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Dialectical Behavior Therapy (DBT)

Dialectical Behavior Therapy (DBT) is a comprehensive cognitive-behavioral treatment for complex, difficult-to-treat mental health issues.  It has evolved and been adapted to help people with disorders involving emotion dysregulation, substance dependence, binge eating, depression, mood disorders, and anxiety disorders.  DBT has been proven successful in a variety of settings, including residential treatment.

DBT combines the basic strategies of behavior therapy with mindfulness practices and exists within a dialectical landscape that emphasizes the synthesis of opposites.  It is meant to express the multiple tensions that co-occur in therapy with complicated patients. DBT also enhances dialectical thinking patterns to replace rigid, dichotomous or black-and-white thinking.  The fundamental dialectic in DBT is between validation and acceptance of the patient as they are in this moment while at the same time facilitating their change.  The dialectical emphasis brings the "technologies of change" based on principles of learning and crises theory with "technologies of acceptance" from principles of Zen and western contemplative practices.

DBT helps in the following areas: 1) enhances behavioral capabilities; 2) improves motivation to change; 3) assures that new capabilities generalize to the natural environment, 4) structures the treatment environment in the ways essential to support patient and therapist capabilities, and 5) enhances therapist capabilities and motivation to treat patients effectively.  Concepts such as radical acceptance and validation of patients' current capabilities and behavioral functioning are part of DBT.  It is about movement between acceptance and change to help patients move forward despite patients moving between crises, withdrawal and dissociative responses, refusal to collaborate, attack, rapid emotional escalation and full engagement and collaboration.   DBT focuses on keeping track of the ultimate goal of helping the patient move from a life in hell to a life worth living as quickly and efficiently as possible.

DBT is an evidence-based therapy with randomized clinical trials comparing DBT to treatment-as-usual controls supporting DBT as effective in reducing parasuicidal behavior, decreasing medically severe parasuicides, limiting treatment drop-out, fewer psychiatric admissions, fewer inpatient psychiatric days, and improved scores on global and social adjustment.  In addition, DBT has been shown to provide a reduction in a number of significant areas, such as: depression, suicidal ideation, hopelessness, anger, hostility, and illicit substance use in individuals with Borderline Personality Disorder.

DBT emphasizes learning and refining new skills in changing behavioral, emotional, and thinking patterns associated with problems in living that cause misery and distress.  DBT skills training uses modules to teach and practice skills to decrease interpersonal chaos, labile emotions and moods, impulsiveness, confusion about self, cognitive dysresgulation, and relationship difficulties.  Skills are taught on core mindfulness, interpersonal effectiveness, emotion regulation, and distress tolerance.

DBT skills help patients with co-occurring mental health and substance use issues replace old maladaptive and ineffective coping strategies with healthy and effective skills that assist the person to be fully aware in the present moment to support their recovery, relapse prevention, and to integrate and generalize these skills into all aspects of the patient’s life – employment, family, friends, spiritual, physical, and emotional.

Kelly M Seidlitz, MS, CDP is the Program Director of The Canyon and facilitates three DBT skills groups each week at The Canyon.  He completed the 10-day Intensive Training with Dr. Marsha Linehan and her team as well as attending and actively participating in multiple 3-day training sessions to more effectively learn, understand and implement DBT skills training in a residential setting.  Prior to working at The Canyon, Kelly was a key team member in implementing DBT skills as a part of the treatment protocol in a locked psychiatric unit, a correctional setting, as well as bringing DBT skills into a foster family environment.  He practices DBT skills regularly and is able to bring daily life experiences into the skills group to help patients learn and generalize the skills into their lives.  Kelly is committed to helping patients at The Canyon learn and understand DBT skills so they are able to integrate them into all areas of their lives.