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DIALECTICAL BEHAVIORAL THERAPY (DBT), devised by Marsha Linehan, the founder of Behavioral Tech, has been found to be particularly effective in treating those who, in part due to their childhood experiences, have gone on to develop BORDERLINE PERSONALITY DISORDER (BPD).
Five skills are central to dialectical behavioural therapy (DBT); these are as follows:
1) CORE MINDFULNESS:
DBT describes the mind as having 3 components (these are concepts, not actual, distinct, physical parts of the brain, obviously). The 3 components are:
a) the reasonable mind
b) the emotional mind
c) the wise mind
Let’s examine each of these in turn:
a) the reasonable mind: this can be summed up, according to DBT, as the part of the brain which acts according to reason, logic and rationality
b) the emotional mind: according to DBT, this is the part of the brain which operates on the basis of our feelings (when the ‘heart controls the head’)
c) the wise mind: ideally, according to DBT, we should allow this part of the brain to guide us; it is A BALANCE BETWEEN 1 and 2 above when the reasonable and emotional brain is operating in HARMONY.
If we are able to operate in ‘wise mind mode’, this will mean we can maintain control and prevent ourselves from becoming a victim of our own intense emotions. In order to see the importance of this, we need only consider times in our lives when our behaviour has been dominated by our emotions and the negative effects this may have led to. Indeed, not learning to control emotions can leave our lives in ruins, not least due to the frequent self-destructive effects of our emotional outbursts.
2) DISTRESS TOLERANCE :
Practitioners of DBT try to instil the view in their clients that sometimes it is easier, and psychologically healthier, to stop struggling against reality, and,(they tell us) we need to accept that we, nor anybody else, for that matter, can prevent painful events from occurring in life (sometimes extremely painful ones, if we’re going to be up-front about it), nor can the painful emotions they bring with them. It is hardly a new idea, but practitioners of DBT also remind us that some painful things in life cannot be changed and that the only viable option we really have, therefore, is to accept the fact. This, of course, is difficult and requires considerable inner strength. By accepting the things which cannot be changed, though, it is reasoned, we free up energy which could have been wasted (by, say, being angry and bitter about the existence of these unchangeable facts) to deal with what CAN BE CHANGED.
DBT therapists tell us that there are certain skills we may wish to develop which will INCREASE OUR ABILITY TO TOLERATE DISTRESS; these are:
a) distraction/improving the moment
c) considering the pros and cons of the situation
d) radical acceptance
Let’s briefly look at each of these in turn:
a) distraction/improving the moment – eg distracting ourselves with activities we enjoy, keeping our minds busy; reminding ourselves of the good things in life; reminding ourselves that it is better to think clearly and in a focused way about our problems ‘after the storm has passed’ (rather than try to make decisions when in the middle of an intense crisis which may be over-determined by our emotions); remind ourselves that difficult periods will pass
b) self-soothing – e.g. we can use positive self-talk; meditation/relaxation activities/breathing exercises; using our imaginations to recall a soothing and comforting memory or place (if recalling a place it can be helpful to imagine, for a while, actually being there); thinking of things in life which are meaningful to us and give us the motivation to get through the difficult period.
c) considering the pros and cons of the situation: e.g. we may wish to consider how getting through a very difficult period may benefit us – for example, we may learn from it, it may strengthen us, it may make us more compassionate and sensitive towards others, we may be able to pass on the benefit of our experience to help others, it may even open up completely unexpected avenues in life which may not otherwise have been available to us (bad events do sometimes lead to positive outcomes, however indirectly – it is often worth keeping that in mind).
d) radical acceptance: this might involve trying to view what is happening, however undesirable, from as objective and detached a perspective as possible – a bit like watching the events unfold around somebody else in a movie; another, perhaps surprising, technique suggested by DBT therapists is to try to, literally, half-smile. This sounds strange and even rather silly, but research shows that just as the mind can affect the body (eg thinking about something embarrassing and going red in the face) so too can the body affect the mind – in this case, the idea is that the half-smile ‘fools’ the brain into ‘believing’ things aren’t as bad as all that. It is obvious, however, that in certain situations this technique would be highly inappropriate (I need hardly list examples).
3) EMOTIONAL REGULATION :
The fourth skill that DBT teaches is how to cope with intense and overwhelming emotions – this skill is referred to by practitioners of DBT as emotional regulation.
This skill is made up of three sub-skills: a) increasing one’s understanding of one’s emotions; b) decreasing one’s emotional vulnerability; c) lessening the degree of distress caused by one’s negative emotions.
4) INTERPERSONAL EFFECTIVENESS :
The final skill of interpersonal effectiveness helps the person undertaking DBT to communicate with others effectively when interacting with others in a way that helps to improve his/her relationships.
In order to achieve this, s/he is helped to communicate with others in a more controlled manner and to be less prone to speaking impulsively and without forethought due to stress or overwhelming emotions (such as anger).
TAKING THE MIDDLE PATH:
This is a metaphor for avoiding the trap of constantly seeing issues in terms of BLACK AND WHITE (eg all good/all bad and a marked tendency to perpetually think IN TERMS OF EXTREMES). DBT stresses the importance of teaching ourselves to FOCUS MORE ON THE GREY AREAS and to try to take A BROADER RANGE OF PERSPECTIVES when considering issues, to think more FLEXIBLY and to THINK LESS IN ABSOLUTE TERMS.
Taking the middle path, according to DBT, also involves BOTH VALIDATING OUR OWN THOUGHTS/FEELINGS AND THOSE OF OTHERS. Even if others don’t understand, DBT stresses that we need to comfort ourselves when distressed by reminding ourselves that how we are feeling is real and makes sense under the current circumstances we find ourselves in. We can remind ourselves, too, that no matter what others may think, NOBODY UNDERSTANDS US AS WELL AS WE UNDERSTAND OURSELVES (others can’t understand what it is ‘to be in our heads’; we should not be ashamed of how we feel). By applying this compassion and understanding to ourselves, as part of ‘taking the middle path’ it seems fair that we should extend similar understanding to others – we can accept what they feel, as non-judgmentally as possible, irrespective of whether we approve or not.
Research Suggests That DBT Can Beneficially Alter Brain Functioning :
THE STUDY :
Research conducted by Schnell and Herpertz (2006) involved looking at the effects of DBT (specifically, training in emotional regulation, see number 3, above) on female patients’ brain functioning (this was done by taking magnetic resonance images, or MRIs, a type of brain scan) after they had spent 12 weeks undergoing an inpatient treatment program.
RESULTS OF THE STUDY :
The female, BPD patients who improved following the DBT / emotional regulation skills 12-week inpatient program were found (by analysis of their MRIs) to show:
Such a reduction of activity in these brain regions is associated with an increase in the individual’s ability to prevent themselves from overreacting to stressful situations (overreacting to stressful situations, also known as impaired emotional regulation, is one of the hallmark features of BPD).
The above can be interpreted as further evidence for the effectiveness of DBT for treating patients suffering from borderline personality disorder (BPD).
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David Hosier BSc Hons; MSc; PGDE(FAHE).