Dialectical behavior therapy (DBT) is a cognitive-behavioral treatment program originally developed by Marsha Linehan as a treatment for highly suicidal women with borderline personality disorder (BPD) and other difficult-to-treat mental disorders. DBT draws its principles from behavioral science (e.g., reinforcement, classical conditioning), Zen mindfulness practices (e.g., quieting the mind and focusing attention), and dialectical philosophy (e.g., finding the synthesis between two differing or opposing positions). The essence of DBT as a treatment is helping the client find the synthesis of and middle path between acceptance and change. This emphasis came out of the finding that focusing solely on behavioral change or on acceptance and validation of the client’s pain led to poor outcomes. Clients in DBT require a balance of acceptance and validation of their painful experiences while also working to change the behaviors and environmental factors contributing to the pain.
Functions and Modes of Dialectical Behavior Therapy
DBT is a comprehensive treatment approach designed to serve five functions. First, DBT therapists help clients correct behavioral skills deficits by enhancing their capabilities. Second, motivational enhancement is generally accomplished by removing factors that detract from therapy success and increasing reinforcement of effective behaviors. A third function of DBT is to assure generalization of skillful behaviors to client’s lives outside of therapy. Fourth, therapists and clients work to structure the client’s environment and intervene in the world outside of therapy in ways that maximize therapy gains. Finally, to avoid therapist burnout and increase the chances of therapy being successful, DBT serves the function of enhancing therapist capabilities and motivation.
DBT uses individual therapy, telephone consultation, therapist consultation teams, and group skills training to serve these functions. The individual DBT therapist takes primary responsibility for a client’s treatment plan, progress toward therapy goals, integration of therapy modes, and management of life-threatening behaviors and crises. Individual therapy dyads engage in brief phone consultations to help the client engage in effective behavior outside of therapy sessions. DBT therapists meet as a consultation team to help one another engage in more effective treatment and to reduce burnout.
The fourth mode of DBT is skills training, which teaches clients four sets of skills. The core set of skills includes the mindfulness skills of observing, describing, fully participating, being nonjudgmental, focusing on one thing in the moment, and focusing on being effective. Interpersonal effectiveness skills include obtaining objectives, maintaining or improving relationships, and increasing self-respect in interactions. Emotion regulation skills include methods to increase positive emotions and to decrease ineffective emotional responses. Finally, distress tolerance skills include methods to help clients accept life’s unchangeable and unwanted characteristics and survive crises.
Dialectical Behavior Therapy Targets
DBT提供了治疗目标的层次结构,以帮助组织治疗师与有混乱生活和多重问题的客户的工作。威胁生命的行为,包括自杀企图和故意自我伤害,并敦促从事这些行为是最高的目标。一旦获得了这些目标,重点就会将消除干扰治疗有效性的客户和治疗师行为。下一个目标是干扰生活质量的行为(例如,犯罪行为,人际功能障碍,高风险的性行为或无家可归)。最后,DBT个人治疗师帮助客户获得技能。
总体而言,DBT的目标是帮助客户用更有效的行为代替自杀行为,并帮助客户建立他们认为值得生活的生活。
参考:
- Linehan,M。M.(1993)。边缘人格障碍的认知行为治疗。纽约:吉尔福德出版社。
- Linehan,M。M.(1993)。Skills training manual for treating borderline personality disorder. New York: Guilford Press.
- Salsman, N. L., & Linehan, M. M. (2006). Dialectical-behavior therapy for borderline personality disorder. Primary Psychiatry, 13, 51-58.