Dialectical Behavior Therapy
Having bipolar disorder means having changing moods, 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 – 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 – or dialectical behavioral therapy – is a type of psychotherapy that branched out of cognitive behavioral therapy (CBT) in the 1980s and 90s. 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 chronically 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 very 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 2.5 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 practices 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 distress 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 towards you gaining a better control 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. Surely, 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 tried 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 4 is less about dealing will symptoms and more focused on finding well-being and a life of happiness.
Next Page: Does DBT work? And how to build your own DBT house.