DBT: The Emotional Control Therapy You Need Now
Dialectical behavioral therapy (DBT) may help prevent intense emotions from throwing you off course. Learn why it’s becoming the next big treatment strategy for ADHD here.
Amanda, 33, struggles with ADHD. She takes medication and sees a coach to help her with organization and time management skills, but her mood swings are her biggest remaining problem — snapping at others when feeling overwhelmed or impulsively taking on too many responsibilities when she is feeling better. She worries that her boyfriend will leave her because he is tired of her defensiveness when she is forgetful and her unloading her work-related stress on him. Amanda wants to work through these behaviors — for herself and for her relationship — but she needs a new approach to help her.
Progress in Non-Medical Treatment Options for ADHD
One of the heartening advances in treating ADHD is the increasing number of non-medical options available to people looking to improve their lives. Adults who take medication often find that adjunctive approaches, such as cognitive-behavioral therapy (CBT) and coaching, help them better manage the effects of ADHD on their lives. But unfortunately, even though these treatments are effective for many adults, they don’t work for everyone. And they illustrate the paradox of psychosocial treatment for ADHD: Behavior change requires specialized skills and strategies, but, as most of us know, implementing them is tough for adults with ADHD.
Amanda needed other options for her persistent problems. So she turned to an important innovation within the CBT family of treatments: dialectical behavior therapy (DBT). DBT focuses on the social and emotional challenges in one’s life. It is not a new therapy, having come on the scene with other CBT-oriented treatments for adult ADHD in the early 2000’s. DBT offers advice to improve self-regulation skills that may be helpful for those who do not respond to other approaches. Read on to learn the history of DBT, why it works for ADHD, and how it might help you.
Wasn’t DBT Designed to Treat BPD?
DBT was used to treat other mental conditions before it was adapted to treat adult ADHD. It is the brainchild of Marsha Linehan, Ph.D., ABPP, a professor of psychology at the University of Washington and founder of The Linehan Institute. DBT was designed to withstand bouts of emotional turmoil — including self-harming behaviors, such as cutting — for those diagnosed with borderline personality disorder (BPD). BPD is characterized by unpredictable mood swings and reckless behaviors, chaotic relationships, extreme reactions to stress, and a chronic risk for self-harm and suicide.
Why Is DBT Becoming the Go-To Treatment for ADD?
Linehan’s DBT is now the go-to treatment for improving emotional regulation skills, in those diagnosed with anxiety and ADHD. DBT rests on scientifically sound behavioral and cognitive strategies, and incorporates skills like mindfulness and acceptance principles. DBT skills include fostering the “wise mind” (the balance between the logical and emotional minds), self-soothing activities, and acting in ways that are in contrast to the immediate, distressing emotion — for instance, smiling during an upsetting situation.
These and other coping strategies are presented in a series of skill-based modules in weekly group sessions, with each session focused on a particular skill. By-the-book DBT is a group treatment, with each group member also having an individual therapist for additional support to personalize the use of these skills in life situations.
Alexandra Philipsen, M.D., and Bernd Hesslinger, M.D., as well as their colleagues in Germany, saw many similarities in the challenges of BPD and adult ADHD, such as impulsivity, low self-esteem, and difficulties with emotional self-control. They tailored the session topics to make them better fit the needs of adults with ADHD.
The Key to DBT: Accepting Intense Emotions
So what does DBT offer adults with ADHD who want to improve their lives? DBT is heavily based on CBT with one exception: It emphasizes validation, or accepting uncomfortable emotions before trying to change them. By coming to terms with troubling thoughts and emotions, change appears possible, and patients can work with their therapists to create a plan for recovery. The therapist’s role in DBT is to find the balance between acceptance and change.
Self-control is a theme running through group sessions. This involves recognizing behavioral and thinking patterns, and learning strategies for dealing with stress and impulsivity.
Although designed as a group treatment for adult ADHD, DBT is also used as an individual therapy. A benefit of the group format, though, is the chance for members to share experiences, to realize “I’m not the only one dealing with this.” There is mutual support while discussing solutions and practicing new skills in the group. DBT may be the right choice for adults with ADHD, like Amanda, looking to improve their lives.
Four Ways to Manage Thoughts and Behaviors
DBT skills training is made up of four modules designed to assist individuals in better managing behaviors, emotions, and thoughts.
- Mindfulness skills help members focus on the present and attend to what is happening in the here and now in a calm way. This helps people slow down and focus on doing what is needed to care for oneself in the moment.
- Distress tolerance helps people get through times when emotions are running high. It teaches people to soothe themselves in healthy ways rather than becoming overwhelmed by emotions or hiding from them.
- Interpersonal effectiveness skills involve helping people understand their needs in relationships and to develop ways of dealing with others to have those wants met in a healthy fashion. This involves respecting the self and others, listening and communicating effectively, repairing relationships, and being able to say no.
- Emotion regulation skills teach patients to decrease the intensity of their feelings, without acting on them.