Category Archives for Dialectical Behavior Therapy (DBT)

Walking the Middle Path in DBT

Walking the Middle path in Dialectical Behavior Therapy

Dan Pierce from Mentally Fit and Dr. Kate Balestrieri, PSYD talk about walking the middle path in DBT, plus childhood coping mechanisms that develop naturally in response to difficult situations.

DBT Experts respond

Melissa Ifill, LCSW

I am a LCSW (NY) LCSWC (MD) with 20 years experience working with children and families in various capacities. My private practice is based in Brooklyn, NY and centers around working with young people and assisting them in coping through many life transitions while developing the skills needed to manage emotions. My passion is working with young women who are often seen as angry, uncontrollable or dysregulated and providing them with the support needed to better understand themselves and use the tools learned in session to develop the life that they want.

I agree with what Dr. Kate says about learning to "walk the middle path." We have automatic reactions to the things that occur in our lives because of our early childhood development and messaging that we receive about what is safe, what is appropriate and possible consequences (either natural consequences or those created by our family/community of origin) for not behaving a specific way.

Mindfulness teaches us to pay attention to what we are doing, get curious about the reasons we are behaving in a specific way and leave room to consider alternatives. Understanding these concepts has broad implications on the micro-level (treatment of various individuals) and macro-level (social organization/educational systems), as well. Understanding of how these learned responses impact marginalized populations is not often talked about or explored. 

Our understanding of the impact of trauma tells us that thought processes and understanding of options can be limited ('black or white thinking"). Further the choices that are considered are one's that allow the individual to feel safe, remain in their perceived locus of control and reactive (automatic, no preplanning). Teaching DBT techniques, specifically mindfulness and how to hold duality (i.e. "walking the middle path") can help students in school learn different ways to resolve conflict. It can help individuals in communities that are high crime/high poverty understand different ways to earn money or feel safe other than perpetuating the cycle. The implications for understanding the impact of trauma and for teaching people the skills to address it effects are far reaching and should be widely considered.

Sal Raichbach, PsyD at Ambrosia Treatment Center

Dr. Raichbach has over 25 years of experience as an actively licensed psychologist in Florida, New Jersey, Nevada and New York. Currently, he serves as the Chief of Clinical Compliance for Ambrosia Treatment Center.

In short, I agree with Dr. Kate. Walking the Middle Path translates to replacing an “either-or” thought process with a more collaborative style such as a “both-and” approach. Far too often we make up our minds about how we feel about someone or something using a black and white, all or nothing, decision-making method. As a result, there’s the prospect that we’ll become imbalanced by closing ourselves off to another way of thinking. For instance, if we disagree with others, it’s not uncommon to believe we’re right and they’re wrong.

But it doesn’t have to be this way. As we discuss dialectical behavior therapy (DBT), focus on the word dialectical. If we take a dialectical approach, we embrace new possibilities by appreciating alternative perspectives. When we do this, each perspective becomes an opinion rather than a supreme truth. Walking the Middle Path helps us pave the way for compromise, which can validate our feelings and those of others, and in turn bring about a more harmonious outcome.

Extreme thinking can lead to extreme reactions, either making too much or too little of a situation, and this not only affects us but also the people around us. Walking this Middle Path can make us more flexible and balanced in our own perspective, encourage us to become more open-minded, and can serve as a powerful mentality for creating feelings of tranquility and satisfaction.

What is the Difference Between CBT & DBT?

WHAT IS THE DIFFERENCE BETWEEN CBT & DBT?

People often ask: what is the difference between Cognitive Behavior Therapy (CBT) and Dialectical Behavior Therapy (DBT). CBT was created by Dr. Aaron T. Beck in the 1960s. DBT is a cognitive therapy, created by Marsha Linehan based on CBT, that adds some critical components to the existing therapeutic methods.

There are a variety of answers to the the question of "what makes DBT different from CBT" out there on the web, covering this topic from an academic perspective--but we wanted to find out what real people thought about it. We asked over 2,500 members of the Learn DBT Group on Facebook (a free group we run) what they thought, and here's what some of them had to say...

DBT is More Effective for Highly Sensitive People.

DBT is simply a modified form of CBT that uses traditional cognitive-behavioral techniques, but also implements other skills like mindfulness, acceptance, and tolerating distress. DBT has been found to be considerably more effective in treating highly sensitive people, trauma survivors etc. DBT is always done in groups vs CBT can be done in individual therapy. DBT is about skill building so the groups are about learning the DBT skills and applying them to everyday life, CBT is often more processing.
- Myria A.

DBT Changes Behaviors First; Cognition & Mood Follow

My experience of CBT was using cognitive skills; changing thoughts to change behaviors. In DBT you actually learn skills to change behaviors FIRST and then changes in cognition and mood follow as a result of the behavior change.
- Kelly A.

DBT Adds a Lot to CTB

CBT combined with dialectics, validation,  mindfulness, distress tolerance, emotional regulation, interpersonal effectiveness and walking the middle path equals DBT! Oversimplified I know. But it’s the simplest explanation.
- Ashley M.

CBT Focuses on Thoughts, DBT Adds the Body

On a very basic level I conceptualize CBT as being more for our head (thoughts), whereas DBT does that, as well as incorporating body with mindfulness (breathing, tapping, grounding).
- Trevor J.

DBT Adds a Focus on Radical Acceptance

CBT is limited and not always easily generalized because it’s just about thought and acceptance in not a core value. DBT teaches deeper truths that bring in the body and soul. Starting with the first assumption that we are doing the best we can with the skills we currently have, or in other words radical acceptance of who and where we are. That is the only path for lasting and long term change. CBT just moves thoughts but never address acceptance, in my opinion it focuses on too much change.
- Milton M.

DBT Adds a Focus on Radical Acceptance

CBT is limited and not always easily generalized because it’s just about thought and acceptance in not a core value. DBT teaches deeper truths that bring in the body and soul. Starting with the first assumption that we are doing the best we can with the skills we currently have, or in other words radical acceptance of who and where we are. That is the only path for lasting and long term change. CBT just moves thoughts but never address acceptance, in my opinion it focuses on too much change.
- Milton M.

DBT Has More Components

One thing to note is that true DBT programs include 4 components: skills group, individual therapy, phone coaching, and a consultation group (for the team members). If a DBT program doesn’t include all of these parts, it’s just DBT-informed (rather than being true DBT). CBT does not require all of these components in order to adhere to its intended model.
- Christina C.

DBT Will be More Intensive

DBT is a Cognitive Behavior Therapy--it is considered one of the “third wave” of CBTs. I find DBT balances both acceptance and change. Generally DBT will be more intensive and require more sessions.
- Tea H.

DBT Works on Dangerous Behaviors First

The target in DBT is different from CBT, however, a big part of the therapy have a lot of skills that came from CBT. In DBT it's more important to work first on dangerous behaviours that can attempt against life and qualty of life, than other problems as anxiety or depression.
- Daniela G.

Both DBT & CBT Focus on Changing Behavior

They are similar in that they both focus on a behavioral change. In CBT, Behavior is assumed to be developed and maintained by both external events and internal processes or cognitions.
- Kristie O.

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