DBT and CBT
What is the difference between Dialectical behaviour Therapy (DBT) and Cognitive Behaviour Therapy (CBT)? In my private practice I mainly use a psychodynamic approach with Cognitive Behaviour therapy. Psychodynamic therapy works on the premise that many of our behaviours are learned in childhood and are maladaptive. These ineffective coping mechanisms thwart us and limit us in adulthood and becoming aware of these behavioural patterns is the first step in counteracting their negative effects.
Dialectical behaviour is type of cognitive behavioural therapy that focuses on the psychosocial aspects of a person’s psychology. It is based on the theory that some people react more intensely to experiences involving romantic partners, family and friends. A maladaptive coping mechanism causes distress and distorted thinking regarding social aspects of their lives. Dialectical Behaviour Therapy often consists of a group session element as well where people can learn from one another in a social setting. The following skills are learned in group DBT sessions:
Effective interpersonal skills
Distress tolerance/ reality acceptance skills
Core Mindfulness Skills
Mindfulness skills in DBT come from the eastern spiritual traditions. These skills help members focus on the present and attend to what is happening in the here and now in a calm way. It helps people slow down and focus on doing what is needed to care for oneself in the moment. Members learn the value of wise mind instead of succumbing to intense emotions and acting in a destructive way.
Distress Tolerance Skills
Distress tolerance helps people get through difficult times when emotions are running high. It teaches people to soothe themselves in healthy ways when they are feeling upset rather than becoming overwhelmed by emotions or hiding from them. This allows individuals to make wise decisions about whether and how to take action, rather than falling into the intense, desperate and often-destructive emotional reactions. Crisis survival skills are also taught so that one does not engage in problematic behaviors and ultimately make the situation worse. Reality Acceptance Skills focus on helping people fully accept reality and provide a guideline for responding to painful aspects of life.
Interpersonal Effectiveness Skills
Interpersonal effectiveness skills involve helping people understand what their needs are in their relationships and helps develop effective ways of dealing with others in order to get one’s wants or needs met in a healthy way. This involves respecting the self and others, listening and communicating effectively, dealing with difficult people, repairing relationships and being able to say no.
Emotion Regulation Skills
The DBT emotion regulation skills help people understand their emotions. It teaches people to decrease the intensity of their feelings and helps them ride out strong emotions without acting on them. It provides education about the function of emotions and how to not be swamped by them.
Both Cognitive Behavioural Therapy and Dialectical Behaviour Therapy can incorporate exploring an individual’s past or history, to help an individual better understand how it may have impacted their current situation. Discussion of one’s past is not a focus in either form of therapy.
Both types of psychotherapy have strong research backing and have been proven to help a person with a wide range of mental health concerns.
Benefits of Dialectical Behaviour Therapy:
The following are some of the benefits of DBT:
- Increased awareness of destructive behaviour relating to interpersonal relationships as well as areas where self sabotage exists
- Decrease high risk suicidal and self-harming behaviour
- Decrease behaviour that interfere with quality of life
- Mastering behaviour skills for mood-independent life choices
- Decrease symptoms related to trauma, stress, anxiety and depression
- Enhance and sustain self-respect
- Assistance with goal setting in order to create a life worth living
By focusing on facts rather than emotions or value judgments such as good/bad or fair/unfair, DBT patients enhance their abilities to respond positively and productively, without descending into self-blame or other destructive thoughts and behaviours.