Dialectical behavior therapy (DBT)

Dialectical behavior therapy (DBT)

Dialectical behavior therapy (DBT)

• is a comprehensive, evidence-based treatment for borderline personality disorder (BPD) (1)
• cognitive behavior therapy (CBT) and DBT - a third-wave CBT - have been proposed as alternative treatments that may be appropriate when FBT (family based treatments) is not feasible (2)
• patient populations for which DBT has the most empirical support include parasuicidal women with borderline personality disorder (BPD), but there have been promising findings for patients with BPD and substance use disorders (SUDs), persons who meet criteria for binge-eating disorder, and depressed elderly patients (1)
  • dialectical philosophy
    • is most commonly is associated with the thinking of Marx or Hegel
    • considers that reality consists of opposing, polar forces that are in tension
      • for example, the push to apply change-oriented treatment strategies creates tension by increasing patient's desire to be accepted rather than changed
    • poses that each opposing force is incomplete on its own, and that these forces continually are balanced and synthesized
      • also is the reflected in DBT where:
        • focusing completely on change-oriented efforts was an incomplete strategy, as it lacked the essential ingredient of acceptance
        • focusing completely on acceptance of the patient also may be incomplete and ineffective, as multiproblematic, suicidal patients require extensive changes in order to create lives that are worth living.
• DBT has many similarities with other cognitive-behavioral approaches
  • however, several critical and unique elements must be in place for the treatment to constitute DBT
  • some of these elements include:
    • (a) serving the five functions of treatment
      • DBT is a program of treatment, rather than a single treatment method conducted by a practitioner in isolation
    • (b) the biosocial theory and focusing on emotions in treatment,
    • (c) a consistent dialectical philosophy, and
    • (d) mindfulness and acceptance-oriented interventions
• standard DBT treatment package consists of weekly individual therapy sessions (approximately 1 hour), a weekly group skills training session (approximately 1.5-2.5 hours), and a therapist consultation team meeting (approximately 1-2 hours)
• FBT has the strongest empirical support for the treatment of EDs (eating disorders), however, a significant subgroup fail to respond adequately or to fully recover (3)
• a systematic review conclude that CBT and DBT demonstrate promise as alternatives to family-based approaches for adolescent eating disorders (2)

Reference:

• Chapman AL. Dialectical behavior therapy: current indications and unique elements. Psychiatry (Edgmont). 2006 Sep;3(9):62-8. PMID: 20975829; PMCID: PMC2963469
• Vogel EN, Singh S, Accurso EC. A systematic review of cognitive behavior therapy and dialectical behavior therapy for adolescent eating disorders. J Eat Disord. 2021 Oct 18;9(1):131. doi: 10.1186/s40337-021-00461-1. PMID: 34663452; PMCID: PMC8522082.
• Pennell A, Webb C, Agar P, Federici A, Couturier J. Implementation of Dialectical Behavior Therapy in a Day Hospital Setting for Adolescents with Eating Disorders. J Can Acad Child Adolesc Psychiatry. 2019 Apr;28(1):21-29. Epub 2019 Mar 1. PMID: 31001348; PMCID: PMC6457442