Dialectical Behavioral Therapy: theory, phases and effects

The large number of theories and currents of thought that have existed throughout the history of psychology has allowed that a large number of therapeutic techniques have been generated that allow facing different problems and disorders.

One of the most prevalent currents today is the cognitive-behavioral, which through behavior modification intends to alter the patterns of thought and behavior of individuals with difficulties to make them more adaptive to the environment and reduce their suffering. Among the techniques that allow such a thing, especially in the face of self-destructive behaviors and severe personality alterations, there is dialectical behavioral therapy.

• Related article: "Types of psychological therapies"

Dialectical Behavioral Therapy: theoretical bases

Experiencing impulses and emotions in an intense way is something that most people have done at some point. However, in some cases the experience of exaggeratedly intense emotions can lead to exaggeratedly impulsive behaviors, including 

self harm and the suicide attempt, derived from the inadequacy and repression of the frustration felt.

In order to treat these problems in many patients, Marsha Linehan would try to apply behavior modification techniques characteristic of the cognitive-behavioral paradigm. However, these techniques would not have the expected effect, the treated individuals feeling little understood, emotionally ignored in their feelings of emptiness and even attacked at the attempt to change their behavior without more.

Linehan would become aware of this fact and the feelings of the patients being treated, and in response to it she would end up mixing these behavior modification techniques with a focus more focused on dialectics, which would end up being the fundamental axis of the treatment to be applied. Linehan would create what today is known as dialectical behavioral or dialectical behavioral therapy, especially dedicated to the treatment of self-destructive and addictive behaviors.

What is your objective?

It is a technique belonging to the third wave or generation of behavioral therapies, so that it does not focus so much on eliminating the behavior or characteristic that produces difficulties but on, in addition to that, transform the patient's relationship with her and guide him so that he can accept it and see reality differently from original.

The Basic Goal of Dialectical Behavioral Therapy is to ensure that the patient learns to correctly manage her emotions and behavior, so that she is able to control impulsive behaviors caused by mental alterations while both the subject and the therapist who attends him accept his experience of the events and what for him they suppose. A balance is therefore sought between self-acceptance behavioral change strategies.

This acceptance and validation of one's own experience by itself increases the ability to manage one's own emotions more adaptively, thereby decreasing the impulsiveness that ultimately leads to extreme behaviors. Within this therapy, the figure of the (or of the) is of great importance, since a team of professionals is usually employed. therapist, being the therapeutic relationship and acceptance on his part of those elements that hinder change an essential constant for the success.

• You may be interested: "Behavioral Therapies: first, second and third wave"

Basic components

Dialectical behavioral therapy uses a large number of treatment modalities, working in different ways two basic aspects that this type of treatment tries to solve.

The first of these aspects is based mainly on the fact of causing the patient desire to continue forward and motivate you to continue treatment, by focusing your attention on the reasons for improvement and helping you to achieve vital goals to pursue and for which it is worth living.

The second component is based on training, training the patient in specific skills in order to be more capable of accepting and managing himself in a more adaptive way. This training is based on four main modules.

Among these modules we find training in increase tolerance to discomfort in order to combat the tendency to perform impulsive behaviors, another in generating self-awareness skills through techniques such as Mindfulness to treat the feelings of emptiness and the different cognitive-emotional alterations, a module dedicated to working on emotional regulation and finally a module in which social and interpersonal skills are worked on, making the relationships of these people less chaotic, more stable and durable.

Psychotherapy is used at the individual level to try to find a solution to the problems experienced by the patient, while that group therapy is used when training the client in different skills necessary to improve their self-acceptance. Faced with specific problems in daily life, it is possible to establish telephone contact with the therapist so that it is possible to apply the situations worked in consultation to daily life.

Phases of therapy

The application of dialectical behavioral therapy is carried out through a series of three phases, subsequently to orient the patient about the therapy, make see the need for it and promote the active participation of the treated individual in the face of established objectives between patient and therapist.

In the first phase, the work focuses on increasing self-awareness and skills of both tolerance to discomfort and regulation of emotions and personal relationships, together with the control and management of impulsive behaviors, accepting and taking into account all those variables and behaviors that may affect the individual. In general, most of the activities aimed at achieving both self-acceptance and behavioral change are carried out.

In a second moment we proceed to act on stress that has produced and produces the situation in individuals.

Finally we proceed to help the subject to rebuild and create a more positive realistic self-concept and self-validating, contributing to the setting and orientation towards important life goals for each client.

Clinical uses and applications

Dialectical behavioral therapy has shown its usefulness in a large number of disorders, being especially effective in controlling impulsive behaviors and intense emotions. Some of the disorders in which it is most indicated are the following.

Borderline personality disorder

Dialectical behavioral therapy is primarily known to be the most empirically supported type of therapy in the treatment of borderline personality disorder. From the perspective of dialectical behavioral therapy, this disorder is understood as an ongoing pattern of emotional dysregulation due to the interaction between biological variables that predispose to emotional vulnerability and a disabling restrictive environment of emotions that prevents them from being managed efficiently.

This produces that the emotions end up intensifying and getting out of control, having an extreme emotional lability together with an intense feeling of inner emptiness that can end up leading to self-injurious and even suicidal behaviors and dependent attitudes and unpredictable. Thus, in this disorder, dialectical behavioral therapy aims to work on the vulnerability and feelings of impotence of the subject, the vital passivity of which they end up showing off and the expression of anguish and feelings repressed.

• Related article: "Borderline Personality Disorder (BPD): causes, symptoms and treatment"

Mood disorders

Dialectical behavioral therapy has been applied successfully to a large number of disorders in which the main problem was difficulties in regulating emotions. For this reason, the studies carried out indicate that it seems to be of great help in the reduction of symptoms of mood disorders as the major depression.

Eating Disorders

Eating disorders such as anorexia, bulimia, and binge eating disorder They tend to have serious emotional regulation problems at their base related to the acceptance of the own body image or an inability to maintain control over own behavior food.

In this regard, dialectical behavioral therapy has shown that reduces the symptoms of these types of disorders, especially binge eating disorder and bulimia nervosa in which massive consumption of food occurs based on immediate impulses.

• Related article: "The 10 most common eating disorders"

Substance abuse

It must be borne in mind that in a large number of cases, substance abuse is carried out with the intention of facing an existential void, as an escape mechanism emotions that are difficult for those who suffer them (such as fear or guilt) or to alleviate the compulsive desire to consume derived from abstinence from the substance to which they are addict. Thus, in cases where there is a problem of emotion regulation behind consumption, dialectical behavioral therapy it has also been shown to be particularly effective.

Others

Although it has not been as successful as in previous cases, dialectical behavior therapy has been applied frequently both in post traumatic stress disorder as in anxiety disorders such as panic disorder.

Bibliographic references:

• Almendro, M.T. (2012). Psychotherapies. CEDE PIR Preparation Manual, 06. CEDE: Madrid.

• Aramburu, B. (1996). Dialectical behavior therapy for borderline personality disorder. Behavioral Psychology, 4, 123-140.

• Linehan, M. M. & Dimeff, L. (2001). Dialectical Behavior Therapy in a nutshell. The California Psychologist, 34, 10-13.

• Soler, J.; Elices, M. and Carmona, C. (2016). Dialectical Behavioral Therapy: clinical applications and empirical evidence. Behavior Analysis and Modification, vol.42, nº165-166. 35-49.