Mindfulness and Dialectical Behavior Therapy

 

Dialectical Behavior Therapy (DBT), pioneered by Marsha Linehan, has emerged as a groundbreaking treatment for individuals battling borderline personality disorder (BPD) and a spectrum of related conditions. Linehan's innovative approach to therapy addresses the profound challenges faced by those with BPD, particularly in managing intense emotional responses and regulating behavior. Central to DBT is the recognition of emotion dysregulation as a core issue, contributing to a cascade of difficulties including impulsive behavior, mood swings, and self-destructive tendencies. Linehan's insights into the inability of individuals with BPD to self-soothe and control their emotions shed light on the complex interplay between emotional dysregulation and cognitive inflexibility. Moreover, DBT's efficacy extends beyond BPD, with research showcasing its effectiveness in treating depression, schizophrenia, PTSD, addiction, and eating disorders. By targeting emotion dysregulation and fostering cognitive flexibility, DBT offers hope and healing for individuals grappling with profound psychological challenges.

Dialectical Behavior Therapy (DBT) operates on three fundamental pillars, each contributing essential principles to its therapeutic framework. These components encompass Behaviorism, Mindfulness, and Dialectics, which collectively form the backbone of DBT's effectiveness in promoting positive change and acceptance.

Behaviorism

 In DBT, Behaviorism serves as a guiding principle for understanding how behaviors are learned and reinforced. Therapists collaborate with clients to identify triggers, thoughts, and emotions that lead to maladaptive behaviors. By recognizing the patterns of behavior and their underlying motivations, individuals can develop strategies to replace harmful behaviors with healthier alternatives. For instance, DBT utilizes conditioning to create an environment where adaptive behaviors are rewarded while maladaptive behaviors are not.

Mindfulness

A core element of DBT, mindfulness draws from Buddhist traditions to cultivate present-moment awareness without judgment. By focusing attention on the here and now, individuals can observe their thoughts and emotions with clarity and acceptance. The concept of "wise mind" in DBT emphasizes integrating rational and emotional intelligence to make informed decisions and navigate life's challenges more effectively.

Dialectics

DBT embraces the principle of dialectics, which acknowledges the tension between opposing forces and seeks synthesis. In therapy, this dialectical approach guides individuals in balancing the need for change with radical acceptance of their current reality. For example, clients may confront the dilemma of needing to alter damaging behaviors while simultaneously accepting themselves and their circumstances. Through the synthesis of opposing viewpoints, individuals can achieve a more balanced and adaptive way of being.

Thus, DBT's integration of Behaviorism, Mindfulness, and Dialectics provides a comprehensive framework for promoting psychological well-being and facilitating meaningful change. By addressing the interplay between thoughts, emotions, and behaviors, DBT empowers individuals to lead lives that are more fulfilling and aligned with their values and aspirations.

The therapeutic approach of Dialectical Behavior Therapy (DBT) underscores the importance of problem-solving and validation, two complementary strategies that form the backbone of therapeutic transformation. As I reflect on DBT's emphasis on addressing the need for change while fostering self-acceptance, I see the inherent dialectic nature of this approach. Collaborative efforts between therapist and client involve identifying specific behaviors for modification, such as enhancing meeting deadlines while reducing instances of shouting at family members. Moreover, the validation of clients' experiences, even the most challenging behaviors, stands out as a cornerstone of DBT. Marsha Linehan's emphasis on validating clients' feelings and experiences resonates deeply as a means of fostering a sense of calm and understanding, laying the groundwork for problem-solving and growth.

Considering the structure of DBT treatment, which encompasses individual psychotherapy and group skill development sessions, I appreciate the holistic approach aimed at equipping individuals with the tools needed to cultivate a fulfilling life. Core components like emotional regulation, mindfulness, distress tolerance, and interpersonal effectiveness are integrated to address various facets of psychological functioning. As individuals identify and nurture their own strengths, they develop a sense of self-worth and agency in navigating life's challenges. Central to the success of DBT is the establishment of a supportive relationship between clients and therapeutic staff, which fosters engagement and progress. Through a blend of individual therapy, skills training, therapist consultation, and telephone consultation, DBT offers a comprehensive approach to treatment that attends to the diverse needs of clients and promotes enduring change.

In Dialectical Behavior Therapy (DBT), therapist consultation and telephone coaching serve as vital components in providing comprehensive support to clients on their journey towards healing and growth.

Therapist Consultation

DBT recognizes the importance of collaboration and shared expertise among therapists and skills trainers. Through weekly gatherings, professionals convene to discuss clients' progress and tackle any treatment challenges that may arise. These consultations aim to enhance therapists' effectiveness in addressing clients' needs by leveraging collective insights and experiences. Moreover, DBT encourages therapists to embrace their imperfections and acknowledge limitations, fostering an environment of humility and continuous learning.

Telephone Counseling

DBT's between-session telephone coaching offers clients immediate support during crises. With a focus on skill utilization, these short-term exchanges aim to mitigate suicide emergencies, enhance skill simplification, and mend any therapeutic relationship gaps. Clients are empowered to reach out to their counselors before engaging in problematic behavior and are guided to refrain from contacting them after instances of self-harm, preventing reinforcement of maladaptive patterns.

 

Acknowledging Limitations

While DBT presents a powerful therapeutic approach, it's crucial to recognize its limitations. Third-wave modalities like DBT may inadvertently normalize personal experiences of neglect, abuse, and injustice. It's imperative to understand that exploitation often stems from individuals with power exploiting those with less privilege. DBT prompts reflection on systemic issues perpetuating such injustices, highlighting the need for broader societal responses beyond individual therapy sessions.

In essence, DBT's emphasis on therapist consultation, telephone coaching, and acknowledgment of limitations underscores its commitment to holistic healing and support for clients. By fostering collaborative environments and addressing systemic challenges, DBT strives to empower individuals on their path towards resilience and well-being.

Bibliography

 Hayes, S. C., & Hofmann, S. G. (2017). The third wave of cognitive behavioral therapy and the rise of process‐based care. World Psychiatry, 16(3), 245-246. 

Hofmann, S. G., & Asmundson, G. J. (2008). Acceptance and mindfulness-based therapy: new wave or old hat?. Clinical psychology review, 28(1), 1-16. 

Kemp, C. (2018). Dialectical Behavior Therapy as a Possible Treatment Modality for Schizophrenia. Intuition: The BYU Undergraduate Journal in Psychology, 13(1), 7. 

Kroons, C. R. (2008). Dialectical behavior therapy. Social Work in Mental Health, 6(1-2), 109-132. 

Kroons, C.R., Chapman, A.L., Betts, B.B., Morse, N. and Robins, C.J., (2006). Dialectical behavior therapy adapted for the vocational rehabilitation of significantly disabled mentally ill adults. Cognitive and Behavioral Practice, 13(2), pp.146-156. 

Linehan, M.M. and Wilks, C.R,.(2015). The course and evolution of dialectical behavior therapy. American journal of psychotherapy, 69(2), pp.97-110. 

Mohamadizadeh, L., Makvandi, B., Pasha, R., BakhtiarPour, S., & Hafezi, F. (2018). Comparison of the Efficacy of Dialectical Behavior Therapy (DBT) and Schema Therapy (ST) on Impulsive Behavior in Patients With Borderline Personality Disorder. Journal of Guilan University of Medical Sciences, 27(106), 44-53. 

Prochaska, J. O., & Norcross, J. C. (2018). Systems of psychotherapy: A transtheoreticalanalaysis (9th ed.). New York, NY: Oxford University Press.

Soltani, Z., Alipour, G., Ghasemi Jobaneh, R. and Salimi, H.(2018). Efficacy of Dialectical Behavior Therapy on Emotion Regulation and Quality of Life among Women with Borderline Personality Disorder in Shahr-e-Kord, Iran, in 2015. scientific journal of ilam university of medical sciences.26(3), pp.47-55.