Our Approach
Contextually-Focused Dialectical Behavior Therapy
For those interested, here is a more detailed description of our modifications to DBT in light of recent literature.
Dialectical behavior therapy (DBT) is a cognitive-behavioral approach originally developed as a treatment for women, who struggle with emotional dysregulation and engage in suicidal and/or para-suicidal behaviors (Linehan, 1993). However, emotional distress is experienced in many more diverse ways across a much broader spectrum of people.
Contextually-focused dialectical behavior therapy (C-DBT), a modified version of DBT, is based on a model of emotional dysregulation that helps us discriminate between those aspects of human experience amenable to change from those where acceptance is our only choice.
Traditional DBT therapists tend to focus on following specific treatment protocols, checking the facts and learning specific skills. In contrast, C-DBT examines how well our coping behaviors work, assists us to decouple these behaviors from the emotion and thoughts that trigger them and helps us to use those things that matter most to organize our behavior.
Mindfulness is the foundation of this work. This is the process of disciplining our mind; rather than trying to control our experience, we take an accepting stance toward it.
C-DBT uses the Chronic Distress Model as an explanation of emotional dysregulation. This model is based in literature that suggests that we have a fundamental need for recognition, a basic sense that we “belong” or “matter.” Invalidating/oppressive environments thwart this sense. These types of environments may exist at the familial, community, cultural and global levels. Chronic distress is a cycle of coping with a lack of mattering in which we alternate between efforts to disprove it and moments when we buy into it.
The arc of treatment in C-DBT involves three main processes:
Consciousness-raising
Increase our awareness of the ways in which attempts to cope with a lack of mattering or belonging has resulted in habitual patterns of self-defeating behavior that are self-perpetuating.
Freedom from
Decouple these automatic, habitual ways of behaving from troubling emotions, thoughts, and memories via exposure, emotional experiencing and contact with prediction errors.
Freedom to
Non-reactivity to our past provides opportunities for using the future in the form of commitments and values as the parameters with in which to make sound choices and exercise a sense of personal agency.
By engaging in these three processes, we develop a sense that we can shape and direct our lives. We transform ourselves by reorienting from a preoccupation with our problems and our past, to a commitment to a future we desire for ourselves.