Dialectical Behavior Therapy

Dialectical Behavior Therapy is often used in helping treat eating disorders. This article helps define Dialectical Behavior Therapy (DBT) and discusses the relationship between DBT and Cognitive Behavioral Therapy (CBT). Keep reading to learn how DBT helps treat eating disorders.

The Origins of Dialectical Behavior Therapy

Marsha Linehan of the University of Washington developed Dialectical Behavior Therapy (abbreviated DBT) in the 1970s as she was focusing on the treatment of patients who had a history of attempted suicide and urges to harm themselves. Linehan had been using Cognitive Behavioral Therapy (CBT) but several problems characteristically arose, and DBT was developed as she sought to solve these three issues:

  • Her clients felt that the inherent emphasis on change in CBT was invalidating. Typical responses included anger or withdrawal from treatment.
  • Because therapists responded to clients’ anger or withdrawal or other negative responses over this issue by diminishing the aspect of therapy that the clients found problematic (change), clients, rather than therapists, ended up in control of the therapy, which became less effective.
  • Because Linehan’s clients were dealing with ongoing problems that were severe, numerous, and resistant to change, the standard CBT protocol did not provide enough session time to learn protocols focused on change as well as deal with current issues that were extremely serious, if not life-threatening.

The Main Elements of Dialectical Behavior Therapy

Linehan’s development of DBT was formulated to address all three of the concerns that arose when treating clients with serious current issues with the standard CBT approach. She introduced validation strategies, new strategies that demonstrated acceptance, allowing the therapist to communicate to the client that he or she was accepted in his or her current state and that the use of self-harm was understandable in some way.  To balance this, and prevent therapy from entering a stalling pattern, dialectical strategies were introduced to maintain the progress towards change without undercutting the sense of acceptance.

Restructuring of CBT followed, with the introduction of five critical functions, and modes or methods calculated to carry the functions out. The modes included different aspects of therapy, including the weekly, in-person coaching with the therapist, phone coaching, homework assignments, and skills group meetings for the client, while the therapist carried out a weekly meeting with a consulting team.

Part of the restructuring of CBT therapy included creating stages and targets that addressed client issues in a predetermined order, beginning with issues that are immediately life threatening, then those that threaten the client’s participation in therapy, followed by issues for which an alternative to the client’s current strategy for coping would be an improvement. At the same time, the restructuring aims to balance the claims of current issues and long-range goals, which necessitates dealing with things that are not of the moment.

As time has passed, several different forms of DBT have evolved, but the one called “Standard and Comprehensive DBT” has been researched the most. These trials have demonstrated effectiveness of DBT in the treatment of Borderline Personality Disorder co-occurring with substance abuse, and is currently under study for use with eating disorders, in particular, binge eating disorder.




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