What is Dialectic Behavior Therapy?

Dialectic Behavior Therapy (DBT) is the amped, bumped, pumped, jacked, e-ticket ride to mental health. It is a hot topic at social gatherings. Everybody is talking about it. Everybody is using it. And rightfully so.

Well-designed evidence-based research has shown that DBT effectively treats borderline personality disorder, depression, substance abuse, post-traumatic stress disorder and anxiety.

But what is it? How does it work? DBT aims to help patients recognize maladaptive behavior and choose more effective ways to manage personal conflicts and stress.

Dialectic or dialectics is a fancy way to describe how discussions regarding different points of view can lead to a deeper, better, improved way of thinking about conflicts. 

Remember Socrates from freshman philosophy? He ambled around ancient Greece exposing false beliefs by asking a bunch of questions. These questions helped people think more clearly. DBT uses the Socratic method to understand and change maladaptive behavior. 

The therapist is a kind, gentle ally who accepts and validates the patient's feelings while at the same time, through a series of non-confrontational questions, helps the patient find better ways to manage feelings.

Let me be more specific by discussing five major elements to DBT: 

1. Corrective Emotional Response: A trustworthy therapist who demonstrates non-possessive warmth (love without controlling behavior) and genuine respect for the patient helps the patient correct a distorted view of his/herself that enables the patient to learn self-soothing behavior. 

2. Meditation and relaxation techniques to manage stress. 

3. The patient practices changing thoughts to have better feelings. For example if a patient says, "Everybody hates me" the therapist may respond with these questions:

• Really?
• Everybody? 
• Who told you that?
• Where did you learn that?
• How do you know?
• When did you discover that?
• What makes you say that?
• Can you name a specific person who hates you?

4. Improving Responses to Day-to-Day Events: The patient keeps a daily journal that records events, feelings and thoughts generated by daily events. The therapist asks a series of questions to enable the patient to learn better ways of handling conflict.

5. Developing Emotional Skills: Through a series of questions the therapist explores the what, where, when, why, and how of conflict and stress. The therapist teaches skills to deal with stress and interpersonal conflict in the following areas: 

• Evaluation of distorted thinking: The patient is helped to see different viewpoints in a conflict. 
• Dealing with stress: The patient learns to manage emotions that are triggered by distressing events, including those that cannot be immediately resolved. 
• Dealing with interpersonal conflict: The therapist teaches the patient to maintain healthy relationships. The patient learns that certain rules of society must be followed to get along in the world and to break social, ethical, and moral rules leads to self-destruction. The therapist helps the patient find ways to fulfill emotional needs while allowing others to fulfill their needs.
• Developing emotional stability: The therapist may respond to maladaptive behavior by asking  a set of questions:
• What are you thinking (or doing) right now? 
• Is what you are thinking (or doing) helping you?  
• What thoughts (or actions) can help you feel better about yourself? (Several options may be formulated until the best solution is discovered.) 
• Will you commit to changing your thoughts (or actions)? 
• How will you demonstrate that you have committed to change?

As I was writing this article I began to realize that these techniques could help me improve my response to day-to-day events. Indeed it may help all of us to question our thoughts and actions and thus learn to respond to stress in a more beneficial way.