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Dialectical Behavioral Therapy |
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| Marsha Linehan
(1991) pioneered this treatment, based on the idea that
psychosocial treatment of those with Borderline
Personality Disorder was as important in controlling the
condition as traditional psycho- and pharmacotherapy
were. Concomitant with this belief was a hierarchical
structure of treatment goals. Paramount among these was
reducing parasuicidal (self-injuring) and
life-threatening behaviors. |
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| Next came
reducing behaviors that interfered with the
therapy/treatment process, and finally reducing
behaviors that interfered with the client's quality of
life. In 1991, Linehan published results of a study that
seems to do remarkably well at achieving these goals. |
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The Theory |
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| Basically, DBT
maintains that some people, due to invalidating
environments during upbringing and due to biological
factors as yet unknown, react abnormally to emotional
stimulation. Their level of arousal goes up much more
quickly, peaks at a higher level, and takes more time to
return to baseline. This explains why borderlines are
known for crisis-strewn lives and extreme emotional
liability (emotions that shift rapidly). Because of
their past 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. |
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How It Works |
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Dialectical Behavioral Therapy (DBT) consists of two
parts |
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1) Once-weekly psychotherapy sessions in which a
particular problematic behavior or event from the past
week is explored in detail, beginning with the chain of
events leading up to it, going through alternative
solutions that might have been used, and examining what
kept the client from using more adaptive solutions to
the problem. |
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"Both
between and during sessions, the therapist actively
teaches and reinforces adaptive behaviors, 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."
-Linehan, 1991 |
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DBT
targets behaviors in a descending hierarchy |
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- Decreasing high-risk suicidal behaviors.
- Decreasing
responses or behaviors (by either therapist or
patient) that interfere with therapy.
- Decreasing
behaviors that interfere with/reduce quality of
life.
- Decreasing
and dealing with post-traumatic stress responses.
- Enhancing
respect for self.
-
Acquisition of the behavioral skills taught in
group.
- Additional
goals set by patient.
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2) Weekly 2.5-hour group therapy sessions in which
interpersonal effectiveness, distress tolerance/reality
acceptance skills, emotion regulation, and mindfulness
skills are taught (see summaries of sample). Group
therapists are not available over the phone between
sessions; they refer patients in crisis to the
individual therapist. |