DBT Therapy in New Jersey

History of DBT

The program was developed by Marsha Linehan in the 1970s and 1980s, as a subset of cognitive behavioral therapy (CBT), and was originally designed to treat borderline personality disorder and help suicidal women. She first started applying the therapy to students at the University of Washington, using mindfulness techniques. Her research proved it was effective in reducing self-harm, suicide rates, and dropouts.

The therapy gained popularity with the founding of Behavioral Tech LLC in 1997. The institute trained thousands of specialists worldwide, helping them become certified in DBT practices.

DBT vs. CBT

Although DBT is a subset of CBT, they are not the same. CBT focuses on identifying and changing negative thought patterns. DBT builds on that by adding emotional regulation, interpersonal skills, and mindfulness strategies.

Other differences to note include:

• Length of treatment: CBT is typically short-term, lasting 8-20 sessions; DBT is longer-term, lasting a year or more.

• Disorder Targeting: CBT is recommended for anxiety, depression, and phobias; DBT is best for BPD, self-harm, suicidal ideation, and chronic emotional regulation

• Therapist’s Role: In CBT, the therapist acts more as a teacher or problem solver; in DBT, the therapist plays a more collaborative role

The Four Modules of DBT Skills Training

DBT is often presented as four modules, as follows:

Mindfulness Techniques

Mindfulness requires you to stay in the present moment and view your emotions and surroundings without judgment. It is beneficial in the treatment of substance abuse and mental health conditions because it causes you to step back and think about how you are going to react to a situation, rather than moving forward with a knee-jerk reaction, such as getting angry or using drugs and alcohol. The technique also allows you to gain a new perspective, breaking the cycle of addictive thinking.

There are several ways to achieve mindfulness. Meditation and deep breathing are often recommended because they help you tune in to your surroundings and inner self. Or, you can simply go on a walk, pay attention to nature, eat food more carefully, and practice your active listening skills.

Distress Tolerance

Distress tolerance helps you deal with difficult emotions through self-soothing techniques, leading to better outcomes. There are several ways to practice this technique, including the STOP method. It requires you to:

• S-Stop, freeze for a second before you act

• T-Take a step back to assess the situation

• O-Observe what you’re thinking and feeling

• P-Proceed mindfully, considering the impact of your actions

Other techniques include splashing cold water on your face, exercising, or engaging in relaxing practices like meditation and deep breathing.

Emotion Regulation

You can’t always avoid negative emotions, but you can regulate how you respond to them to improve your approach. The best way to do this is to build awareness of your emotions. Once you recognize what you’re feeling, you can think about how you’ll react.

Here’s how to practice:

• 1-3 times a day, ask yourself, “What am I feeling?”

• Rate the strength of your emotions on a scale of 1-10

• Notice where you feel that emotion in your body

Once you become aware of your emotions in a controlled setting, you will be better able to regulate them when they arise in everyday circumstances.

Interpersonal Effectiveness

Interpersonal effectiveness requires getting better at asking for what you need, saying no, and setting boundaries to increase self-esteem and develop better relationships. One way to practice this is through the DEARMAN technique. It requires:

• D- Describing the facts of the situation

• E- Expressing your feelings and opinions, briefly

• A- Asserting what you want or don’t want

• R-Reinforcing how it will happen

• M-Mindful- stay on topic, don’t get sidetracked

• A- Appear confident using a steady voice and eye contact

• N-Negotiate, be willing to compromise

What to Expect in DBT Sessions at BlueCrest

Many people are reluctant to start therapy because they don’t know what to expect. This section will review the steps to help you prepare for what’s ahead.

• Assessment: The therapist will start by assessing your individual needs based on your goals, lifestyle, and health history.

• Sessions: During sessions, you will explore how you’ve reacted to emotions in the past. The therapist will guide you through a step-by-step process to determine where things went right or wrong and how you can improve your reactions.

• Exercises: You will participate in various exercises to role-play situations and your reactions, and you will be assigned homework between sessions.

• Format: The therapist typically takes a participatory role, guiding you through your reactions. Sessions are usually 45-50 minutes, and therapy can continue for 6 months to a year or longer.

Individual Therapy and Group Sessions in DBT Programs

DBT can take place in individual and group sessions as follows:

• Individual Sessions: The therapist will work with you one-on-one, reviewing your experiences and helping you develop coping strategies.

• Group Sessions: Small groups with similar issues discuss their problems in a safe, comfortable setting, allowing you to learn from your peers and understand you are not alone.

• How They Work Together: The combined approach of learning from others and the customized attention your therapist provides empowers you to regulate your emotions in a healthy way without engaging in harmful behavior.

Who Benefits from DBT Therapy and Treatment?

• Individuals With Borderline Personality Disorder (BPD). DBT therapy was initially developed to treat BPD and is considered the gold standard treatment for this disorder. People with BPD often struggle with intense and unstable emotions, self-destructive behaviors, and difficulties in interpersonal relationships.

• Individuals With Other Mental Health Disorders. The therapy has been found to be effective in treating various mental health conditions, including depression, anxiety disorders, post-traumatic stress disorder (PTSD), substance abuse, eating disorders, and bipolar disorder.

• Individuals With Self-Destructive Behaviors. This is particularly beneficial for those engaging in self-harming behaviors, suicidal ideation, or attempting suicide. It provides individuals with skills to manage overwhelming emotions and develop alternative coping mechanisms.

• Individuals With Difficulties in Emotion Regulation. This helps individuals who struggle with emotional dysregulation, who experience heightened, intense emotions that are difficult to manage. It teaches skills for identifying and regulating emotions effectively.

• Individuals With Impulsive Behaviors. This addresses impulsive behaviors such as substance abuse, binge eating, reckless driving, overspending, and impulsive aggression. It helps people develop skills to pause, evaluate consequences, and make healthier choices.

• Individuals With a History of Trauma. DBT therapy, particularly when conducted as individual therapy, can be helpful for individuals who have experienced trauma. It provides tools for coping with distressing memories, managing triggers, and building resilience.

• Individuals with Eating Disorders: Eating disorders are typically a coping tool for people who can’t handle certain emotions. DBT teaches these individuals healthy coping strategies to replace harmful behaviors.

• Individuals with PTSD: DBT teaches mindfulness skills that help people with PTSD handle trauma and the associated emotions. It also addresses co-occurring disorders, such as self-harm, disassociation, and suicidality in complex cases.

• Individuals with Emotional Dysregulation: The mindful concept of DBT assists with emotional dysregulation. It teaches people to recognize and manage their emotions in various situations.

• Individuals with Self-Harm Behaviors: For some people, self-harm is a way to deal with emotions. It may make them feel better in the short-term, but it is unhealthy in the long run. DBT improves mental health by teaching emotional regulation, distress tolerance, and mindfulness, thereby reducing harmful behavior.

• Chronically Suicidal Borderline Clients: DBT was originally designed to treat suicidal ideation, alongside BPD. It works by first reviewing life-threatening behaviors, then teaching clients the skills necessary for survival.