Dialectical behavior therapy ‘a formula for effectiveness’

NEW YORK: Mindfulness. Distress tolerance. Emotion regulation. Interpersonal effectiveness. If ever there were a set of psychological skills for negotiating life in the 21st century, this is it.

They just happen to be the skills that are the focus of dialectical behavior therapy, the cognitive-based therapeutic program specifically designed to help those with borderline personality disorder curb their self-destructive impulses and manage their unruly emotions. The more that studies demonstrate the effectiveness of the program, which consists of both group instruction and individual therapy sessions, both conducted weekly for a year, the more it has been applied to other disorders.

Take interpersonal effectiveness. One of its core principles is that learning how to ask directly for what you want diminishes resentment and hurt feelings, reactions that typically emotionally derail borderlines but which are no strangers to the rest of us; just ask the nearest divorce lawyer.

In DBT, the skill is encapsulated in a mnemonic device known as DearMan: Describe what you want; Express yourself in ways that reflect the importance of your request; Assert yourself effectively but not aggressively; Reinforce a request by explaining what good would come from it; stay Mindful and don’t get caught up in another’s defensiveness or your own intensity; Appear confident; Negotiate, don’t demand. Why should a diagnosis be required to acquire such basic relationship skills?

Or to acquire mindfulness? Learning how to stay focused on the present moment, noting the fleeting nature of emotions so as not to get whipsawed by them, not getting mired in regret about the past or overcome with anxiety about the future. It affords us a choice of how we want to respond to experiences.

“When Marsha Linehan first came out with dialectical behavior therapy,” says Barry Lubetkin, cofounder and director of New York’s Institute for Behavioral Therapy, “most of us looked around and said, ‘My God, this is the stuff we have been teaching people for the last 20 years, and this is the way we ourselves want to live our lives. As therapists and as human beings we are always trying to develop more effectiveness.’”

If DBT made sense for a clinical population when it was introduced two decades ago, it makes at least as much sense for the general population in 2013. There’s considerable evidence that pathology is increasing among Americans; the prevalence of anxiety, depression, and narcissism is rising, especially among younger cohorts. One in 10 Americans now takes antidepressant medication.

The increasing rates of such conditions may in fact reflect sudden changes in the way we now must live our lives. Depression, argues Brandon Hidaka in the Journal of Affective Disorders, is likely a disease of modernity. In fact, a signal marker of modernization-per capita GDP-correlates with lifetime risk of the disorder, the result of an evolutionary mismatch between longstanding human environments and recent lifestyle shifts. Declining social interaction, increased sedentariness, diminished sun exposure, sleep deprivation-all the products of the way we now function-contribute to depression risk.

The context of all our lives has changed dramatically just within the last two decades. The most obvious change is the advent of the Internet and related technologies.

It’s axiomatic that different environments impose differing demands on us. This, after all, is the fundamental dialectic of evolution: Adapt-or wither into ineffectuality. The Internet, the universe many Americans inhabit much of the time, increasingly enables our livelihoods. But it also offers unlimited opportunities for distraction: View pornography and every other kind of sexual activity at the touch of a button. Prefer to search for that old sweetheart, or a new one? Or just contact friends? Maybe video games are more your thing, made all the more irresistible by instant feedback. Escape and entertainment are often overwhelmingly tempting in the face of difficulty. (Much of the popularity of so-called study drugs can be attributed to the attempt, however misguided, to maintain a focus in the face of easy escape.) Hello, distress tolerance.

Think of digital diversions as add-ons; traditional outlets for frustration have not lost their appeal in the electronic age. In 40 years of practice, Lubetkin notes, “I have never seen so many people having affairs. A man has a fight with his wife or girlfriend and he immediately acts out with someone else, rather than managing the distress and finding alternative ways of controlling a bad reaction or learning better communication skills. “Adolescent psychologist Carl Pickhardt sees a growing gap between the degree of self-discipline young people now need and the little they acquire. Concerned parents, he contends, typically focus on their kids’ academic achievement and on minimizing social risk-taking. “But they’re really not preparing their kids for self-management.”—MCT