Dialectical Behavior Therapy (DBT) for Managing PTSD

Dialectical behaviour therapy (DBT) is a specific type of cognitive-behavioural psychotherapy developed in the late 1980s by psychologist Marsha M. Linehan to help better treat borderline personality disorder. Since its development, it has also been used for the treatment of other kinds of mental health disorders. It is used very successfully for those with Complex PTSD, PTSD and other trauma-based disorders also.

Dialectical behaviour therapy (DBT) treatment is a cognitive-behavioural approach that emphasises the psychosocial aspects of treatment. The theory behind the approach is that some people are prone to react in a more intense and out-of-the-ordinary manner toward certain emotional situations, primarily those found in romantic, family and friend relationships. DBT theory suggests that some people’s arousal levels in such situations can increase far more quickly than the average person’s, attain a higher level of emotional stimulation, and take a significant amount of time to return to baseline arousal levels. What does dialectical mean? In brief, dialectics represent the mind’s way of understanding concepts by understanding and appreciating their polar opposites.

Dialectics are one of the important unifying concepts that reflect how the mind fundamentally understands and perceives most core concepts and ideas. And the field of psychology contains an abundance of such concepts, including self-esteem, trust, courage, honesty, rage, passivity, withdrawal, impulsivity, inhibition, blameworthiness, guilt, risk-taking, and on and on. Dialectics are based in part on the fact that we cannot fully understand any of these abstract concepts without appreciating that they consist of bipolar opposites with a higher level of integration somewhere in between them.

For example, what would light mean without understanding darkness, what would wetness mean to a fish who had never experienced anything else, what would blue mean in an all blue world, what would inhibition mean without appreciating what complete disinhibition looks like? Dialectics breaks down our concepts into their seemingly opposite parts–viewed another way, as thesis, antithesis, and synthesis (or white, black, and gray). Here are a few more examples of bipolar constructs (from an earlier book written by Charles Elliott, Ph.D. and Maureen Lassen, Ph.D.):

• Love and Hate

• Yin and Yang

• Introvert and Extrovert

• Constriction and Expansion

• Matter and Anti-Matter

People who are sometimes diagnosed with borderline personality disorder experience extreme swings in their emotions, see the world in black-and-white shades, and seem to always be jumping from one crisis to another. Because few people understand such reactions — most of all their own family and a childhood that emphasised invalidation — they don’t have any methods for coping with these sudden, intense surges of emotion. DBT is a method for teaching skills that will help in this task.  DBT helps PTSD in the following ways:

Addresses and removes dangerous behaviour is commonly seen among individuals with PTSD

Develops a trusting relationship between therapist and patient(s)

Teaches skills that regulate emotions or symptoms of PTSD. It does this through mindfulness concepts, interpersonal effectiveness skills and distress tolerance skills.

DBT helps patients analyse their emotional and psychological issues and teaches them to control their behaviour. It encourages patients to identify their emotional experiences and manage them through skills they learn and practice in therapy. DBT teaches mindfulness, interpersonal effectiveness, distress tolerance and emotional regulation skills with real-life scenarios. The goal is for patients to take these skills outside therapy, to cope with symptoms that enable PTSD, anxiety and other mental and emotional health problems.

Characteristics of DBT

Support-oriented: It helps a person identify their strengths and builds on them so that the person can feel better about him/herself and their life.

Cognitive-based: DBT helps identify thoughts, beliefs, and assumptions that make life harder: “I have to be perfect at everything.” “If I get angry, I’m a terrible person” & helps people to learn different ways of thinking that will make life more bearable: “I don’t need to be perfect at things for people to care about me”, “Everyone gets angry, it’s a normal emotion.

Collaborative: It requires constant attention to relationships between clients and staff. In DBT people are encouraged to work out problems in their relationships with their therapist and the therapists to do the same with them. DBT asks people to complete homework assignments, to role-play new ways of interacting with others, and to practice skills such as soothing yourself when upset. These skills, a crucial part of DBT, are taught in weekly lectures, reviewed in weekly homework groups, and referred to in nearly every group. The individual therapist helps the person to learn, apply and master the DBT skills.

Generally, dialectical behaviour therapy (DBT) may be seen as having two main components:

1. Individual weekly psychotherapy sessions that emphasise problem-solving behaviour for the past week’s issues and troubles that arose in the person’s life. Self-injurious and suicidal behaviours take first priority, followed by behaviours that may interfere with the therapy process. Quality of life issues and working toward improving life, in general, may also be discussed. Individual sessions in DBT also focus on decreasing and dealing with post-traumatic stress responses (from previous trauma in the person’s life) and helping enhance their own self-respect and self-image.

Both between and during sessions, the therapist actively teaches and reinforces adaptive behaviours, especially as they occur within the therapeutic relationship. The emphasis is on teaching patients how to manage emotional trauma rather than reducing or taking them out of crises. Telephone contact with the individual therapist between sessions is part of DBT procedures.

During individual therapy sessions, the therapist and client work toward learning and improving many basic social skills.

2. Weekly group therapy sessions, generally 2 1/2 hours a session and led by a trained DBT therapist, where people learn skills from one of four different modules: interpersonal effectiveness, distress tolerance/reality acceptance skills, emotion regulation, and mindfulness skills are taught.

DBT is a very effective tool for managing Complex PTSD and PTSD.

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