Adaptations from M. Linehan’s original protocol
Dialectical Behavior Therapy was developed for the treatment of people with significant problems of impulsivity, interpersonal chaos, and confusion regarding their own identity, but has proven very effective (in various formats adaptable to different needs) also in the treatment of
- Eating Disorders
- Substance Addictions
- New addictions (pathological gambling, internet addiction, addictions in the context of sexual behavior…)
- Post-Traumatic Stress Disorder
- and in all circumstances where prolonged stress conditions are associated with difficulties in regulating one’s emotions, behavior, and interpersonal relationships…
According to DBT, this type of suffering depends on a dysfunction of the emotional regulation system which in turn finds its possible causes:
- on one hand in a sort of “biological predisposition,” that is, in a nervous system particularly sensitive to emotional experience (emotional vulnerability)
- on the other hand in the presence in the person’s life history of an invalidating environment (critical and judgmental), incapable of considering valid and recognizing the same emotional experience that so activates the person.
In this way, the person soon becomes accustomed to not considering valid and, even before that, to not recognizing their own internal experience (thoughts, emotions, impulses). The tendency toward self-invalidation (devaluing self-judgments) and the lack of awareness are among the greatest obstacles to the possibility of developing good mastery capacity of one’s internal states.
EMOTIONAL DYSREGULATION consists, therefore, in the inability, when faced with the activation of a strong emotion, to perform the necessary operations to reduce its intensity (without going to the opposite extreme: emotional blunting or inhibition – feeling nothing anymore) and return to the baseline or optimal emotional tone.
The ability to regulate one’s level of emotional activation makes possible our innate access to wisdom: it allows us to activate what this type of therapeutic approach defines as Wise Mind, characterized by the ability to remain lucid, intuitive, and in balance between Rational Mind and Emotional Mind.
Commonly, people with Emotional Dysregulation problems report feeling continuously in the state of Emotional Mind, constantly under the control of their emotions: this leads them to act impulsively and unstrategically, generating a sense of personal ineffectiveness and additional suffering.
But the situation of those who report feeling, alternatively, in the domain of rational mind is not necessarily better: the state in which logic and reason control thoughts and behaviors does not allow for creativity, warmth, and empathy and exposes us to rigidity, obsessiveness, and loneliness.
DBT sets as its general objective the learning of those skills that more easily allow access to Wise Mind, considered in summary as a condition of dialectical balance between the two opposite states of mind (emotional and rational), to which is added a form of intuitive knowledge.
The concept of dialectical balance permeates all interventions and objectives of Dialectical Behavior Therapy which:
- on one hand promotes, favors, and sometimes pushes for change, through interventions for the development or acquisition of new skills and competencies such as problem-solving
- on the other hand, mitigates and makes more acceptable such tension toward self-modification through important experiences of self-acceptance, favored by constant VALIDATION interventions by the therapist (interventions aimed at recognizing and acknowledging how dysregulated emotional, cognitive, and behavioral reactions have a comprehensible meaning, if contextualized within their life history). To quote Swenson, validation “is what allows us to go to Hell with our patients and then come back and work together” toward change.
Dialectics, also considered as a specific mode of dialogue between therapist and person, therefore constitutes the fundamental tool for managing inevitable conflicts and overcoming moments of impasse.
DBT includes various implementation modalities: Individual psychotherapy, psychoeducational groups for skills acquisition (Skills Training) for patients and their family members.
For further information on Individual Dialectical Behavior Psychotherapy, please refer to the section on Borderline Personality Disorder: this type of intervention (in combination with group intervention) becomes necessary in cases of significant dysregulation (emotional, behavioral, and cognitive) and in the presence of severe self-injurious behaviors.
