Advances in Dialectic Behavior Therapy

Socratic Method Used in Dialectic Behavior Therapy

Well-designed evidence-based research has shown that Dialectic Behavior Therapy (DBT) effectively treats emotional instability disorder, depression, substance abuse, post-traumatic stress disorder and anxiety.  

DBT aims to help patients recognize maladaptive behavior and choose more effective ways to manage personal conflicts and stress. Remember Socrates from freshman philosophy? He ambled around ancient Greece exposing false beliefs by asking a bunch of questions. These questions helped people think more clearly. DBT uses the Socratic method to understand and change maladaptive behavior.     

There are five major elements to DBT:   

1. Corrective Emotional Response: A trustworthy therapist who demonstrates non-possessive warmth (love without controlling behavior) and genuine respect for the patient helps the patient correct a distorted view of his/herself that enables the patient to learn self-soothing behavior.  2. Meditation and relaxation techniques to manage stress.    3. Changing thoughts to have better feelings: For example if a patient says, “Everybody hates me” the therapist may respond with these questions:  Really? Everybody? Who told you that? Where did you learn that? How do you know? When did you discover that? What makes you say that? Can you name a specific person who hates you?   4. Improving Responses to Day-to-Day Events: The patient keeps a daily journal that records events, feelings and thoughts generated by daily events. The therapist asks a series of questions to enable the patient to learn better ways of handling conflict.   5. Developing Emotional Skills: Through a series of questions the therapist explores the what, where, when, why, and how of conflict and stress. The therapist teaches skills to deal with stress and interpersonal conflict in the following areas:   

  • Evaluation of distorted thinking: The patient is helped to see different viewpoints in a conflict. 
  • Dealing with stress: The patient learns to manage emotions that are triggered by distressing events, including those that cannot be immediately resolved. 
  • Dealing with interpersonal conflict: The therapist teaches the patient to maintain healthy relationships. The patient learns that certain rules of society must be followed to get along in the world and to break social, ethical, and moral rules leads to self-destruction. The therapist helps the patient find ways to fulfill emotional needs while allowing others to fulfill their needs.
  • Developing emotional stability: The therapist may respond to maladaptive behavior by asking  a set of questions:
    • What are you thinking (or doing) right now? 
    • Is what you are thinking (or doing) helping you?  
    • What thoughts (or actions) can help you feel better about yourself? (Several options may be formulated until the best solution is discovered.) 
    • Will you commit to changing your thoughts (or actions)? 
    • How will you demonstrate that you have committed to change?

  As I was writing this article I began to realize that these techniques could help me improve my response to day-to-day events. Indeed it may help all of us to question our thoughts and actions and thus learn to respond to stress in a more beneficial way. 

Emotional Instability Disorder

Meaningless Conflicts

Emotional Intelligence

Word Programing

Complete Mental Health

This Post Has One Comment

  1. A Dialectical Behavior Therapy Skills Intervention for Women with Suicidal Behaviors in Rural Nepal: A Single Case Experimental Design Series Background: Suicide in low- and middle-income countries (LMICs) accounts for 75% of the world s burden of suicide mortality and is the leading single cause of death among Nepali reproductive age women. To advance treatment for suicidal behaviors in LMICs, a single-case experimental design (SCED) was conducted of a culturally adapted Dialectical Behavior Therapy skills intervention for Nepali populations (DBT-N). Method: Ten Nepali women with histories of suicidality participated in the 10-session intervention. Outcomes of emotion regulation, suicidal ideation, depression fa, anxiety, resilience, and coping skills use were measured at multiple time points pre-intervention, during, and at follow-up. Qualitative interviewing assessed DBT-N s feasibility and acceptability. Results: Participants showed improvements in emotion regulation over the course of treatment, which were associated with increased skills use. Rapid, sustained reductions in suicidal ideation and improvements in resilience were observed after DBT-N initiation. Conclusion: This SCED supports conducting further evaluation of DBT-N through controlled trials with emotion regulation as a target mechanism of action for reducing suicidal behaviors in LMICs.

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