takes a functional approach, and emphasizes acceptance as the only viable stance toward private experience (in particular, troubling cognitions and emotions). It uses workability as the outcome criteria for evaluating effectiveness.
Take the example of a client struggling with depressogenic thoughts. The cognitive therapist will work with the client in examining the content of their thoughts and assist them in developing challenges or counters to them–i.e., cognitive therapy ultimately focuses on changing the content of the client’s thoughts. Unfortunately, the depressed person never thinks to challenge or counter until the thoughts are already present.
In contrast, the contextual behavioral therapist assists the client in examining if their current style of thinking and content of mind is new and novel or more of the same thoughts and reactions that have been experienced in the past — i.e.,.new situation, same old thoughts. The therapist assists the client in examining how well it has worked for them to take the thoughts under consideration seriously– i.e., to react to their thoughts as if they were facts. Then, emphasis is placed on teaching the client how to notice rather react to their thoughts-(i.e., to accept private experience). Once the client learns to notice and be aware of their current stance toward private experience and is free from the tendency to react automatically, they are able to experiment with alternative solutions and identify effective responses. The client can focus on problem-solving rather than on controlling aversive private experiences.
What does DBT involve?
DBT entails three clinical activities: skills group, individual therapy, and telephone consultation.
Participants learn effective coping strategies to be more mindful of current experiences, better regulate emotions, effectively manage interpersonal relationships, and skillfully tolerate emotional distress. Skills group is organized much like a classroom setting. Participants commit to completing daily diary cards and homework assignments.
Participants also attend an individual therapy session each week where they learn to evaluate precipitants to their daily distress and apply coping strategies learned in skills group. The participant and the therapist work collaboratively to assess current behaviors, and to develop precise operational definition of treatment targets.
Emphasis is placed on reducing life-threatening, therapy-interfering, and quality-of-life-
interfering behaviors, as well as increasing the frequency of effective coping. To this end, EMP therapists are available to participants for phone consultation in order to provide skills coaching outside of regular program hours. Participants learn to apply effective coping strategies to real life situations.