Dialectic Behavioural Therapy- an Overview

Dialectic Behavioural Therapy (DBT) is an eclectic incorporation of concepts and techniques, mainly from cognitive behavioural therapy, Zen philosophy and relationship oriented therapy approach such as person centred and psychodynamic. (Mc Leod, 2013). This integrative treatment approach was developed by psychologist , Dr. Linehan Marsha in the late 1980's, to treat suicidal individuals. Later on, it was evolved into a cognitive based treatment for borderline personality disorder (BPD), which is a mental health problem (Scheel, 2000). DBT is a support oriented, and a collaborative approach. It consist of intensive individuals therapy, skills training often in group, regular supportive telephone contacts and coaching, and therapist consultation meeting. Key principles of DBT is that it encompasses validation and acceptance of the clients' troubled life. It is coupled with resolute and consistent emphasis on learning new skills, such as self-regulation and self-control of emotions and coping with relationships. The theory behind this approach is that early social environmental factors have impeded an individual's development of adaptive skills to regulate emotions (Scheel, 2000). People with BPD are subject to an increased in emotional arousal in certain situations and hence leading to emotional and cognitive dysregulation and failure to process new information (Robins, Schimidt and Linehan, 2004). A significant amount of time is required to return to their normal condition (Mc Leod, 2013). Within the DBT theoretical framework, people with BPD are self-destructive because they lack important interpersonal, self-regulation and distress tolerance skills (Panos et al., 2013). Hence client seeking DBT has a unique history and a set of assumptions and thus, the aim of the treatment is to help the client build skills that would make their life worth living and adapt to any situations ( Robins, Schimidt and Linehan, 2004). In DBT, clients are taught and encourage to accept life completely and radically , as well as for changing it. DBT is organize in hierarchically into stages that associated with specific targets of intervention. The prestage is to obtain collaboration from the client, to the treatment. The first stage of the therapy is to target any life threatening behaviours such as suicide, self-harm, and homicidals. In the second stage, the therapy interfering behaviours from either the therapist or the client that is preventing successful delivery of treatment is identified. And finally to conclude, the quality of life interfering behaviours which are severe Axis I disorder or any psychosocial problems that interferes with the clients ability to maintain a reasonable quality of life ( Rizvi, 2011). According to general populations, prevalence for BPD is estimated at 0.2 to 1.8% (Linehan, 2000). 8 to 11% are mental health outpatient and from 14 to 20% meets the criteria for inpatient mental disorder (Linehan, 2000). DBT has been developed to enhance and modulate emotions skills as well as behavioural skill. Research have shown supporting evidence, and no apparent difference in terms of treatment and discriminating literature in regards to dialectic behavioural therapy. The following work is a critical review that will assess effectiveness of dialectic behavioural therapy in reducing mental problems.

To begin with, DBT studies have shown relevant improvements as to how client behave and cope within certain situations and a significant decrease in self-harm has also been observed. DBT has demonstrated effectiveness in two controlled randomized clinical trials. In the first study conducted by Linehan and colleagues (2000) at the University of Washington, 47 chronically suicidal BPD patients were randomly assigned either receive to DBT to treatment as usual (TAU) in the community for a year. It was observed that DBT patients were less likely to attempt par suicidal acts or drop out during the year. 84% of patients remained in the treatment. Furthermore it was observed that DBT patients spent less time in psychiatric hospitals, experience a reduction in psychotropic medications and were well adjusted to the treatment at the end of the year. They were also more able to regulate their emotional behaviours by making usage of their developed skills during therapy to a particular situation. It was further mention that the new behaviour persisted even after the treatment ended (Linehan, 2000). Another study conducted by Marsha Linehan, at the University of Washington, consisting of 23 drug abuse BPD women were either referred to DBT or TAU. Results states that patients receiving DBT recorded a decrease in substance abuse and a higher rate of attendance to therapy, compared to TAU (Linehan, 2000). Overall, a decrease in suicidal and self-harm behaviors were observed as well as a reduction in illicit drug abuse.

On the other hand, Linehan being the creator of this integrative approach, admits that clients seeking DBT are left feeling miserable (Santopinto, 2005). Relevant studies have shown that DBT indeed reduces problematic behaviours, however some studies shows that despite receiving DBT treatment, people with BPD are still experiencing hospitalization due to self-injurious and suicidal behaviours. Linehan et al (2006) reports that nearly 20% of patients receiving DBT has been hospitalized due to psychiatric reason (Rizvi,2011). To further support that, patients are prone to problematic behaviour during treatment can be found in the study by Verheul et al.,(2003) whereby it states that 35% of patients with BPD reported an episode of intentional self-harm in the last 6 months of a 1 year treatment (Rizvi, 2011). Linehan and colleagues(2006),