D stands for dialectical. Dialectics are based on the concept that everything is composed of opposites and that change occurs when there is a "dialogue" between opposing forces. Dialectics can be summarized as thesis, antithesis, and synthesis; therefore, they capture the synthesis between two opposites. In the case of DBT, the major synthesis for clients and therapists is Acceptance and Change. The process of dialectics makes three basic assumptions:
All things are interconnected.
Change is constant and inevitable.
Opposites can be integrated to form a closer approximation of the truth.
B stands for behavioral. DBT is a behavioral approach, which means that assessing and targeting behaviors is a priority in order to help clients solve their problems. The ultimate intention is to target problem behaviors, monitor them, and then systematically analyze the emotional/ cognitive/ behavioral drivers of the behavior. This involves initially targeting deliberate self-harm/ suicidal urges or other dysfunctional behaviors, and working with the patient to figure out what factors, both preceding, during, and after the behavior, make the behavior more likely to occur, . This leads to a joint solution analysis, such that new ways of dealing with overwhelming negative emotion can be generated, tested, and subsequently used in everyday living. An important component of this is learning new life skills, taught in a group program that runs alongside individual therapy.
DBT consists of four components, a fact which makes it stand out from others. A brief introduction to the four components can be found below:
1. Individual therapy: The aim of the weekly individual therapy sessions is to develop a supportive relationship between the therapist and the client. Individual therapy helps the client stay focused and motivated throughout treatment and sessions can be used to assist the client to individualize the use of skills and with reaching their personal goals. Also, individual therapy provides practical applications for an individual’s specific issues.
2. Skills group: The cornerstone of DBT, skills group, involves teaching a skill set that balances acceptance and change. The skills group covers the skills of mindfulness, emotional regulation, distress tolerance, and interpersonal effectiveness. Mindfulness skills focus on learning to observe, describe and participate in all internal and external experiences (including thoughts, emotions, and things we can perceive with our five senses) without judging these experiences as “good” or “bad.” Mindfulness skills are considered “core” skills that are necessary in order to implement the other DBT skills successfully. Emotion Regulation skills aim to manage and change emotions, to become more robust in the face of emotional triggers, and to enhance positive emotions through specific strategies. Distress Tolerance skills include practical strategies for tolerating and surviving distressing situations in the moment, without doing anything that could make the situation worse. It also focuses on radical acceptance for making peace with situations that have caused emotional suffering. Interpersonal Effectiveness skills teach how to build and maintain relationships and how to enhance self-care and respect within various types of relationships.
3. Telephone consultation: Crisis situations can happen at any time. In-the-moment coaching allows the therapist to give a client real-time skills training at his or her most vulnerable times. Phone consultation is typically brief and focused on DBT skills.
4. Consultation team meetings: This component indirectly benefits the client and is targeted to the therapist. These meetings are all about supporting the therapists in proving the treatment. It requires that DBT therapists participate in weekly consultation team meetings which serve to maintain and enhance each their motivation to provide DBT as effectively as possible.