Dialectical Behavior Therapy

Overview of DBT

DBT stands for Dialectical Behavior Therapy. Dialectical means to understand how two (Di) things that seem opposite could both be true. In DBT, this means learning to accept yourself and change your behavior. Accepting oneself can look like accepting one’s position in society as well as accepting one’s diagnosis, which can look different for every person. DBT teaches that it is possible to achieve both of these goals and practice skills to achieve them.

As a form of Cognitive Behavior Therapy (CBT), DBT works on changing behavior by recognizing how our thoughts influence our feelings, actions, and behaviors. However, DBT adds aspects of accepting oneself and understanding your own uniqueness while learning coping and mindfulness techniques. There have been many studies on the effectiveness of DBT, with many showing it to be beneficial for the neurodivergent community.

Effectiveness

Dialectical Behavior Therapy has been proven to effectively reduce emotional dysregulation in autistic adults (Bemmouna, 2021). This means that individuals who received DBT reported less dysregulation, a closer understanding of emotions, as well as an ability to rely on learned coping skills compared to those who were not part of the initial DBT group. This finding was reported across multiple studies, as another study found that DBT improved emotional regulation skills by helping autistic individuals gain coping and mindfulness skills (Haney, 2017). Acceptance and emotional regulation practices taught in sessions help individuals to develop care plans to use as interventions. When implementing these interventions, individuals were able to recognize their emotions and accept and understand them when they began to get overwhelmed or shut down.

Another study found that DBT increased interpersonal effectiveness, meaning individuals improved their ability to communicate and create relationships with others. The study also showed that individuals who received DBT had a deeper understanding of healthy relationships and their own worth in building strong connections (Chapman, 2006).

DBT was originally designed in the 1970s for individuals diagnosed with Borderline Personality Disorder (BPD). Over the next few decades, continued research proved that DBT is an effective treatment for a variety of other mental health disorders, including:

• Autism

• ADHD

• Substance use

• Eating disorders

• Anxiety

• Depression

• Mood disorders

In session

Each group session follows the same routine/ritual. The session will typically be done in groups or individually and start with a beginning ritual; this is typically a mindfulness practice that has been taught to the group, such as a meditation or breathing exercise. After this, a review of the week and how you implemented mindfulness and coping skills throughout the week. After this, there is a break, where socialization, games, food, and bathroom breaks could happen. Then the group will focus on learning a new skill and new coping mechanism to practice throughout the week. Lastly, the closing or wind-down practice will end the group; this is typically a mindfulness exercise.

Differences from other Therapies

CBT (Cognitive Behavioral Therapy)

CBT utilizes a model (often drawn in a triangle) that connects thoughts, feelings, and behaviors to one another. The theory is that one of these elements inevitably leads to the others and that understanding how they are connected can bring about changes in each area.

DBT (Dialectical Behavior Therapy)

DBT is a form of CBT, with extra elements. These additions are mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness skills. DBT is typically done in group therapy!

ACT (Acceptance and Commitment Therapy)

ACT is aimed at the acceptance of one’s life’s difficulties. The six core principles are cognitive defusion, acceptance, contact with the present moment, observing self, values, and committed action. ACT is similar to DBT because it also focuses on Acceptance, Mindfulness, and emotion regulation.

Accessing DBT

Self Guided Workbook:

The Neurodivergent DBT workbook by Sonny Jane Wise

This workbook is written by an Autistic, ADHD, non-binary individual with Bipolar and Borderline Personality Disoder. In this workbook, they lay out the skills for DBT in easy-to-follow and fun pages designed for neurodivergent minds!

Local DBT providers:

• Bluebird Child and Family Psychology: https://www.bluebirdcfp.com/dbt

  • Individual coaching for teens and young adults with their families

• Mala Children’s institute: https://malafamily.org/groups/

  • Groups for children and teens

• EMU Community Behavioral Health Clinic: https://www.emich.edu/cbhc/index.php

  • Groups for adults

• Ann Arbor DBT Center: https://www.annarbordbt.citymax.com/therapy.html

  • Groups for adults and for teens with their family

References

Bemmouna, D., Coutelle, R., Weibel, S.  (2022)et al. Feasibility, Acceptability and Preliminary Efficacy of Dialectical Behavior Therapy for Autistic Adults without Intellectual Disability: A Mixed Methods Study. J Autism Dev Disord 52, 4337–4354 (2022). https://doi.org/10.1007/s10803-021-05317-w

Chapman A. L. (2006). Dialectical behavior therapy: current indications and unique elements. Psychiatry (Edgmont (Pa.: Township)), 3(9), 62–68.

Fleming, A. P., McMahon, R. J., Moran, L. R., Peterson, A. P., & Dreessen, A. (2015). Pilot Randomized Controlled Trial of Dialectical Behavior Therapy Group Skills Training for ADHD Among College Students. Journal of Attention Disorders, 19(3), 260–271. https://doi.org/10.1177/1087054714535951

Haney, K.. H Effects of DBT Skills Training on Emotion Regulation and Social Skills of High-Functioning Autistic Adolescents Hofstra University ProQuest Dissertations Publishing,  2017. 10689985.

Huntjens, A., van den Bosch, L.M.C.W., Sizoo, B. (2020)et al. The effect of dialectical behaviour therapy in autism spectrum patients with suicidality and/ or self-destructive behaviour (DIASS): study protocol for a multicentre randomized controlled trial. BMC Psychiatry 20, 127 (2020). https://doi.org/10.1186/s12888-020-02531-1

Linehan, M. ((2015) DBT skills training handouts and worksheets / Marsha M. Linehan. — Second edition.Published by The Guilford PressA Division of Guilford Publications, Inc. 72 Spring Street, New York, NY 10012

Linehan, M. ((2015) DBT® Skills Training Manual/ Marsha M. Linehan. — Second edition.Published by The Guilford PressA Division of Guilford Publications, Inc. 72 Spring Street, New York, NY 10012

 Ladysnessa (2019). Dialectical Behavioral Therapy & Autism: An Empowering Set of Skills. Neuroclastic.

Sakdalan, J. and Maxwell, Y. (2022). “The application of adapted dialectical behaviour therapy concepts and skills in the treatment of adults with autistic spectrum disorder who display challenging or offending behaviours,” Advances in Autism, Vol. ahead-of-print No. ahead-of-print. https://doi.org/10.1108/AIA-01-2022-0002