DBT Therapy

About DBT

DBT (Dialectical Behavior Therapy) was created by Marsha Linehan to address the bio-psyco-social problems associated with Borderline Personality Disorder; mood instability, impulsivity, poor interpersonal effectiveness, intrapersonal confusion (not being sure of how to be/act).

The four modules are aimed at training  the brain to balance emotion with reason.  The skills offer ways to stay calm in a crisis, improve mood, negotiate with difficult people in difficult situations. 

DBT can be learned in individual or group settings.  Core Mindfulness skills are introduced first, followed by Emotion Regulation, Interpersonal Effeciveness and Distress Tolerance. Typically new skills are introduced, opportunity for practice is provided and homework is assigned.  Typical participation in DBT Therapy is 6-12 months or more, depending on factors such as severity of symptoms, outside support and motivation of the participant.

Here is a website that is maintained by people who have been clients of DBT therapy.  In this are some first-person experiences of their challenges and use of DBT skills.  Not all of the information is accurate, and much of it is individual opinioins, which don't necessarily reflect mine, but this website provides the actual DBT skills with discussion used in therapy and provides some good insights. 

DBT in depth

If you can sift through the vocabulary, here is an excellent article on how DBT works on a neurological level. 

Basically, the article discusses the differences in brain structure in Borderline Personality Disorder (BPD).  BPD is characterized by dramatic mood swings, prolonged states of anger and/or anxiety, patterns of idolizing and devaluing of significant relationships, recurrent suicidal gestures or attempts, and impulsive acts fo self-harm. This is thought to be caused by a combination of genetic and environmental factors. 

The researchers studied brain imaging, comparing BPD subjects with subjects without a mental health diagnosis, and group with schizoid personality disorder, a type that features lack of emotional expression and experience. 

he parts of the brain most involved in emotion formation are the amygdala, which is in the limbic system, in the center of the brain and responsible for production of emotions and hormones.  Also examined are the anterior cingulate cortex, which layers between the limbic system and outer lobes of the brain and assigns emotional value to sensory input.  With BPD, the amygdala is thought to be over active, while memory and cognitive processing are suppressed. Thus, the individual tends to have a heightened emotional response, and emotions tend to stay escalated for longer. 

They tracked each group over a 12 month period to compare how the brain changes or doesn't change over time.  They used functional imaging, scanning while they presented the subject with unpleasant images, and scored the response. They evaluated these images in those who had met 2 of 3 treatment goals in a 12-week inpatient DBT program. They found that using self-report tests and brain imaging, that individuals receiving DBT decreased their emotional responsiveness by an apparent 20% and "significantly decreased" amygdala activity.

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