Dialectical Behavior Therapy, an outgrowth of Cognitive Behavioral Therapy, was developed by psychologist Marsha Linehan of the University of Washington in the 1970’s and 1980’s to treat suicidal behaviors, often emanating from Borderline Personality Disorder. It was later expanded to treat depression, Bipolar Disorder, and other mental disorders involving severe emotional dysregulation. Symptoms commonly treated by DBT clinicians include neediness, self-harm, co-dependency, suicidal impulses, impulsiveness, mood swings, identity disturbance, unstable interpersonal relationships, self-mutilation, dissociation, and uncontrolled rage.
The core principle in DBT is called radical acceptance. Radical acceptance teaches those practicing it the need to both view and accept life as it actually is; to observe oneself through the lens of a journalist and refrain, as much as possible, from moral judgment when doing so. Rather than stigmatize the feelings of patients, DBT sets out to acknowledge the validity of those feelings, while simultaneously recognizing their destructive nature and the need to rein them as much as possible.
Once a patient’s self-destructive tendencies—as well as their origins and the purposes they have served— have been identified, the focus shifts to finding ways to change those thoughts and behaviors. Many of the symptoms of Borderline Personality Disorder, for example, are defense mechanisms that have built up over years—if not decades—as a means to deal with childhood trauma, including sexual abuse, loss and abandonment, and neglect. In order for DBT to accomplish its goals, the patient must be committed to changing his or her behavior. Without such a commitment, DBT treatment will almost certainly fail.
Because the patterns of people with self-destructive tendencies produce such overwhelmingly negative results over time, it is necessary that DBT patients develop new coping strategies as a means to ensure they don’t fall back into those patterns. Opposite action, where a person’s actions are contrary to his or her thoughts when those thoughts are inappropriate, is one approach used to aid people change their thinking and behaviors. Mindfulness is also an important part of the DBT process, as it allows its practitioners to develop a better understanding and awareness of their thoughts and how those thoughts influence their actions. Writes Jon Kabat-Zinn, “An operational working definition of mindfulness is: the awareness that emerges through paying attention on purpose, in the present moment, and non-judgmentally to the unfolding experience moment by moment.”
Many books have been written on the subject of Dialectical Behavior Therapy, including Mind Over Mood: How to Change to Way You Feel by Changing the Way You Think; Don’t Let Your Emotions Run Your Life: How Dialectical Behavior Therapy Can Put You in Control; The Dialectical Behavior Therapy Skills Workbook; and Linehan’s own Skills Training Manual for Treating Borderline Personality Disorder, which teaches readers the four basic DBT skills sets used to treat BPD: interpersonal effectiveness, emotion regulation, distress tolerance, and mindfulness. Each book offers instructions on how to incorporate the various tenets of DBT into their daily lives through writing exercises, worksheets, questionnaires, meditation, and personal accounts.