What is Dialect Behavioral Therapy
DBT therapy is a type of cognitive behavioral therapy. DBT was created around 1987 by American psychologist Marsha Linehan. This type of psychotherapy was developed for the treatment of patients suffering from borderline personality disorder, demonstrating suicidal and self-injurious behavior. This approach helps to adapt to an overly intense emotional reaction to stressful situations. In this article you will learn about the diaect behavioral therapy in London and the different modules of it.
DBT includes 4 main modules.
- Mindfulness, or mindfulness: increasing focus in the present moment. Practicing mindfulness skills helps reduce psychological symptoms (negative emotions and anxiety).
- Emotional regulation: managing emotions. Emotion regulation skills training helps to overcome emotional instability.
- Interpersonal effectiveness: relationship management, completion, recovery, relationship development.
- Resilience: resilience in a crisis situation, reducing suffering by accepting reality.
There have been no studies on the use of DBT as a method that increases psychological resilience to an upcoming operation in surgical hospitals. The presented topic is quite relevant, since often the patient in the preoperative period has a pronounced anxiety, fear, fear for his life. In this regard, it is very important for patients to master the skills of stress resistance and emotional regulation in order to experience uncomfortable thoughts and feelings before the upcoming operation.
Note that there are foreign studies on DBT, which were conducted in various fields of medicine. For example, work has been done on the use of virtual reality to facilitate mindfulness training in dialectical behavioral therapy for spinal cord injury. While listening to DBT mindfulness training instructions, each patient put on the virtual reality goggles and had the sensation of gently “floating” on the river in the virtual world. They completed brief psychological questionnaires before and after each virtual reality session.
Here is an example of mindfulness training in patients with spinal injury. Track 1: Observing Sound (Linehan, 2002; 8.5 minutes total). Excerpt: “What we’re going to do now is to practice watching the sound…. the idea is not to think about the sound, the idea is just to notice it… I’m going to start by ringing the bell three times …. just listen to the calls, how long they last, how they go from loud to soft, just listen, focusing on your inhalation and exhalation. If your mind wanders, bring it back.” Repeating the practise helps to develop present-moment awareness, which makes it easier to live in the “here and now” rather than the past or future. How to deal with distressing ideas is taught using this approach.
When used in clinical practice, DBT skills training usually requires frequent repetition before long-term benefit can be observed. It is important for spinal injury patients to learn effective coping skills to help them cope with the lifestyle changes associated with sudden severe and often permanent loss of mobility.
The authors note that more research and development will be needed to determine whether training in DBT mindfulness skills results in any long-term improvements in outcomes. To date, there are no PubMed-indexed studies investigating the use of DBT in patients with spinal injury [5].
Another study evaluated the use and effectiveness of dialectical behavioral therapy skills modified for use by patients with breast cancer.
In addition, work was carried out, which presents the high role of the clinical psychologist in the treatment of pain in patients in a hospital. During the period of preoperative pain, patients are characterized by anxiety, bad mood, catastrophization and depression. They have been identified as predictors of pain intensity and analgesic consumption, and are risk factors for the development of persistent postoperative pain. Pain that is poorly controlled can lead to emotional and psychological problems that manifest as feelings of frustration, anger, anxiety, low mood, depression, or withdrawal. It was found that it is important to use an eclectic approach for patient recovery, including cognitive-behavioral and DBT methods, combined with short-term counseling.
Note that another study looked at the effect of dialectical behavioral therapy on postpartum depression, the stress associated with coping with traumatic childbirth. The researchers were developing an approach to teach skills to women who had a traumatic birth. Such skills are components of DBT.
Thus, in the presented examples of studies, the relevant role of DBT in the correction of psychological distress as a result of various somatic pathologies was noted. Further research is needed to confirm the effectiveness of DBT in various categories of patients, which will allow the use of skills for the treatment of conditions associated with stress as a result of the disease. A clinical psychologist, a psychotherapist can inform patients about various skills and practice them together with patients in the format of individual counseling.
Note that not all the skills of experiencing a crisis are realistically feasible in a hospital setting. Therefore, we will consider only a part of the DBT skills that a clinical psychologist can teach patients on the basis of a surgical hospital.
For example, in order to mitigate the effects of stress, a psychologist can gently invite patients to find a positive meaning in what happened (“an operation is not only pain and an inability to fully move, but also a way to become stronger, look at your life from a different angle, this is a time to take care of yourself “).
Another specialist can offer patients to perform the “breathing exercises” exercise (4 seconds – inhale, 8 seconds – exhale) during a period of stress, when the patient only learns about the upcoming operation, prepares for it and experiences anxiety.
The Mindfulness of Current Thoughts exercise will help you cope with the influx of disturbing thoughts. Training is carried out using various images, offering to “observe” thoughts (a conveyor belt along which feelings and thoughts move; a river, and thoughts and feelings are boats floating downstream; a railway, and thoughts and feelings are cars of a passing train sky, and thoughts are clouds). The exercise is easy to perform and is a kind of “lifeline” in a stressful situation. This technique is easy to perform in a hospital setting.
The exercise “Radical Acceptance” can help in the recognition of a disease state. As a result of the exercise presented, the patient is helped to stop fighting with reality, he (she) ceases to be annoyed because reality is not what one would like to see it. The patient learns to let go of his resentment about the situation in life, to accept the features of his illness. Acceptance of the disease allows you to move forward and constructively solve the problems of treatment and rehabilitation.
then you can offer to turn, thank the Lord and ask for health. In addition, in some hospitals there are special prayer rooms where patients and their relatives can come to light a candle and gain spiritual strength.
The skills from the Emotional Regulation module are useful for patients. For example, such as awareness of one’s emotion, its description and designation. This will allow you to understand how he (she) feels in a certain situation and not be absorbed by his emotions.
In some difficult life situations, training in “problem solving” skills is suitable. In the process of mastering the skill, patients, together with the psychologist, can determine goals, tasks for solving problems, brainstorm and choose the appropriate solution, as well as ways to implement it.
To reduce emotional vulnerability, it is important to use the “Care” skill (normalization of sleep, sleep hygiene, balanced nutrition before and after surgical treatment).
Exercise “Awareness of current emotions” for the correction of emotional dysregulation in a stressful situation. It is performed according to the following algorithm: “Watch your emotion – take a step back and note the emotion, its presence. Then feel the emotion as a wave that comes and goes. Imagine yourself balancing on the crest of this wave. Try not to block or suppress the emotion. Don’t try to get rid of the emotion or repress it. Don’t try to keep the emotion, don’t cling to it, don’t reinforce it. Remember: You are not your emotion. You do not need to act under the pressure of emotion. Think back to times when you felt different. Practice “radical acceptance” of your emotions.” This exercise allows you to distance yourself from the emotions that patients often experience before surgery, namely: fear, anger, anxiety, guilt, despair, sadness. Without getting involved in emotions, the patient will be able to withstand complex negative states.
The article provides a brief overview of the skills of dialectical behavioral therapy adapted for use in the hospital for patients in the preoperative period. It is important to modify the DBT for each individual patient using an individual approach.
In general, it is worth noting that DBT is an integrated approach that develops resilience to adverse life situations. Before surgical manipulations, patients in the hospital are especially vulnerable and psychologically exhausted. For them, the very news of the operation is often stressful. Therefore, it is important for a clinical psychologist to prepare patients for a difficult test. DBT provides a toolkit that allows patients to adapt to changing health and life conditions, helps prevent the development of anxiety-depressive, panic disorders.