You have probably heard of Dialectical Behavior Therapy (DBT) if you have casually researched therapy approaches online. Though a widely popular treatment, DBT is often difficult to find in practice. It can be daunting to think about searching for treatment and then needing to decide between a plethora of approaches. Here’s a bit about DBT and what could make it a good fit for you.
Dialectical Behavior Therapy (DBT) was designed and made known to the world by Dr. Marsha Linehan in her 1993 book “Cognitive Behavior Therapy for Borderline Personality Disorder”. As the book title suggests, DBT is a type of cognitive behavioral approach, yet it goes beyond this to include a wider range of concepts and principles such as mindfulness, living in line with one’s own values and wisdom, being skillful, and most importantly, finding the synthesis or “dialectic” in all aspects of life. DBT is structured and skills-based, yet it has a very humanistic approach to treatment.
DBT was originally designed for individuals diagnosed with borderline personality disorder, which can include difficulties with emotion regulation, impulsive and self-destructive behaviors, difficulties maintaining relationships, and unstable self-image. DBT was initially found to be most effective for a cluster of symptoms related to life-threatening behaviors, such as self-injury and suicidality. Since its advent in 1993, DBT has been widely researched and found to be effective across different diagnoses and for multiple symptom clusters. In its purest form, DBT is a very comprehensive treatment that includes individual therapy, a skills training group, live phone coaching access, and a consultation group for the DBT therapists themselves. The skills training aspect of DBT is most central to achieving positive results for a broad range of diagnoses.
Not sure yet if DBT is for you? Here are a few pointers. If you primarily struggle with any of the following, you could benefit greatly from DBT:
- Moodiness, difficulties with rapidly changing emotions, frequent emotional upheaval, and being highly sensitive
- Emotions seem to develop very rapidly and you engage in self-destructive behaviors to cope. These behaviors may include suicidal behavior, self-injury, substance or alcohol use, verbal or physical altercations, aggressive or violent behavior, binge-eating, or impulsive behaviors such as gambling or risky sexual behavior
- Difficulty understanding your own emotions and behaviors and experiencing emotions that seem to spiral out of control
- Interpersonal difficulties, such as unstable relationships, frequent high-conflict relationships, and often feeling misunderstood and rejected
- High levels of anger and irritability, or ever having been recommended an anger-management program
- Chronic thoughts of suicide or death
- Eating disorder difficulties, such as binge-eating or bulimia nervosa
- History of abuse, especially childhood sexual abuse
- Difficulties managing high-stress situations or intense emotions
- Diagnosis of a personality disorder, bipolar disorder, or attention deficit hyperactivity disorder (ADHD)
If you answered yes to one or more of the symptom clusters listed above, chances are that you could significantly benefit from treatment based in DBT. The intensity, format, and frequency of DBT needed will depend on your specific struggles. For life-threatening behavior (i.e., suicidality and self-injury) for instance, comprehensive DBT using all 4 modes of treatment is recommended. Individual therapy and skills training could be the next best option. On the other hand, for high anger and irritability, DBT skills alone could be very effective. The best way to ascertain this is to consult with a clinician who specializes in DBT and to complete a full clinical assessment with them.
Once you enter DBT treatment, you will embark on a journey to balance accepting and changing yourself in order to build a “life worth living.” Individual treatment is structured, helpful in personalized application of skills, and progresses through different stages of treatment. Initial focus is on stabilization, reduction of life-threatening behaviors, learning to utilize therapy to its fullest, and committing to treatment. Later stages focus on other behaviors that may interfere with the quality of your life, such as eating difficulties, interpersonal behaviors, minor substance use, and other impulsive behaviors. Treatment of trauma-related difficulties then becomes a focus of treatment, followed by growth-oriented goals.
At Cambridge Psychology Group, we provide different formats of DBT. Some clinicians incorporate DBT skills in standard therapy, and other clinicians are intensively trained to offer comprehensive DBT (including the author of this blog, Dr. Pooja Saraff). CPG currently offers DBT in individual therapy, as well as DBT skills training in our brief skills group. Dr. Saraff offers phone coaching to select clients based on her availability and clients’ commitment to the full DBT model. She also is part of a DBT consultation team with other therapists, ensuring provision of effective therapy. Based on different client needs, we can adapt the format of DBT to individual DBT only, DBT skills group only, or a combination of individual and group therapy. Less intense approaches may be most appropriate in the absence of life-threatening behaviors and when difficulties are specific and narrow. If you have questions about DBT services at CPG, please reach out to our intake team for a brief consultation.
You can find more information below about clinicians at CPG who either offer comprehensive DBT or incorporate DBT skills in standard therapy:
Pooja Saraff, PhD is a clinical psychologist at Cambridge Psychology Group. Dr. Saraff specializes in anxiety, OCD, trauma, and life-threatening and self-destructive behaviors. She works with clients of all ages and offers both telehealth and in-person sessions. She utilizes evidence-based therapy such as CBT, exposure and response prevention, and Dialectical Behavior Therapy (DBT). She enjoys helping individuals develop more self-compassion and confidence in themselves as they work toward improving their lives.
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