Dialectical Behavioral Therapy was created by Marsha Linehan in the 1970's to treat chronically suicidal individuals. It has since been adapted to treat various mental health conditions and is one of the primary evidence based interventions for Borderline Personality Disorder and Substance Use Disorders. The overarching purpose of DBT is to develop adaptive coping strategies to build long-term resilience. One of the aspects of DBT that is different from other interventions is the concept of dialectics. A dialectic in this context is the synthesis of two seemingly opposing concepts to create something better. The primary dialectic used in DBT is the balancing act between 'acceptance' and 'change.'

 

Imagine trying to use this strategy to cope with anxiety. From an acceptance perspective, "I have anxiety and that's ok. I don't need to change it or fix it. I can embrace anxiety as just a sensation and ride the wave as it moves through me." This sounds counterintuitive since anxiety is an unpleasant sensation that most people will instinctively try to escape or eliminate. However, this acceptance perspective will alleviate the strain of resistance and allow the anxiety to naturally subside. On the other end of the dialectic we have 'change.' This is a completely different approach to dealing with anxiety. "I feel anxious so I'm going to practice breathing exercises or go for a jog to try and change the way I feel." This 'change' strategy is more common for people with anxiety; unfortunately, most people use maladaptive skills like substance use, food, shopping, or other "temporary-fix" solutions that reduce resiliency over time.

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A dialectic would be the synthesis of both 'acceptance' and 'change' strategies which sounds like, "I'm anxious right now and that's ok. I don't need to change or fix anything and I can completely embrace this sensation... AND I'm going to practice some breathing exercises and take a cool shower to reduce my anxiety level." Balancing the combined approach gives the benefits of both without being rigidly locked into either strategy. There are several different dialectics that will be brought into the skills development process. Dialectics can seem a bit abstract at first, but once an individual begins to adopt a dialectical way of thinking, an incredibly powerful coping skill set becomes available to them.

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Throughout the 12-week skills group curriculum, we teach our clients all four skill sets: Mindfulness, Distress Tolerance, Emotional Regulation, and Interpersonal Effectiveness. The adaptive skills built into each module are then used to replace the maladaptive strategies that each client has identified for themselves. Individual DBT sessions serve to fine tune this process by ensuring the client can effectively utilize the skills taught in group for their own real world scenarios.