Dialectical Behavior Therapy Dbt Dialectical

Dialectical Behavior Therapy

DBT

Dialectical Behavior Therapy is a medication meant to treat persons with mental health disorders especially borderline personality disorder. These patients normally have a history of urges to induce self-harm, self-mutilation, suicidal ideation among others. This therapy uses a cognitive-behavioral approach that deals with the psychological aspect of treatment (Heard, 2009). The theory depends on the approach that some people are more susceptible to a more tense reaction and unconsciously toward specific emotional situations, specifically those found in romantic, friends and family relationship. In the same theory, it has been found that some people react more than others in such situations or that their arousal level in those individuals normally rises faster than an average person's, they also gain a higher level of emotional stimulation and consumes a lot of time to return back to baseline arousal level.

Person's diagnosed with borderline personality disorder normally have the following characteristics, these include; they go through regular emotional swings, they sometimes see the world in black and white shades, more so they find themselves from one crisis after the other. Those who have this disorder normally fail to get the aid/assistance they deserve because they do not have the skills to cope with these irregular, sudden and intense surges of emotion (McMain, 2001).

Characteristics of Dialectical Behavior Therapy

The following are the characteristics of Dialectical Behavior Therapy, they include; it is cognitive based. The use of Dialectical Behavior Therapy helps to realize the thoughts, beliefs and assumption that the people have that makes life harder for him/her. Dialectical Behavior Therapy is also support-oriented, in that, it helps a person to identify their positive potential and build it up so that the person's with the disorder may have a positive attitude towards him/herself (Robins, 2001). The therapy is also collaborative in that it needs regular attention to relationships between the therapist and the patient. The therapy also, relies on total disclosure of problem, between the therapist and the person with the disorder, in a way that each one of them has to open up and share their problems in their efforts towards working them out (Clarkin, 2007). It is also collaborative in a way that the theory asks the people involved to complete homework assignment, they are also to try and practice by doing role play on the new ways they could interact with others people and to design ways a person can sooth him/herself when feeling disturbed or upset.

Distinctive theoretical features of a DBT

The first distinctive feature is that it is a principle driven treatment. This is because the treatment can be issued at any time and place and it uses a guiding theory to execute the required treatment plan. This guide helps the therapist to decide what strategy he/she is to employ on the patient in order to remove him/her from the current problem/situation. In DBT the therapist must constantly attend to the key principle provided in treatment. The therapist usually has some difficulties while using this principle because most of the principle-based treatments are related to one another (Heard, 2009).

The second feature is that DBT uses integrative treatment. This is because DBT treatment is through open ended dialog process where changes are accepted and used independently. The theory relies on the patient's description of situations to figure out the solutions to them; therefore, it combines all the information acquired to rectify a given problem (Willem, 2012).

Cognitive behavioral assessment procedures of DBT

This the first phases of a therapist-patient encounter. At this stage, the patient is normally asked several questions to give the therapist a better understanding of his/her condition so as to find the right treatment the patient need. The patient is normally asked to provide any information that makes him/her to think that he/she needs the treatment, he is also supposed to provide information concerning his/her problems, the therapist is also to find out about his/her general health, thereafter other information related to the history of substance abuse, trauma history and mental health issues are presented (Westen, 2000). Then the therapist will collect other clinical details based on the patient's assessment such as previous mental health status, hospital records, and any other treatment given previously

Therapeutic Interventions (Treatment)

Individual therapy involves weekly sessions where by problem behaviors such as purging, therapy interfering behaviors, self-mutilating and abuse of alcohol among other behaviors, are analyzed in great depth so that the causes and consequences which leads to, elicit or maintain the behavior is determined (McMain, 2001). Within this individual therapy, solutions are sought which will address what hinders skillful behavior by modifying reinforcement mechanisms, surpassing barriers through exposure to those factors, cognitive modification and direct tutoring skills. First, efforts are directed towards doing away with self-destructive tendencies/behaviors, then followed by life interfering behaviors are assessment and resolved (Clarkin, 2007). Through motivating the patient to use his/her own skillful behavior, the person may give the therapist his/her phone for consultations and assessment of skills outside their scheduled session.

Daily self-monitoring entails rating and doing follow ups on urges, emotions and behaviors relevant to the DBT case on a diary card. The patients work together with their therapist to design diaries which are relevant to their targeted areas for change. Here the patients are also supposed to do the skills homework which consists of practicing positive skills, observing and maintaining that experience (Willem, 2012).

Call coaching is also an essential tool because the patients can make calls to their therapist wherever they have an urge to engage in a maladaptive behavior and require help to overcome it. Patients are able to be given the necessary help for skill generalization in the environment they are in when going through intense urges and emotions (Heard, 2009).

Medication management is done by an individually assigned psychiatrist who is supposed to monitor and manage the medication he/she has given to the patient while still in the program.

Rehabilitation Counseling is used to help the patients to utilize their potentials sufficiently and to become independence in life.

Family therapy is conducted by individual's assigned therapist who will give both the family and multifamily groups their individualized sessions for support and education purposes. The family session is suitable because it helps the family to solve problems, make the home a better environment and more so to improve on communication (McMain, 2001).

Group skills training is where persons with BPD may lack the basic skills required to control their emotional experience, persevere painful experiences, engage in interpersonal relationships and manage cognitive dys-regulation. Group skills comprises of twice a week trainings sessions and it takes about 6 months to complete successfully, the duration may take this long because these patients normally have aversive emotions which often hinder the amount of learning that can take place (Willem, 2012).

Due to the difficultness in dealing with this disorder, there is needed to have a consultative approach towards treating it. This consultative team may comprise of a social worker, psychologist, psychiatrist, nurses among other resourceful people.

In DBT, group skills become necessary because it involves four modules. This includes interpersonal skills, mindfulness skills, emotional regulation skills and distress tolerance skills (Robins, 2001).

Mindfulness is the core skill taught in the group. Some of the advantages with enhancing this skill are that it is quite basic because most human beings possess it and it can be easily developed. It entails turning the patient's focus to a specified or a chosen direction and to observe, acknowledge and let go of other thoughts not in the path of the chosen focus. The aim of this skill is to fully participate and be aware of the present moment's events without any judgments. For instance a patient may be asked to imagine him/herself next to a waterfall's base, while seeing droplets of water fall down creating a rainbow illusion (Clarkin, 2007). The patient is not to change the illusion of what he/she is thinking about, but he/she should not interfere with them. Therefore, the skills enable the patient to know how to deal with arising issues and not being judgmental. Hence they can start being distant from emotions and learn to live a full life.

Interpersonal effectiveness involves strategies used to ask the patient what he/she needs, he/she saying no to various life threatening behaviors and to enable him/her to know how to deal with interpersonal conflicts. Interpersonal skill is also used in group skills because the patient may be able to explain his/her effective behavioral sequences well when another case of problematic situation is analyzed or discussed. Discussions of similar problematic situations may be used to analyze their own situation (Willem, 2012).

Distress tolerance is one of the most fundamental approaches to tackling mental health because it involves changing distressing circumstances and events. The patients are taught the skill to accommodate pain skillfully. This accommodation comes by when they are come to terms that they have a problem in a non-judgmental and non-evaluative fashion. Here, the persons with the disorder are also taught how to persevere and survive crisis by accepting life as it is (Robins, 2001). For them to survive crisis they are equipped with the skills to; self-soothing, thinking of the pros and cons, improving the moment and looking for destructive things to do. They can also exhibit acceptance skills by turning the mind to accept, radical acceptance and willingness vs. willfulness.

Individuals with under this therapy are taught how to regulate their emotions. This is because most of those suffering from this disorder are known to be angry, depressed, intensely frustrated and anxious among other behaviors. The steps taught towards emotional regulation include; identification and labeling of emotions, identification of obstacles to any change of emotion, reducing of vulnerability to having an emotional mind, by having more positive emotional events, giving the patient the ability to control the current emotions and wherever a negative one presents itself he/she can take the opposite action, and lastly, he/she can apply the distress tolerance techniques taught (Heard, 2009).

Modes of Treatment

There are five clear components of treatment of DBT. They component include; individual therapy session to address and maintain the patients motivation for treatment, group skills training to increase the patient's capabilities, brief weekly phone calls to insure generalization of new skills, therapist consultation team to provide supervision and prevent burnout and lastly, administrative function to structure the environment so that effective treatment can take place (Westen, 2000).

Stages of treatment

Borderline Personality disorder being one of the conditions treated by Dialectical Behavior Therapy is more centered towards patient's egregious behaviors. Dialectical Behavior Therapy has four stages, pre-treatment stage; this stage basically deals with assessment of the patient's disorder, commitment to the treatment choice, and orientation to Dialectical Behavior Therapy (Heard, 2009).

The first one is based on reducing any present life threatening behaviors, quality of life threatening behavior and therapy-interfering behaviors and to enhance behavioral skills. The second stage revolves around improving the experience of a patient who has reached a state of desperation having managed to come through the damaging behavior which was present in stage one of the Dialectical Behavior Therapy treatments. The characteristic focus presented in this stage is the post-traumatic stress responses (McMain, 2001).

The third stage is meant to promote the patient to develop a positive attitude and a way to resolve the daily problems. Whereas the fourth stage consist of where the patient can now live in joy through his/her abilities to overcome the feeling of incompleteness.

Treatment strategies

With the different intervention measures put in place in Dialectical Behavior Therapy. The main strategies used are the validation and problem solving. These strategies tries to facilitate change by validating a patient's behavior and responses as understandable as possible while also associating it to his/her current life ordeals and which portrays an understanding of the patient's difficulty and suffering (Robins, 2001).

Problem solving strategy on the other hand majors on imparting the patient with the necessary skills for coping. In case the patient is not taking care of him/herself by taking care of the arising problems then, either he/she do not poses the necessary skills needed to solve the problem or there may be something hindering him/her to do so (Clarkin, 2007). When the patient doesn't solve his/her problem, because he/she doesn't have the skills, then this can be solved by having skills training sessions. While, in any case he/she has the skills but doesn't use them, then, that situation may be because of environmental factors or maybe cognitive or emotional problem hindering treatment. The solution to this is by contingency management, cognitive therapy, exposure based therapies and pharmacotherapy, which are used in informal way into the therapy.