Dialectical Behavior Therapy Track
Dialectical Behavior Therapy (DBT) is a research-supported cognitive behavioral psychotherapy that has been found to be effective in treating symptoms and behaviors related to emotion dysregulation. The treatment uses cognitive and behavioral strategies to help residents develop more adaptive ways of thinking and more effective behaviors. The Retreat delivers DBT in accordance with the scientifically-supported model, and all staff members at The Retreat are formally trained in providing DBT.
Residents are encouraged to practice their DBT skills in the milieu with supportive coaching from staff in order to help them generalize these new skillful behaviors into their natural environments. When residents are better able to manage difficult emotions, they are often also better able to do deeper psychotherapy work, leading to a more robust treatment outcome.
Emotion dysregulation is a common feature in a variety of psychiatric disorders such as borderline personality, bipolar, trauma-related, eating, and substance use disorders, as well as anxiety and depression. At The Retreat, DBT is integrated throughout the continuum of care as an integral component of state-of-the-art psychiatric care, and is infused into the milieu of our residential, group home, and outpatient treatment environments so that we are able to meet the needs of our clinical population as they progress through the stages of treatment.
DBT Skills Trainers
All staff members at The Retreat are formally trained to provide DBT and skills coaching on the milieu to enhance the use of this behavior in the resident’s natural environment. The DBT Skills Trainers at The Retreat form a coherent team under the leadership of our psychologist and DBT coordinator. The team works together to administer dialectical behavior therapy aimed at treating emotion dysregulation. This type of therapy combines cognitive behavioral therapy with meditative approaches and has been proven to effectively treat borderline personality disorder and other manifestations of emotion dysregulation.
The following staff members lead the skills training and therapy groups:
Five Functions of DBT
DBT is designed to address five essential functions of successful treatment, listed below.
• Capability enhancement
• Motivational enhancement
• Enhancement of generalizations of gains
• Enhancement of capabilities and motivation of therapists
• Structuring of the environment to support clinical progress
DBT skills focus on acceptance and change. Mindfulness and distress tolerance are acceptance skills. Emotion regulation and interpersonal effectiveness are change skills.
The DBT skills groups are taught in three, six-week cycles. Homework, consisting of specific exercises related to the skills topics for that week, is an essential component of behavioral therapies and is assigned and reviewed at each group. Although everyone is encouraged to practice DBT skills in daily life, homework assignments are specific exercises assigned to help reinforce the skills taught in the skills group. A weekly homework assistance group is available to help residents apply the skills training to their individual goals.
Mindfulness is the core DBT skill; it is the foundation upon which all the other skills are built. It is the practice of being fully aware and present in the moment. In order to change one’s thinking or behavior, one must first be aware of their thoughts, feelings, and behaviors.
Mindfulness group is focused on skill acquisition and teaches patients strategies to develop a mindfulness practice. Various exercises are introduced and practiced so that each person can learn the types of mindfulness exercises that are particularly effective for them. Mindfulness practice cultivates “attention control muscles” so that the person is better able to keep their attention in the present moment as opposed to focusing on the past or the future. Mindfulness is a tool used to understand how problem behaviors develop and how to take notice and intervene earlier, with the goal of decreasing these problem behaviors. An important aspect of mindfulness is learning how to develop self-compassion and a spirit of loving kindness. One therapy group session per week is dedicated to mindfulness training, and there are also daily practice mindfulness sessions. Residents use the diary card provided at The Retreat as a tool to track their own emotional experiences and behaviors daily.
Mindfulness is also critical for relapse prevention. Relapse prevention is not limited to substance use problems; it is relevant to any problem behavior or symptom. The earlier one becomes aware that the vulnerability to negative emotion or behavior is emerging, the sooner one can practice skillful behaviors that may reduce potential consequences and unnecessary suffering.
DBT therapy group focuses on helping patients to embrace a dialectical world-view. Suffering can be decreased by adopting a view of oneself, one’s future, and the world that balances acceptance and change, resolves tensions, and synthesizes polarities. In the DBT therapy group, patients discuss their target behaviors in the context of changing their thinking and practicing skillful behavior. The diary card is the principal tool used to gain awareness of one’s emotions and skillfulness on a daily basis. During the diary card review, we are able to observe when DBT skills have been practiced and where there may be opportunities to apply skills more effectively. Reviewing the diary card helps to validate the patient’s feelings, reinforce his or her improved skillfulness, monitor target behaviors, and treat therapy-interfering behaviors. The DBT therapy group focuses on cognitive-restructuring, which is based on the idea that one’s thinking is related to one’s emotional experiences and behaviors. Cognitive behavioral therapy helps residents become more aware of their dysfunctional automatic thoughts and develop more adaptive ways of thinking and behaving.
This group provides patients with an opportunity to complete DBT skills training homework with support and skills coaching from DBT trained staff. The purpose of homework is to help residents practice and apply skills to their own treatment and to practice the skills learned that week. This group reinforces the importance of completing homework as a way to practice the skills taught during that week’s session.
Linehan, M. (2014). DBT Skills Training Manual (2nd ed.). New York: The Guilford Press.