How is Dialectical behavior therapy (DBT) different than other cognitive behavioral therapies (CBT)?
CBT usually focuses on identifying and changing thoughts. People may find its focus on change invalidating and not supportive. DBT tries to balance acceptance and change strategies. Change and acceptance may seem like opposites which makes it a dialectic. DBT focuses on helping individuals build a life worth living. DBT’s underlying assumptions are that people have an emotional vulnerability which causes difficulty with emotion regulation and they experienced an invalidating environment which caused them to use certain strategies to cope. This means they may not have caused all their problems but they are responsible for solving them. Individuals must change if they want a life worth living. DBT helps individuals identify when they should use what types of skills to be more effective in their life.
What type of skills are taught and why?
Mindfulness skills help you stay in the here and now, learn how to be less attached to emotions and thoughts, be nonjudgmental towards self and others, and focus on what works. Distress Tolerance skills help you learn to distract and survive a crisis or distressing situation without making things worse. This involves a certain amount of acceptance of reality even if you do not agree with it as well as willingness to try skills. Emotion regulation skills help you decrease impulsivity and mood swings while increase positive emotions and experiences. Interpersonal effectiveness skills help you decrease interpersonal chaos, get your needs met in relationships, maintain healthy relationships, and maintain your self-respect in relationships.
What can I expect in the DBT Skills track?
A focus on learning new skills from the four skills domains (Mindfulness, Distress Tolerance, Emotion regulation, and Interpersonal effectiveness) rather than processing emotions and events. Skills training group is run like a class rather than a traditional psychotherapy group. Group members are given homework to help them learn the skills. Skills coaching is available during the program day as well as after hours to help individuals learn to generalize skills. Individual therapy is offered on a weekly basis. Group members are asked to complete a diary card on a daily basis to help them monitor their emotions, urges, behaviors, and skill use. Behavior chain analysis is done to help understand why target behaviors happen and to problem solve more effective coping strategies. DBT targets reducing life threatening behaviors (suicide and self-harm behaviors), therapy interfering behaviors, and quality of life interfering behaviors in that order.
What kind of training has staff received to make them qualified to do DBT?
Princeton House Behavioral Health has an ongoing DBT education and training program for Women’s Program clinicians. This consists of participation in intensive external training workshops, internal supervision by intensively trained supervisors, and weekly team consultation meetings.
How does Women’s program DBT Skills track differ from traditional DBT?
Women’s program offers all components of DBT but adaptations have been made for a partial hospital/intensive outpatient setting since the length of treatment is shorter. Program participants learn skills and are given homework every day they are in treatment. Monday is Distress Tolerance, Wednesday is Mindfulness, Thursday is Interpersonal Effectiveness, and Friday is Emotion Regulation. Tuesday is dedicated to review of homework and skill practice. After hours phone coaching is provided by a Princeton House clinician who can help guide you on what DBT skills to use.
How will DBT help me cope if I have a trauma history?
The program uses a phase oriented approach to the treatment of trauma. The first stage is focused on helping individuals establish safety in their lives and symptom control. The second stage focuses on improving functioning, improving relationships, and healthy expression of emotions. DBT at this level of care focuses on helping individuals learn skills to be able to have more control over symptoms and emotions and improve functioning and relationships so that individuals are better able to stay within their window of tolerance and expand their window of tolerance. Once skills are acquired individuals can more safely process their history of trauma.