Dialectical Behavior Therapy: Theory, Phases and Effects

The large number of theories and currents of thought that have existed throughout the history of psychology has allowed the generation of a large number of therapeutic techniques that allow us to face different problems and disorders.

One of the most predominant currents today is cognitive-behavioral, which through behavior modification aims to alter the patterns of thought and behavior of individuals with difficulties to make them more adaptive to the environment and reduce their suffering. Among the techniques that allow this, especially in the face of self-destructive behaviors and severe personality alterations, there is dialectical behavioral therapy.

Dialectical Behavior Therapy: theoretical bases

Experiencing impulses and emotions intensely is something that most people have done at some point. However, in some cases the experience of exaggeratedly intense emotions can lead to exaggeratedly impulsive behaviors, including self-harm and suicide attempts, derived from the lack of adequacy and the repression of the frustration felt.

In order to treat these problems in numerous patients, Marsha Linehan would try to apply behavior modification techniques typical of the cognitive-behavioral paradigm. However, these techniques would not have the expected effect, with the treated individuals feeling poorly understood, emotionally ignored in their feelings of emptiness, and even attacked when attempting to simply change their behavior.

Linehan would realize this fact and the sensations of the patients who were being treated, and in response to this he would end up mixing these behavior modification techniques with an approach more focused on dialectics, which would end up being the fundamental axis of the treatment. apply. Linehan would create what is known today as dialectical behavioral therapy or dialectical behavior, especially dedicated to the treatment of self-destructive and addictive behaviors.

What objective does it have?

It is a technique belonging to the third wave or generation of behavioral therapies, so that it does not focus so much on eliminating the behavior or characteristic that produces difficulties but on, in addition, transforming the patient’s relationship with it and guiding him or her accordingly. so that I can accept it and see reality in a different way than the original.

The basic objective of dialectical behavioral therapy is to ensure that the patient learns to correctly manage his emotions and behavior, so that he is able to control impulsive behaviors caused by mood disorders while both the subject and the therapist who cares for him accept his experience of the events and what for him they suppose. A balance is therefore sought between behavioral change strategies of self-acceptance.

This acceptance and validation of one’s own experience It itself increases the ability to manage one’s own emotions more adaptively, which in turn decreases the impulsivity that ultimately leads to extreme behaviors. Within this therapy, the figure of the therapist (or therapists, since a team of professionals is generally used) is of great importance, with the therapeutic relationship and acceptance on their part of those elements that hinder change being an essential constant. for success.

Basic components

In dialectical behavioral therapy, a large number of treatment modalities working in different ways two basic aspects that this type of treatment tries to solve.

The first of these aspects is based mainly on the fact of causing in the patient desire to continue forward and motivate you to continue the treatment, by focusing your attention on the reasons to improve and helping you achieve vital objectives to pursue and for which it is worth living.

The second component is based on training, training the patient in specific skills so that it is more capable of being accepted and managed in a more adaptive way. This training is based on four main modules.

Among these modules we find training in increase tolerance to discomfort in order to combat the tendency to engage in impulsive behavior another in generating self-awareness skills through techniques such as Mindfulness to treat feelings of emptiness and different cognitive-emotional alterations, a module dedicated to working on emotional regulation and finally a module in which social and emotional skills are worked on. interpersonal relationships, making these people’s relationships less chaotic, more stable and lasting.

Psychotherapy is used at an individual level to try to find a solution to the problems experienced by the patient, while group therapy is used to train the client in different skills necessary to improve their self-acceptance. When faced with specific problems of daily life, it is possible to establish telephone contact with the therapist so that it is possible to apply the situations worked on in consultation to daily life.

Phases of therapy

The application of dialectical behavioral therapy is carried out through a series of three phases subsequently guiding the patient about the therapy, making their need known and promoting the active participation of the treated individual in the face of objectives established between patient and therapist.

In the first phase, the work focuses on increasing self-awareness and skills of both discomfort tolerance and regulation of emotions and personal relationships along with the control and management of impulsive behaviors, accepting and taking into account all those variables and behaviors that may affect the individual. In general, most activities aimed at achieving both self-acceptance and behavioral change are carried out.

In a second moment we proceed to act on stress that has produced and produces the situation in individuals.

Finally, we proceed to help the subject to rebuild and create a more positive realistic self-concept and self-validating, contributing to the setting and orientation towards important life goals for each client.

Clinical uses and applications

Dialectical behavioral therapy has proven useful in a large number of disorders, being especially effective in controlling impulsive behaviors and intense emotions. Some of the disorders in which it is most indicated are the following.

Borderline personality disorder

Dialectical behavioral therapy is mainly known for being the type of therapy that has the most empirical support in the treatment of borderline personality disorder. From the perspective of dialectical behavioral therapy, this disorder is understood as a continued pattern of emotional dysregulation due to the interaction between biological variables that predispose to emotional vulnerability and a restrictive, invalidating environment of emotions that prevents them from being managed efficiently.

This causes emotions to intensify and get out of control, resulting in extreme emotional lability along with an intense feeling of inner emptiness that can end up leading to self-harming and even suicidal behavior and dependent and unpredictable attitudes. Thus, in this disorder, dialectical behavioral therapy aims to work on the vulnerability and feelings of helplessness of the subject, the vital passivity that they end up displaying, and the expression of anguish and repressed feelings.

Mood disorders

Dialectical behavioral therapy has been successfully applied to a large number of disorders in which the main problem was difficulties regulating emotions. For this reason, the studies carried out indicate that it seems to be of great help in the reduction of symptoms of mood disorders like major depression.

Eating disorders

Eating disorders such as anorexia, bulimia, and binge eating disorder They usually have at their base serious emotional regulation problems linked to the acceptance of one’s own body image or an inability to maintain control over one’s own eating behavior.

In this aspect, dialectical behavioral therapy has shown that reduces the symptoms of this type of disorders especially binge eating disorder and bulimia nervosa in which massive consumption of food occurs based on immediate impulses.

Substance abuse

It must be taken into account that in a large number of cases the abusive consumption of substances is carried out with the intention of facing an existential void, as an escape mechanism for emotions that are difficult to accept for those who suffer from them (such as fear or guilt) or to relieve the compulsive desire to consume derived from abstinence from the substance to which one is addicted. Thus, in cases where behind the consumption there is a problem of regulating emotions, dialectical behavioral therapy has also proven particularly effective.

Others

Although it has not been as successful as in previous cases, dialectical behavioral therapy has been frequently applied in both post-traumatic stress disorder and anxiety disorders such as panic disorder.

• Aramburu, B. (1996). Dialectical behavior therapy for borderline personality disorder. Behavioral Psychology, 4, 123-140.

• Linehan, M. M. & Dimeff, L. (2001). Dialectical Behavior Therapy in a nutshell. The California Psychologist, 34, 10-13.

• Soler, J.; Elices, M. and Carmona, C. (2016). Dialectical Behavior Therapy: clinical applications and empirical evidence. Behavior Analysis and Modification, vol.42, nº165-166. 35-49.