CBT / DBT

Cognitive Behavioral Therapy (CBT)

Cognitive behavioral therapy (CBT) is a short-term form of behavioral treatment. It helps people problem-solve. CBT also reveals the relationship between beliefs, thoughts, and feelings, and the behaviors that follow. Through CBT, people learn that their perceptions directly influence how they respond to specific situations. In other words, a person’s thought process informs their behaviors and actions.

Cognitive behavioral therapy is not a distinct treatment technique. Instead, it is a general term which refers to a group of therapies. These therapies have certain similarities in therapeutic methodology. The group includes rational emotive behavior therapy, cognitive therapy, and dialectical behavior therapy.

HOW COGNITIVE BEHAVIORAL THERAPY WORKS

Cognitive behavioral therapy is grounded in the belief that how a person perceives events determines how they will act. It is not the events themselves that determine the person’s actions or feelings. For example, a person with anxiety may believe that “everything will turn out badly today.” These negative thoughts may influence their focus. They may then only perceive negative things that happen. Meanwhile, they may block out or avoid thoughts or actions that could disprove the negative belief system. Afterward, when nothing appears to go right in the day, the person may feel even more anxious than before. The negative belief system may get stronger. The person is at risk of being trapped in a vicious, continuous cycle of anxiety. 

Cognitive behavioral therapists believe we can adjust our thoughts. This is thought to directly influence our emotions and behavior. The adjustment process is called cognitive restructuring. Aaron T. Beck is the psychiatrist widely considered to be the father of cognitive therapy. He believed a person’s thinking pattern may become established in childhood. He found that certain cognitive errors could lead to depressogenic or dysfunctional assumptions.

Common cognitive errors and their associated dysfunctional assumptions include:

The cognitive behavioral process is based on an educational model. People in therapy are helped to unlearn negative reactions and learn new ones. These are positive reactions to challenging situations. CBT helps break down overwhelming problems into small, manageable parts. Therapists help people set and reach short-term goals. Then the therapist gradually adjusts how the person in treatment thinks, feels, and reacts in tough situations. Changing attitudes and behaviors can help people learn to address specific issues in productive ways.

Dialectical Behavioral Therapy (DBT)

Dialectical behavior therapy (DBT) is a comprehensive cognitive behavioral treatment. It aims to treat people who see little or no improvement with other therapy models. This treatment focuses on problem solving and acceptance-based strategies. It operates within a framework of dialectical methods. The term dialectical refers to the processes that bring opposite concepts together such as change and acceptance.

Certified practitioners of DBT offer acceptance and support to people in therapy. Many of the people they work with have conditions described as “difficult to treat.” They work to develop techniques for achieving goals, improving well-being, and effecting lasting positive change.

Currently, DBT is used to treat people with chronic or severe mental health issues. Issues DBT treats include self-harm, eating and food issues, addiction, and posttraumatic stress, as well as borderline personality. DBT was originally designed to treat people who had chronic suicidal thoughts as a symptom of borderline personality.

DBT can be used in a variety of mental health settings. It incorporates the following five components:

  1. Capability enhancement. DBT provides opportunities for the development of existing skills. In treatment, four basic skill sets are taught. These are emotion regulation, mindfulness, interpersonal effectiveness, and distress tolerance.
  2. DBT therapists use various techniques to encourage the transfer of learned skills across all settings. People in therapy may learn to apply what they have learned at home, at school, at work, and in the community. For example, a therapist might ask the person in treatment to talk with a partner about a conflict. The person may use emotion regulation skills before and after the discussion.
  3. Motivational enhancement. DBT uses individualized behavioral treatment plans to reduce problematic behaviors that might negatively affect quality of life. For example, therapists might use self-monitoring tracking sheets so sessions can be adapted to address the most severe issues first.
  4. Capability and motivational enhancement of therapists. Because DBT is often provided to people who experience chronic, severe, and intense mental health issues, therapists receive a great deal of supervision and support to prevent things like vicarious traumatization or burnout. For example, treatment-team meetings are held frequently to give therapists a space to provide and receive support, training, and clinical guidance.
  5. Structuring of the environment. A goal of therapy is often to ensure positive, adaptive behaviors are reinforced across all environmental settings. For example, if someone participates in multiple treatment programs within one agency, the therapist might make sure each program was set up to reinforce all the positive skills and behaviors learned.

The standard form of DBT consists of individual therapy, skills training group, phone coaching, and a therapist consultation team. Those in standard DBT attend therapy and a skills training group weekly. The groups are designed to help those in treatment develop behavioral skills through group work and homework assignments. These assignments allow people to practice learned skills in day-to-day life. Phone coaching is also an important part of DBT. It helps people in treatment reach out to their therapist for support when a challenging situation comes up between sessions.

The issues faced by many who participate in DBT can be complex and severe. Due to this, a consultation team is considered essential for DBT providers. The team is made up of group leaders and individual therapists. It can offer support, motivation, and therapy to the therapists working with difficult issues.

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