Kimberly Jones, M.A., ASW
Resilience Treatment Center
Dialectical Behavioral Therapy (DBT) was pioneered by Marsha Linehan, initially to work with chronically suicidal individuals. A diagnosis that often presents with the symptoms that DBT aims to treat at is Borderline Personality Disorder. According to Dimeff and Linehan (2001) “DBT is based on a combined capability deficit and motivational model of BPD,” (p.1). Many individuals diagnosed with Borderline Personality Disorder continue to make progress with DBT therapy and groups, but research has also begun to show the the efficacy of the DBT model to extend to individuals with other mental health diagnoses as well.
Marsha Linehan (2016) writes that when looking at individuals with Substance Dependence, Major Depressive Disorder (MDD), and Eating disorders (ED) diagnoses, a significant remittance of symptoms was reported by a majority of individuals who were treated with DBT. The data Linehan presents of individuals with eating disorders who underwent DBT treatment, show that 64 percent of individuals show remittance in symptomology, for people with major depressive disorder the number was 68 percent, and for substance use disorder 87 percent (2016). The fact that DBT works with a variety of mental health diagnoses makes sense when looking at the underlying principals and structure of DBT.
DBT utilizes a tool known as the diary card, which allow individuals to monitor behaviors they are trying to increase and decrease. An individual with non-suicidal self injurious behaviors (NSSI) receiving DBT for example, would likely work on reducing self harm and perhaps increasing use of their distress tolerance skills. The diary card allows individuals to begin to see patterns of when different behaviors start to emerge for them and how these maladaptive behaviors (i.e. self injury, restricting, drinking, or isolating) may help them cope with feelings of distress even if there are longer term consequences to these behaviors. Individuals with suicidal ideation (SI), NSSI, or both can begin to apply skills in times of distress to regulate or tolerate their emotions (adaptive coping mechanisms) in order to eliminate the behaviors that have create problems for them. The same principals can be applied to a variety of maladaptive coping strategies due to a various mental health diagnoses.
According to Marsha Linehan and Euince Chen (2005)
“DBT for ED is based on a broadly defined affect regulation model of eating disorders, the basic premise of the theory is that disordered eating serves to regulate intolerable affect states in individuals with few or no other adaptive strategies for regulating affect,” (p.168)
Many individuals with ED like individuals with BPD benefit from the skills of DBT to help them replacing certain behaviors while still allowing them the opportunity to cope with distress and regulate the “intolerable affect states” that Linehan and Eunice write about (2005). An individual with ED also undergoing DBT therapy might learn to replacing purging with DBT skills such as ice diving or wise mind breathing and the same is true for Substance Use Disorder as well. Rather than taking a drink and individual learns to cope with difficult emotions through skills use instead of substance abuse.
Another fundamental underpinning of DBT is that it encourages people to attempt to find a balance between acceptance and change. “DBT, for people with substance abuse problems, is a way to is a way to achieve self acceptance while simultaneous accepting the need for change,” (Walker, 2015). Whether an individual is suffering with ED, BPD, Substance Use Disorder, or co-occurring diagnoses, DBT’s has the ability to help individual recognize the life that they want, recognize behaviors that get in the way of their life worth living, and offer people skills and concepts that can help them create change, learn self acceptance, and alleviate suffering in the long term.
Linehan, M. (2016) Dialectical Behavioral Therapy Intensive Training Manuel. Improvements
for Axis I disorders. Behavioral Tech LLC, p. 33-34.
Linehan, M., & Chen, E. (2005). Dialectical behavior therapy for eating disorders. Encyclopedia
of cognitive behavior therapy, 168-171.
Dimeff, L., & Linehan, M. M. (2001). Dialectical behavior therapy in a nutshell. The California
Psychologist, 34(3), 10-13.
Walker, R. (2015). DBT in the Treatment of Addiction. The Fix.