Traditional Uses for Dialectical Behavior Therapy
Dialectical behavior therapy (DBT) is an empowering skill and behavior-based treatment that is effective in treating borderline personality disorder and post-traumatic stress disorder. DBT includes four core elements with components of cognitive-behavioral therapy (CBT).
The first of the four elements involve serving the five functions of treatment through enhancing capabilities and motivation, generalizing skills to a natural environment, structuring the therapeutic environment, and enhancing the therapist’s skills and motivation. The rest of the four elements include the biosocial theory and a focus on emotions, a consistent dialectical philosophy, and mindfulness and acceptance-oriented strategies.
It’s easy to see how these elements could apply to treating other disorders. Research using DBT to treat substance use disorders and eating disorders has been promising. At this point, however, DBT isn’t the main method of treatment for anxiety.
Traditional Treatment for Anxiety
Along with anxiolytic or anti-depressant medications, one modality stands out as the core treatment for anxiety: CBT. CBT is a complex form of treatment that is easily modified to be more talk-oriented or more activity and homework-based, depending on the needs of the client. Exposure therapy is often used in conjunction with CBT, making it applicable for phobia-based anxiety disorders like social anxiety.
CBT has significant overlap with DBT in that it often involves practicing skills and modifying automatic thoughts and behaviors. As DBT is rooted in CBT, it’s those four core elements that differentiate it from its predecessor. Can those four elements make a difference in treatment outcomes? To consider this, one must also identify the goal of treatment for anxiety.
Primary Focuses for Anxiety Treatment
As with any kind of treatment, the primary goal is to reduce symptom severity. Those struggling with anxiety generally suffer physically as well as mentally. Many individuals with anxiety experience fatigue, muscle tension and pain, restlessness, and insomnia. The uncontrollable worry and brain fog are equally inhibiting to functioning in daily life. In more severe cases, the feelings of impending doom, panic, and depression are immediate priorities for symptom improvement.
Reducing symptom severity starts with identifying triggers and teaching skills to help clients cope with and manage their stress levels. Mindfulness-based therapy and stress management skills can be easily taught and practiced with CBT. However, whether DBT can manage symptom severity as effectively is still up for debate. Can increasing client efficacy and motivation treat the underlying causes of anxiety?
Is DBT Effective for Anxiety?
Anxiety is a disorder rooted in automatic thoughts that trigger unpleasant responses. Oftentimes, these thoughts stem from feelings of worthlessness, hopelessness, and lack of control. In theory, DBT could not only help tackle and rewrite these automatic thoughts, but it could also provide the added benefit of helping clients accept themselves where they are.
Results of a study testing the effectiveness of DBT on anxiety showed that DBT skills ameliorated anxiety symptoms. Still, many are skeptical about using DBT as the singular focus for anxiety treatment even with the increasing support of DBT as a supplemental treatment or as a treatment option for treatment-resistant clients. In Robert Leahy’s book, Treatment Resistant Anxiety Disorders: Resolving Impasses to Symptom Remission, the author outlines a method of integrating the principles of DBT into treatment in varying degrees for patients resistant to other treatment modalities. Even small integrations of DBT skills, or adding in treatment principles can give evidence-based CBT the kick it needs to nudge those clients.
While CBT is remarkably flexible, one limitation of DBT is the level of commitment it requires. For this reason, wholesale conversion to DBT should be heavily considered and reserved for the most desperate of client situations. Future research may prove DBT effective as a stand-alone treatment for anxiety. However, the current clinically effective modality reserves DBT used in chunks added to CBT.
3 Ways to Incorporate Elements of DBT Into Your Next Session
While entirely relying on DBT is not usually recommended, some minor changes to your typical CBT regimen may improve client outcomes. If you’re looking for ways to give your client more symptom relief and remission, try these DBT add-ons in your next session:
#1 Add a focus on mindfulness and acceptance skills to your CBT homework.
Mindfulness is a tried and true method of improving emotional regulation, a singular struggle for clients with anxiety disorders. The important addition of acceptance would help clients to accept thoughts, emotions, and feelings without reacting to them. Through mindfulness and acceptance training, clients can learn coping skills that will help manage their symptoms of worry, reduce reactivity to triggers, and reduce distress and physical symptoms.
#2 Add in a group session.
Anxiety sufferers tend to be shy and fearful, with interpersonal struggles. Group sessions can be an effective way to practice interpersonal skills, gain confidence, and practice the skills learned in individual sessions. Responding live to anxiety triggers in a safe place with like-minded people may increase distress tolerance and provide more confidence for challenging social situations.
#3 Increase your skills and motivation for treating your clients.
As a core tenant of DBT, therapist competence and motivation can be significant factors for the effectiveness of anxiety treatment. Especially for clients who challenge your skills, this tenant may be just what you need to refresh yourself for those hard-to-treat cases. DBT-centered classes or other educational opportunities may be what you need to reach your desired outcome.
Anxiety treatment has typically followed one path, the cognitive behavior track. While CBT is an umbrella of many different treatment types, sometimes its action-based treatment may be a limitation. DBT, while not always sufficient for stand-alone treatment, may be a good supplemental treatment to add to your regular CBT sessions. In some cases, with treatment-resistant clients, collaborative treatment may be the answer. With our expert clinical and medical team, personal and supportive staff, and commitment to individualized high-quality care, Casa Recovery can help make a difference for your client. With over 15 treatment modalities to choose from that help target the mind and the body, we can create a treatment with you, putting the client at the helm, that will help breakthrough treatment resistance. If you are interested in beginning collaborative care with the Casa Recovery team that can free your client from the grip of anxiety, call (888) 928-2272.