The large number of theories and currents of thought that have existed throughout the history of psychology have made it possible to generate a large number of therapeutic techniques to treat different problems and disorders.
One of the most predominant currents today is that of cognitive-behavioral behavior, which, through behavior modification, aims to modify the thought and behavior patterns of individuals in difficulty to make them more adaptable to the environment. and reduce their suffering. Among the techniques that allow such a thing, especially in the face of self-destructive behaviors and severe personality disorders, is dialectical behavior therapy.
Dialectical Behavioral Therapy: Theoretical Bases
Experiencing impulses and emotions intensely is something that most people have done on certain occasions. However, in some cases, emotions that are too intense can lead to overly impulsive behaviors, including self-harm and suicide attempt, resulting in insufficiency and suppression of the frustration felt.
In order to treat these problems in many patients, Marsha Linehan would try to apply behavior modification techniques specific to the cognitive-behavioral paradigm. However these techniques would not have the desired effect, leaving the treated individuals misunderstood, emotionally ignored in their feelings of emptiness and even attacked in attempting to change their behavior without further delay.
Linehan would realize this fact and the feelings of the patients in care, and in response to this would end up mixing these behavior modification techniques with a more dialectical approach, which would end up being the fundamental axis of the treatment to be applied. . Linehan would create what is now known as Dialectical or Dialectical Behavior Therapy, specifically dedicated to the treatment of self-destructive and addictive behaviors.
What is your goal?
It is a technique belonging to the third wave or generation of behavioral therapies, so it does not focus so much on eliminating the behavior or characteristic that produces difficulties but, in addition, on transforming the relationship of the be patient with her and guide her so that she can accept it and see reality in a different way from the original.
The fundamental goal of dialectical behavior therapy is to get the patient to learn to manage his emotions and his behavior well, so that he is able to control the impulsive behaviors caused by the mood swings while the subject and the therapist caring for him accept his experience the facts and what they assume for him. A balance between self-acceptance behavior change strategies is therefore sought.
This acceptance and validation of one’s own experience it by itself increases the ability to deal with one’s own emotions more adaptively, so that in turn it decreases the impulsivity which ultimately leads to extreme behaviors. In this therapy, it is of great importance the figure of (or, since in general a team of professionals is entrusted with work) therapist, being the therapeutic relationship and the acceptance by his part of those elements that make difficult change a constant essential for success. .
In dialectical behavior therapy it is used many treatment modalities, Work in different ways two fundamental aspects that this type of treatment tries to solve.
The first of these aspects is based mainly on causing the patient desire to move forward and motivate follow the treatment, focusing their attention on the reasons for improvement and helping to set vital goals to pursue and for which it is worth living.
The second part is based on training, train the patient in specific skills in order to be more able to accept and manage 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 adopt impulsive behaviors, Another to generate self-awareness skills through techniques such as Mindfulness to cope with feelings of emptiness and different cognitive-emotional disorders, a module dedicated to work on emotional regulation and finally a module in which social skills are worked and the interpersonal relationships of these people less chaotic, more stable and lasting.
Individual psychotherapy is used to try to find a solution to the problems faced by the patient, while group therapy is used to train the client in the different skills needed to improve their self-acceptance. 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 behavior therapy is carried out through a series of three phases, Subsequently to guide the patient on therapy, show the need and promote the active participation of the individual treated in the face of the objectives set between the patient and the therapist.
In a first phase, the work focuses on increasing self-awareness and discomfort tolerance skills and regulation of emotions and personal relationships, Along with the control and management of impulsive behavior, accept and take into account all the variables and behaviors likely to affect the individual. In general, most activities aimed at both self-acceptance and behavior change are carried out.
In a second moment act on stress which produced and produced the situation in individuals.
Finally, the subject is helped to reconstruct and create a more positive realistic self-concept and self-validation, helping to set and focus on vital goals important to each client.
Clinical uses and applications
Dialectical behavior therapy has been shown to be useful in a large number of disorders, resulting in particular effectiveness in the control of impulsive behaviors and intense emotions. Some of the disorders in which it is most indicated are as follows.
Borderline personality disorder
Dialectical behavior therapy is primarily known to be the type of therapy that has the most empirical support in the treatment of borderline personality disorder. From the perspective of dialectical behavior therapy, this disorder is understood as a continuing pattern of emotional deregulation due to the interplay between biological variables that predispose to emotional vulnerability and a restrictive and disabling environment of emotions that prevents them from being managed effectively.
This causes the emotions to eventually escalate and run out of control, with extreme emotional lability as well as an intense sense of inner emptiness that can eventually lead to self-destructive or even suicidal behaviors and dependent and unpredictable attitudes. Thus, in this disorder, the dialectical behavioral therapy seeks to work on the vulnerability and the feelings of helplessness of the subject, of which they end up displaying the vital passivity and the expression of the anguish and the repressed feelings.
Dialectical behavior therapy has been applied successfully to a large number of disorders in which the main problem has been difficulty in regulating emotions. For this reason, studies indicate that it appears to be very useful in reduced symptoms of mood disorders like a major depression.
Eating disorders as anorexia, bulimia and binge eating disorder they often have at their root serious problems of emotional regulation related to the acceptance of one’s own body image or an inability to maintain control over one’s own eating behavior.
In this regard, dialectical behavior therapy has shown that reduces the symptoms of this type of disorderEspecially binge eating disorder and bulimia nervosa in which the massive consumption of food occurs on the basis of immediate impulses.
It should be borne in mind that in a large number of cases, substance abuse is done with the intention of facing an existential void, as a mechanism for the escape of emotions that are difficult for those who suffer from it. (such as fear or guilt) or to alleviate the compulsive desire to use that is derived from abstinence from the substance to which one is addicted. Thus, in cases where behind the consumption there is a problem with the regulation of emotions dialectical behavioral therapy it has also been shown to be particularly effective.
Although not as successful as in previous cases, dialectical behavior therapy has been frequently applied in both post-traumatic stress disorder and anxiety disorders such as panic disorder.
- Ametller, MT (2012). Psychotherapies. CEDE PIR preparation manual, 06. CEDE: Madrid.
- Aramburu, B. (1996). Dialectical Behavior Therapy for Borderline Personality Disorder. Behavioral Psychology, 4, 123-140.
- Linehan, MM and Dimeff, L. (2001). Dialectical behavior therapy in brief. The California Psychologist, 34 years old, 10-13 years old.
- Soler, J .; Elices, M. and Carmona, C. (2016). Dialectical behavior therapy: clinical applications and empirical evidence. Analysis and modification of behavior, vol.42, nº165-166. 35-49.