Dialectical behavior therapy (DBT) is a type of psychotherapy that combines elements of cognitive behavioral therapy with mindfulness practices that can be very effective for providing concrete skills to cope in a healthy, adaptive manner. The word dialectical in DBT derives from the word “dialectics” – everything is composed of opposites, and the opposites can co-exist. The middle path!
There is a beneficial role for DBT techniques in the life of any resident physician, although it hasn’t traditionally been studied for this application. Due to the high stress nature of the job, as well as the inherently transient nature of the position (some residents in malignant environments need simply “run out the clock”) improving distress tolerance as well as emotional regulation and interpersonal effectiveness, is a secret weapon that many trainees may not be familiar with.
The goals of DBT therapy are:
- Reduce self-destructive behaviors such as self-harm, substance abuse, and suicidal thoughts.
- Improve emotional regulation and coping skills for managing distress.
- Enhance interpersonal effectiveness and communication skills.
- Increase overall quality of life and sense of well being.
We know that resident physicians love evidence-based practices. There is a plethora of evidence-based research supporting the effectiveness of DBT. While DBT was originally developed to treat suicidal ideation, self-harm behaviors, and borderline personality disorder, it has also demonstrated effectiveness for treatment of mood disorders and substance use disorders as well. Examples of studies establishing the effectiveness of Dialectical Behavior Therapy (DBT) (for specific patient populations) include:
A landmark randomized controlled trial by Linehan et al. (1991) found that DBT was significantly more effective than standard treatment in reducing the number of self-harm behaviors and hospitalizations in individuals with Borderline Personality Disorder.
A meta-analysis by Verheul et al. (2003) that analyzed the results of multiple studies on DBT for Borderline Personality Disorder. The meta-analysis found that DBT was significantly more effective than comparison treatments in reducing self-harm and suicidal behavior.
A randomized controlled trial by Koons et al. (2001) that compared DBT to a supportive therapy for individuals with Borderline Personality Disorder. The study found that participants in the DBT group had significant reductions in suicidal ideation and behaviors, as well as improvements in mood, anxiety, and interpersonal functioning.
You can learn to replace ineffective behaviors and thoughts with more effective ones, so you can manage life’s stressors and difficult emotions.
These are the four major skills, or modules, taught in DBT. Let’s explore each one in depth below: