World of Psychology
Dialectical Behavior Therapy: Not Just for Mental Illness
How then later did I come to embrace cognitive behavioral and related therapies that spell out that we are, essentially, just a mess of behaviors (good and bad)?
If you dig into your family dynamic, and maybe establishing relationships with others from equally dysfunctional backgrounds, you are bound to have a change of heart about old Skinner. Maybe there is something to behaviorism after all, and it can jibe with the deeper therapies that ask you to reflect on early places of pain and identity-molding.
Dialectical Behavior Therapy (DBT) is particularly of interest not just to me, but folks trying to come to grasp with certain subsets of mental illness — borderline personality disorder, bipolar and other depressive disorders. But its principles can be significantly farther-reaching than mental illness circles alone.
There are 4 critical components to the DBT methodology. The categorical names alone should conjure hope for those suffering from mental illness symptoms and individuals afflicted with interpersonal issues at home and in workplace: mindfulness, interpersonal effectiveness, distress tolerance and emotion regulation.
Any reader of Daniel Goleman’s Emotional Intelligence, with an introduction by the Dalai Lama, knows that mindfulness is at the core of human attempts to find balance and centeredness in our own body, as well as connection to others. Nothing is more key for individuals with beginner-level trust in family or therapists or slowly-developing insight into dysfunctional ways of relating to colleagues.
Interpersonal effectiveness involves “strategies” — practical, effective means of dealing with thought, mood and behavioral maladjustments. Yes, actual skills are taught, driven by goals for different situations. (Sound like business counsel?) This is invaluable to those with borderline personality disorder, who “possess good interpersonal skills in a general sense” but are unable to have self-insight to get past “problematic situations” when stress hits.
Now, what better need do we have as humans than to develop distress tolerance? It can help us in our workplace, for ill loved ones, and for ourselves when debilitated by depression, addictive thoughts, or the surfacing of manic traits. This is integral to DBT’s beauty. As in Alcoholics Anonymous, where people are encouraged to discern between what can be changed and what can not, distress tolerance skills involve “the ability to accept, in a non-evaluative and non-judgmental fashion, both oneself and the current situation.”
The heart of helping ill individuals and ourselves lies, I believe, in letting this mindset seep in, allowing for gentle, passive strength. (Not to mention that this simple maxim is a behavioral powerhouse when artfully practiced and applied, and can profoundly affect our professional, family and social life.) “Self-soothing” and “pros and cons” work are two tactics in the distress tolerance strategy, one whose benefits to mentally ill family systems can certainly be equally applied to the needy masses of a larger society.
The last outlined DBT component is emotion regulation, so critical to disorders such as bipolar, where emotional intensity and stress make for frequent anxiety. But we all have encountered situations with bosses and friends that contain these elements. How do we identify obstacles and triggers, and then work on changing emotional patterns? And can we increase positive emotional experiences? Like the mouse after his cheese, is it not possible to stack the deck a certain way in families, in the workplace and within the mental health system so that the satisfaction of getting a little more of that nibble — stability, harmony, collaboration — can happen more effectively and more often?
Want to learn more about dialectical behavior therapy?
Follow our blog, Dialectical Behavior Therapy Understood or read the article, An Overview of Dialectical Behavior Therapy.
Psych Central News
Is Depression Overdiagnosed & Overtreated in US?
Researchers examined adults with depression identified by a doctor or other medical professional, and individuals who experienced major depressive episodes within a 12-month period.
Investigators found that when these individuals were assessed for major depressive episodes using a structured interview, only 38.4 percent of adults with clinician-identified depression met the 12-month criteria for depression — despite the fact that a majority of participants were prescribed and were using psychiatric medications.
The results are featured in the journal Psychotherapy and Psychosomatics.
“Depression overdiagnosis and overtreatment is common in the U.S., and frankly the numbers are staggering,” said Ramin J. Mojtabai, Ph.D., author of the study and an associate professor with the Bloomberg School’s Department of Mental Health.
“Among study participants who were 65 years old or older with clinician-identified depression, 6 out of every 7 did not meet the 12-month major-depressive-episodes criteria. While participants who did not meet the criteria used significantly fewer services and treatment contacts, the majority of both groups used prescription psychiatric medication.”
From a sample of 5,639 participants from the 2009-2010 United States National Survey of Drug Use and Health, Mojtabai assessed clinician-identified depression based on questions about conditions that the participants were told they had by a doctor or other medical professional in the past 12 months.
The study indicates that even among participants without a lifetime history of major or minor depression, a majority reported having taken prescription psychiatric medications.
“A number of factors likely contribute to the high false-positive rate of depression diagnosis in community settings, including the relatively low prevalence of depression in these settings, clinicians’ uncertainty about the diagnostic criteria and the ambiguity regarding sub-threshold syndromes,” said Mojtabai.
Researchers lament that prior research suggested an underdiagnosis and undertreatment of major depression in community settings. Now, experts believe that both undertreatment and overtreatment of depression are occurring.
“The new data suggest that the underdiagnosis and undertreatment of many who are in need of treatment occurs in conjunction with the overdiagnosis and overtreatment of others who do not need such treatment,” Mojtabai said.
Source: Johns Hopkins University Bloomberg School of Public Health
Elderly woman being comforted by nurse photo by shutterstock.
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