Dialectical Behavior Therapy
Dialectical Behavior Therapy (DBT) is one of the leading examples of an evidence-based practice. Originally developed as an outpatient treatment, DBT has more recently been applied in diverse settings such as public schools, community-based group homes, and outreach treatment settings. DBT is a treatment that has been proven to be effective with people who are in persistent emotional distress, have chronically unstable relationships, and present with recurrent self-injury and/or suicidal behavior. DBT has been used to treat high performing, but-distressed students, seriously disturbed adolescents and people with persistent mental illness and/or developmental disabilities.
Modes of Treatment
Weekly Skills Group:
During this group, individuals learn a new skill each week. A full round of skills takes approximately six months to teach. There are four modules covered in a round of DBT.
Mindfulness: These skills are designed to teach group members how to focus their minds and attention. Achieving focus requires control of attention, which is a capability many people with impulsive and mood dependent behaviors lack. Mindfulness teaches individuals to observe and describe their own behaviors, which is necessary when any new behavior is being learned, when there is some sort of problem, or a need for change.
Distress Tolerance: In this module, group members learn skills to deal with the pain and distress that are a part of life. They focus on accepting the current situation and finding ways to survive and tolerate the moment without engaging in maladaptive behavior.
Emotion Regulation: Difficulty regulating painful emotions is often central to behavioral difficulties. The skills taught in this module include learning to identify and label current emotions, identifying obstacles to changing emotions, reducing emotional reactivity, increasing positive emotions, and changing emotions.
Interpersonal Effectiveness: These skills will give group members effective strategies for asking for what they need, saying no, and coping with interpersonal conflict. This module focuses on obtaining changes and goals, maintaining relationships, and maintaining self-respect. Group members will learn to analyze a situation and to determine interpersonal goals.
Weekly Practice Group
At The Bridge, this group is often held for an hour each week (separate from skills training group). Or it can be tacked on to the end of Skills Group, as usually seen in outpatient settings. During this group, individuals get to share their use of the weekly skill. They are also given the opportunity to discuss a success story with any skill used over the previous week as well as to ask for suggestions to address challenges they may have faced using a particular skill. This gives group members the chance to give each other feedback, which can be invaluable. Most often peer to peer feedback can make a big impact.
The individual therapist is seen as the primary therapist in the treatment. Individual Therapy occurs once each week and focused on the DBT hierarchy. Individuals self-monitor their target behaviors and emotions on a Diary Card, which is used to create the agenda of the session each week. The main goals of individual therapy are to decrease life threatening behaviors, treatment interfering behaviors, and quality of life interfering behaviors while increasing skills. A contract between the therapist and individual is completed at the beginning of treatment, which is often referred to throughout the course of treatment.
Individuals in treatment often need help in applying the behavioral skills they are learning to solve problems in daily life. Often when a crisis hits and emotions are heightened, it may be hard for many individuals to utilize the skills learned in group. For this reason, coaching in crisis is a big part of DBT treatment. This can be done in person, if the individual is living in a group home setting, or over the phone. The focus of this interaction is on applying skills in the moment. It is brief, usually ten to fifteen minutes. Over time, the frequency and duration of crisis interventions will decrease as generalization of skills occurs.
The consultation team includes all members of the treatment team: staff, clinicians, skills trainers, program administration, nursing, etc. This is a time for the team members to come together and discuss the difficult cases with which they may be struggling. The functions of the consultation meeting are: to provide ongoing training to improve the skill level of the team, to identify and address treatment interfering behaviors of the team, to increase motivation, to monitory ongoing treatment interventions and structures in order to stay within the DBT therapeutic frame, to address staff burnout, to review client functioning, and to review how groups have been going, etc. This team meeting is essential for DBT to be effective.
For more information on DBT at The Bridge of Central Massachusetts, contact Elizabeth Fessenden, Director of Dialectical Behavior Therapy Services at firstname.lastname@example.org 508-755-0333, extention 1250.
For more information about DBT outside The Bridge, including training and consultation or other community resources such as outpatient treatment, contact the Director of DBT Training and Consultation, Jennifer Eaton, at email@example.com or at 508-755-0333, extension 1248. Or go to: www.thebridgetraininginstitute.org.