Dialectical Behavior Therapy
Having bipolar disorder means having changes in mood, energy levels, sleep patterns and interests, as your episodes shift between depression and mania. Because of the changing symptoms, you will need changing treatments, and one therapeutic style – dialectal behavior therapy (DBT) – works to improve bipolar symptoms no matter your state.
DBT might not be right for every person or every situation, but with its unique focus and style of treatment, it could be the best fit for your bipolar.
What is Dialectical Behavior Therapy?
DBT is a type of psychotherapy that branched out of cognitive behavioral therapy (CBT) in the 1980s and 1990s. DBT is a relatively new treatment technique since other styles came to prominence decades before.
A psychologist, Marsha Linehan, is most commonly named as the creator and driving force behind DBT. She developed DBT due to the constraints of CBT while working with clients who were involved in self-injury and chronic suicidality.
DBT has four principles used to guide treatment:
- People want their life to improve.
- People are trying their best to maintain and improve their life.
- They have the ability to learn new tools and change their life.
- Though the problems are not always the person’s fault, it is their job to resolve it.
Compared to other forms of treatment, DBT is involved and intense. Rather than only focusing on one hour of individual therapy per week, DBT includes:
- Group therapy. A central point of DBT is a therapy group that typically lasts for two hours per week for 24 weeks. These educational groups teach a DBT skill for six weeks before moving onto the next for another six weeks.
- Individual therapy. The group therapy will focus on general skills where the individual sessions address the individual’s unique needs and wants. Sessions will address current concerns, as well as issues from the past.
- Phone coaching. In between group and individual sessions, the therapist will be available via telephone to address and process whatever situations or feelings arise. The therapist will suggest skills and interventions to reduce symptoms and resolve the issue.
- Therapist consultation. The therapists using a DBT framework have a strenuous task. Because of this, they receive a regular consultation with other DBT therapists to gain new insights and skills to benefit the clients.
Dialectical Behavior Therapy Skills
During the therapy, coaching and consultation, DBT will focus on teaching, building and practicing skills to help improve the individual’s life. The four DBT skills are:
- Mindfulness. Mindfulness is the practice of being aware and engaged in your surroundings and yourself. This practice aims to focus your mind in the 'here and now' rather than the negative events and feelings of the past or worries of the future.
- Distress tolerance. Distress tolerance is the idea of sitting with uncomfortable thoughts and feelings rather than quickly taking action to erase everything that causes distress. The notion is born from the idea that what you do to reduce your stress in the short-term might make things worse in the long-term. If you can tolerate discomfort, you will not have to react so immediately.
- Interpersonal effectiveness. If you can communicate well with others, your social network will grow in quality and quantity. By learning how to speak to others and listen to what they say effectively, you can build better relationships, which can offset the stressors life throws your way.
- Emotional regulation. Emotional regulation moves you towards gaining control over your thoughts, feelings and behaviors. No longer do you have to feel powerless in your life. This DBT skill helps you identify how you are feeling and the appropriate steps towards modifying these emotions.
The Goals of Dialectical Behavior Therapy
Using these principles, DBT has four main stages of treatment to move the client from where they are to where they want to be. The stages of DBT treatment are:
- Stage 1: Moving to gain control. People using DBT may have a history of being reckless, out of control and dangerous to themselves or the people around them. Some people with bipolar disorder can relate to this feeling. DBT helps to build attention, improve positive relationships and understand emotions to gain control.
- Stage 2: Moving to express emotions appropriately. Speaking of emotions, DBT tries to help people identify and express their feelings appropriately, rather than turning off or shutting down their feelings to avoid the discomfort.
- Stage 3: Solving normal problems as part of living a normal life. Since not all situations or emotions are extreme, this stage helps to differentiate the serious from the not-so-serious while learning simple problem-solving techniques.
- Stage 4: Moving to feeling completeness as a person. Phase four is less about dealing will symptoms and more focused on finding well-being and a life of happiness.
Does Dialectical Behavior Therapy Work?
DBT is an effective form of treatment with many studies and countless anecdotal incidents to support its claims. Although the therapy style was born with the focus on treating those with suicidal tendencies and a history of self-injury, DBT has expanded and is now used with many people with diagnoses like:
- Personality disorders, including borderline personality disorder.
- Post-traumatic stress disorder (PTSD).
- Anxiety disorders, including panic disorder and generalized anxiety disorder.
- Eating disorders.
- Substance use disorders, including addictions to alcohol and other drugs.
- Bipolar disorders.
The use of DBT with bipolar disorder makes a lot of sense because of the various ups and downs people with the condition often experience. By using the therapy, skills and guiding principles of DBT, someone with bipolar disorder can achieve the stability and sense of consistency they have been trying to achieve.
Building Your DBT House
With bipolar, your changing symptoms can make you feel like you are changing too. The change creates feelings of imbalance and unease that can add stress and worry to each day. Because of this, it is valuable to have an established sense of self. A written standard will help encourage a sense of being grounded, stable and balanced.
A useful tool comes from the work of dialectical behavior therapy (DBT). DBT is a spinoff of cognitive behavioral therapy (CBT) that is helpful for a range of mental health issues including depression, borderline personality disorder and bipolar disorder. The tool is called a DBT house. This intervention works to illustrate aspects of your life by bringing attention to strengths and supports while highlighting areas to grow.
From the Ground Up
A dialectical behavior therapy house is a simple yet engaging and beneficial tool with a lot of information to be gained and processed. Interested? Here’s how to create your own:
- Draw a house. Any house will do, but there are a few necessities. Your house should have a foundation, walls, roof, door and chimney. An online search will yield many templates but don’t worry about how it looks. This is your DBT house, so feel free to use your creativity. After all, the house represents you.
- The house’s foundation is your foundation as a person. List and label the values, beliefs and traditions that direct your life. Do you put family above all else? Do you think that being financially successful is paramount? Include these on your foundation.
- The walls represent your supports. Are you struggling to name supports? Remember that supports can be people, places and things. Who have you interacted with in the last weeks? What did you do and where did you go to feel better and find assistance? Supports can be professionals in your life. A therapist is a great professional support to list on your walls.
- What shelters you? Who protects you? Like supports, these can be people or things. Do you feel like your parents encourage you unconditionally? If so, include them on your roof.
- The door keeps things hidden and others out. What things do you hide? Are you ashamed of things or do aspects of your past? List these in the door.
- The chimney releases hot air. What do you do to blow off steam? Exercising, watching a funny movie, journaling and taking a long bath are great ways to relax and unwind. List these on your chimney.
- Bonus: billboard. So, not many houses have billboards, but your DBT house does. On the billboard, write the things that you are proud of. The accomplishments, skills or characteristics about you that you would like to share with the world.
DBT and the DBT house intervention may be new concepts to you, but they may be invaluable ways to treat your bipolar disorder. DBT’s intensity and structure are great options for people looking for long-term symptom improvement.
Don’t worry about finding a therapist with training in DBT. Since the therapeutic style has the reputation for being so effective, many therapists have some level of training in the techniques.
If your established therapy is not yielding the desired results, mention into your therapist. Your current therapist may also be willing to integrate some DBT skills into the sessions you already enjoy to address your bipolar disorder more effectively than you thought possible.