Dialectical Behavior Therapy (DBT) is becoming increasingly widespread and research continues to suggest that it is an effective treatment for a broad range of problems. Therapists, treatment providers and individuals continue to seek out DBT in order to alleviate severe and debilitating emotional and behavioral problems. There is promising research to indicate that as an adjunct to medication management it is an effective treatment for depression.
What Is Dialectical Behavior Therapy?
DBT grew out of the work of Marsha Linehan, Ph.D. Linehan, a cognitive behavioral psychologist by training, developed the theory while working primarily with women who were suicidal and engaged in self-harming behaviors. Initially, she approached her treatment from a strict cognitive behavioral perspective. However, over time and with careful scrutiny of her work, she found that cognitive behavioral techniques were deficient. Linehan noticed that although many people improved with cognitive behavioral techniques, too many others responded to treatment with anger or withdrawal. She began to adapt her work in order to create a treatment method that both helped people change problem behaviors and provided the acceptance and validation that would reduce anger and improve treatment retention. The result was a blend of behavioral and crisis intervention strategies with an emphasis on acceptance and tolerance.
Today DBT is a cognitive-behavioral and acceptance-based therapy practiced as a comprehensive intervention package aimed at reducing high-risk and treatment-interfering behaviors. The focus of the DBT model is on teaching the individual to:
- modulate extreme emotions and reduce negative behaviors that result from those emotions and
- trust their own emotions, thoughts, and activities.
These two goals are accomplished through multiple treatment modalities, including skills training, individual therapy, coaching in crisis, structuring the environment and consultation teams for providers.
A Study on Dialectical Behavior Therapy and Depression in Older Adults
In a 2002 study published in the American Journal of Geriatric Psychiatry, DBT skills groups and coaching in crisis, in addition to medication management, resulted in significant decreases in depression in older adults. 71 percent of the study participants receiving DBT treatment were in remission at the end of the study, compared to 47 percent of those who did not receive DBT treatment.
The DBT implementation in the study focused on two out of the five treatment DBT treatment modalities: skills group and coaching in crisis. The goals of these two modalities are to teach individuals new skills to manage their emotions and the problems in their lives and to ensure that they can utilize those skills in times of crisis.
A major portion of DBT treatment is devoted to teaching skills. The DBT skills are designed to help modulate emotions and behaviors and are broken down into four categories:
- Skills that increase interpersonal effectiveness in conflict situations;
- Skills that help regulate painful emotions;
- Skills for tolerating emotional distress; and
- Mindfulness skills, designed to help focus attention and experience emotions.
In each group, specific skills are presented and practiced and homework is given for practice during the week. Members review their homework at the following meeting.
The overall aim in teaching DBT is to enhance skill generalization to everyday life. Individuals learn skills in group to help them resolve crises in more functional ways. Coaching in crisis is an integral part of the treatment. The rationale is that the clients often need help in applying the behavioral skills they are learning to problems in daily life as they occur. Individuals are able to access therapists by phone with the focus of this interaction on applying skills. Over time the frequency and duration of crisis interventions will decrease as the therapist responds consistently using these techniques and individuals learn to use skills on their own.
Late-life depression is a serious mental health problem which frequently contributes to physical health problems in older adults. The coping skills that are a central element of DBT treatment seem to be relevant in the improvement of symptoms of depression in older adults.