COGNITIVE + DIALECTICAL
What Is Cognitive Behavioral Therapy?
Cognitive behavioral therapy (CBT) is a short-term form of psychotherapy directed at present-time issues and based on the idea that the way an individual thinks and feels affects the way he or she behaves. The focus is on problem solving, and the goal is to change clients' thought patterns in order to change their responses to difficult situations. A CBT approach can be applied to a wide range of mental health issues and conditions.
When It's Used
CBT is appropriate for children, adolescents, and adults and for individuals, families, and couples. It has been found to be highly or moderately effective in the treatment of depression, generalized anxiety disorder, post-traumatic stress disorder, general stress, anger issues, panic disorders, agoraphobia, social phobia, eating disorders, marital difficulties, obsessive-compulsive disorder, and childhood anxiety and depressive disorders. CBT may also be effective as an intervention for chronic pain conditions and associated distress.
What to Expect
In CBT you will first learn to identify painful and upsetting thoughts you have about current problems and to determine whether or not these thoughts are realistic. If these thoughts are deemed unrealistic, you will learn skills that help you change your thinking patterns so they are more accurate with respect to a given situation. Once your perspective is more realistic, the therapist can help you determine an appropriate course of action. You will probably get “homework” to do between sessions. That work may include exercises that will help you learn to apply the skills and solutions you come up with in therapy to the way you think and act in your day-to-day life.
How It Works
CBT integrates behavioral theories and cognitive theories to conclude that the way people perceive a situation determines their reaction more than the actual reality of the situation does. When a person is distressed or discouraged, his or her view of an experience may not be realistic. Changing the way clients think and see the world can change their responses to circumstances. CBT is rooted in the present, so the therapist will initially ask clients what is going on in their mind at that moment, so as to identify distressing thoughts and feelings. The therapist will then explore whether or not these thoughts and feelings are productive or even valid. The goal of CBT is to get clients actively involved in their own treatment plan so they understand that the way to improve their lives is to adjust their thinking and their approach to everyday situations.
What Is Dialectical Behavior Therapy?
Dialectical behavior therapy (DBT) provides clients with new skills to manage painful emotions and decrease conflict in relationships. DBT specifically focuses on providing therapeutic skills in four key areas. First, mindfulness focuses on improving an individual's ability to accept and be present in the current moment. Second, distress tolerance is geared toward increasing a person’s tolerance of negative emotion, rather than trying to escape from it. Third, emotion regulation covers strategies to manage and change intense emotions that are causing problems in a person’s life. Fourth, interpersonal effectiveness consists of techniques that allow a person to communicate with others in a way that is assertive, maintains self-respect, and strengthens relationships.
When It's Used
DBT was originally developed to treat borderline personality disorder. However, research shows that DBT has also been used successfully to treat people experiencing depression, bulimia, binge-eating, bipolar disorder, post-traumatic-stress disorder, and substance abuse. DBT skills are thought to have the capability of helping those who wish to improve their ability to regulate emotions, tolerate distress and negative emotion, be mindful and present in the given moment, and communicate and interact effectively with others.
What to Expect
DBT treatment typically consists of individual therapy sessions and DBT skills groups. Individual therapy sessions consist of one-on-one contact with a trained therapist, ensuring that all therapeutic needs are being addressed. The individual therapist will help the patient stay motivated, apply the DBT skills within daily life, and address obstacles that might arise over the course of treatment.
DBT skills group participants learn and practice skills alongside others. Members of the group are encouraged to share their experiences and provide mutual support. Groups are led by one trained therapist teaching skills and leading exercises. The group members are then assigned homework, such as practicing mindfulness exercises. Each group session lasts approximately two hours, and groups typically meet weekly for six months. Groups can be shorter or longer, depending on the needs of the group members. DBT can be delivered by therapists in many ways. For instance, some people complete the one-on-one therapy sessions without attending the weekly skills group. Others might choose the group without regular one-on-one sessions.
How It Works
DBT is a cognitive-behavioral treatment developed by Marsha Linehan, Ph.D., in the 1980s to treat people with borderline personality disorder. Those diagnosed with BPD often experience extremely intense negative emotions that are difficult to manage. These intense and seemingly uncontrollable negative emotions are often experienced when the individual is interacting with others—friends, romantic partners, family members. People with borderline often experience a great deal of conflict in their relationships.
As its name suggests, DBT is influenced by the philosophical perspective of dialectics: balancing opposites. The therapist consistently works with the individual to find ways to hold two seemingly opposite perspectives at once, promoting balance and avoiding black and white—the all-or-nothing styles of thinking. In service of this balance, DBT promotes a both-and rather than an either-or outlook. The dialectic at the heart of DBT is acceptance and change.