Mindfulness, Behaviorism, and Zen: How Dialectical Behavior Therapy Works and How It Can Benefit Healthy People
Fashionable today “mindfulness”, Zen Buddhism and behaviorism at first glance, things are completely incompatible. However, all of this is at the heart of Dialectical Behavior Therapy (DBT), an unusual modification of a well-established cognitive-behavioural therapy. Balancing rational CBT with new-age techniques, the creators of DBT recommend it to those who are prone to self-destructive behaviour, lose their identity in romantic relationships, and find it difficult to forgive themselves for past mistakes. T&P understand how appealing to “mindfulness” helps not to kill self-esteem on the way out of the comfort zone and why pleasant emotions need a schedule.
Mindfulness instead of “Think rationally!”
“Mindfulness” is perhaps the most popular word in the modern vocabulary of pop psychology and causes only a smirk to many. However, in the case of DBT, this concept is combined with the cognitive-behavioural approach, one of the most popular and respected branches of psychotherapy in the West with a very strong evidence base.
“It is not the facts and events that upset a person, but the way he looks at them” – this quote from the Stoic philosopher Epictetus can describe the main idea of cognitive behavioral therapy. Its supporters believe that many mental problems are caused by irrational thinking, due to which a person interprets events and situations in such a way that he experiences more than he could. CBT teaches a person to think rationally (cognitive therapy) and reinforce “correct” thought patterns through real-life experiments (behavioral therapy based on behavioral principles). However, the American psychologist Marsha M. Linehan, who suffered from borderline personality disorder (a mental illness characterized by an unstable sense of self, suicidal moods, self-damaging behavior, etc.), noticed that
A mind-control-focused approach won’t help if you’re used to thinking, “My thoughts are wrong, my emotions don’t mean anything, and my actions are wrong, so I’m completely defective.”
(Linehan noted that BPD patients grew up and were brought up in a similar environment: their personality was not accepted, they constantly demanded changes and self-control, which, coupled with biological sensitivity, formed extreme reactions.)
Cognitive-behavioral therapist Yaroslav Isaikin says that Linehan faced recurring problems: clients interrupted sessions, and therapists burned out. So she decided to balance the change-oriented CBT approach with an acceptance mindset (of herself, her emotions, etc.) and “mindfulness” training. Hence the word “dialectic”: in DPT, opposites are combined, promising a healing synthesis.
Criticism and effectiveness
One of the first randomized clinical trials of DBT was published in 1991. In it, Linehan and her colleagues point to significant improvements in chronically suicidal women with BPD. However, most of these studies focus on a specific group of people and have a small sample size . The researchers also note that DBT does not work as well with key BPD factors as other types of psychotherapy, with the exception of suicidality.
Yaroslav Isaikin believes that DBT is effective for a wider range of problems – from working with adolescents and post-traumatic disorder to drug addictions and eating disorders. But it is not suitable for short-term assistance (within 3-5 weeks). If you are interested in working on a specific (not the most time-consuming) query and a quick result, you should pay attention to the classic CBT approach.
“I went to a private psychotherapist for a year, and despite some improvements, my general condition deteriorated so much that I began to contemplate suicide,” says Psychologies journalist and columnist Syuyumbike Davlet-Kildeeva, who has done DBT. – I decided to go to another specialist and, on the advice of a friend, went to the clinic, where I talked about my difficulties: problems with alcohol and psychoactive substances, difficulties in interpersonal relationships, uncontrolled spending money and compulsive overeating. I did not choose DPT myself and did not know about this direction at all: this therapy was offered to me based on specific complaints.”
DBT has helped her learn to deal with stress without resorting to destructive problem-solving: “I can drink a couple of glasses of wine once a week, but it’s nothing compared to what it used to be. At my last job, a cocktail of a full glass of whiskey and ten grams of cola was named after me, and one of my most popular lyrics is called “I haven’t had a drink all February” . Now I plan my life for several years ahead and look to the future with a pleasant feeling – before my horizon was limited to a fog of bad habits and the desire to simply survive.
Zen instead of “Everything is bad!”
Mindfulness, a central skill that DBT seeks to develop, was borrowed from Zen Buddhism by Linehan . Patients are offered to learn how to meditate, concentrate on breathing and focus on specific objects and sensations. Practices of nonjudgmental presence in the present moment help you get out of autopilot mode and stop habitual impulsive reactions (in other words, do not lose your temper). As a result, clients learn to consciously experience emotions that they previously wanted to avoid and realize that
even the most unpleasant feelings are not fatal – you do not have to run away from them.
“When describing some events, one must avoid impulsive irrational judgments. Do not say: “I had a hell of a hard week,” but describe the facts, events and your attitude towards them. This reduces the degree of emotions, makes you calmer and more objective, ”says Davlet-Kildeeva.
Do not run away from problems, but switch attention
During the development of DBT, Linehan wondered why some people cannot cope with suffering, while others, even after going through terrible and traumatic events, continue to live fully? The difference is that some spend a lot of time and energy resisting what can no longer be changed (if you ever could not fall asleep, scrolling through your shame at a party three years ago, then you understand what it is about). Others get used to the past, continuing to live on.
It is this kind of “radical acceptance” that Linehan sees as a skill that helps people bounce back from shocks and crises. Acceptance exercises help to allow the past and present to be as they are and spend energy on things that are truly controllable and changeable.
Of course, not every situation can be “accepted”, especially if something unpleasant is happening here and now and causes inevitable stress in a person. For this case
DBT therapists are taught to resist external stimuli: switch attention to pleasant memories, sex fantasies, breathing, mental counting, and anything that can distract a person from negative emotions, but does not harm.
After that, muscle relaxation, meditation, or something individual (for example, listening to music) comes into play. The main goal is to maintain a stable emotional state.
Plan and have fun
As a rule, during DPT, clients keep a diary in which they write down their emotions and feelings throughout the day. By carefully analyzing these records, you can identify characteristic triggers and patterns of behavior, pay attention to irrational reactions. And after studying yourself with the help of a diary, think about ways to avoid stressful situations and respond to annoying factors.
“One of the skills from the emotion regulation group is not to dramatize. I was surprised at how he makes my life easier, says Syuyumbike. – And number one in my personal top is the accumulation of positive emotions in the short term. Behind this cumbersome title (the translation of DPT literature into Russian leaves much to be desired) hides the simple idea that you need to plan in advance a daily portion of positive emotions.
About DBT (Dialectical Behavior Therapy)?
DBT is a comprehensive system of CBT (Cognitive Behavioral Therapy), which is used to treat quite complex and difficult to treat personality and behavioral disorders.
Dialectical behavioral therapy works with rather complex situations, such as: suicidal behavior and self-harm, borderline personality disorder, and they are accompanied by emotional dysregulation, which can lead to various types of problems. Substance addiction, anorexia and bulimia, various types of depression, and even bipolar disorder are all consequences of various types of disorders. It is with such problems that DBT therapy works.
The main idea of DBT is a balance between accepting a person as he is and helping him make the changes he needs for a happy life.
Dialectical therapy combines the basic strategies of behavioral therapy with mindfulness practices. Self-acceptance uses mindfulness techniques. The therapist takes a nonjudgmental stance towards the life and behavior of the client, which creates a safe space of trust. But behavioral analysis and decision-making techniques help in the changes, the specialist helps the patient develop new ways of communicating and coping with painful feelings. Step by step, he will begin to transfer the skills acquired in psychotherapy into his daily life.
For what problems is this treatment method most suitable?
Dialectical behavioral therapy can help with a variety of illnesses and disorders. For example, it can be used to treat suicidal and other self-destructive behaviors. He teaches patients the skills to cope with unhealthy behavior and change it. DBT works with depressive, panic and anxiety disorders, as well as with various types of eating disorders: anorexia, bulimia, compulsive overeating, etc.
The main goals of the DBT method
Dialectical therapy is aimed at achieving the main goals:
- increase the patient’s motivation for change
- teach the patient to accept himself for who he is
- to teach the patient to cope with various unpleasant, uncomfortable and painful feelings
- develop new ways of communicating
- help the patient to transfer the acquired skills in the course of therapy into his daily life
Achieving these goals is divided between different formats of assistance, including individual psychotherapy, group skills training, telephone coaching (during therapy, the client has the opportunity to contact his psychotherapist at any time by phone and receive help and support in a stressful situation) and the DBT advisory group.
DBT (Dialectical Behavioral Therapy) is one of the “third wave” cognitive-behavioral psychotherapies that was developed to help people with self-harm and proved to be extremely effective in the complex treatment of patients with borderline personality disorder . This method was developed by the American psychologist Marsha Linehan more than 20 years ago and is successfully practiced at the International Institute of Psychosomatic Health Center for the Treatment of Borderline Personality Disorder .
DBT psychotherapy is based on the idea that the main difficulty in borderline personality disorder isis the inability to control one’s emotions and related impulsive actions. The fact is that the roots of borderline disorder go back to childhood. The child’s psyche is mobile, vulnerable, and when in a close environment the child does not find the right emotional support, self-regulation skills, emotional stability is not formed in him. It also happens that the normal reactions of the child are perceived by parents as pathological, a ban on emotions is practiced, a person learns not to feel himself, his needs, but when a stressful situation arises, emotions, like a volcano, break out from under the layers of parental attitudes, burn the person and everything around. . Therefore, one of the most important tasks of psychotherapy for borderline personality disorder- to return the right to emotions to a person, to inform that he can feel what he feels. And then a person has a choice, he ceases to be a hostage to unambiguous cause-and-effect relationships, returns the ability to critical thinking, can take a step back, look at his reactions, at the situation, see that there can be many behavior options and choose the most optimal for himself . Specialists of the Center for the Treatment of Borderline Personality Disorder of the International Institute of Psychosomatic Health practice careful, attentive attitude towards the patient, unconditional acceptance, sincere compassion.
The term “dialectics” here reflects the unity of opposites, the need and development of abilities to combine seemingly mutually exclusive things: acceptance and change, passivity and activity, vulnerability and the need for active contact – therefore, the ability to be flexible in different situations is the path to success.
In order to achieve results, the Center for the Treatment of Borderline Personality Disorder of the International Institute of Psychosomatic Health conducts trainings that help to master and develop basic skills. They are combined into 4 modules:
- Mindfulness skills – helps to stay in the current moment and soberly assess the situation;
- stress resistance skills – allow you to maintain self-control and critical assessment in situations of psycho-emotional overload;
- Emotional regulation skills – help to be in touch with your emotions, to be aware of them and accept them;
- interpersonal effectiveness skills – increase the level of social competence, allow you to communicate more comfortably and productively.
DBT is a flexible, eclectic direction of therapy that uses the methods and techniques of other psychotherapeutic schools, borrowing the most valuable ones. In the course of the work, an analysis of maladaptive behavior is carried out, the development and strengthening of skills in emotional regulation, communication, exposure is used, and much more. As a result, this allows you to achieve the following goals: finding motivation for change, acquiring new ways of behavior, transferring acquired skills to real life, maintaining the structuring of the therapeutic environment necessary to maintain resources.
Dialectical behavioral therapy at the International Institute of Psychosomatic Health Center for the Treatment of Borderline Personality Disorder is conducted in various formats and includes individual sessions with a psychologist, group work in a safe environment and accompaniment by a coach who is always available for support.
