Ask the Pharmacist

Q) I have a teen struggling with depression. My doctor put her on a medication and set us up with an appointment with a therapist. At the appointment, the therapist mentioned that she is having good results with something called dialectical behavioural therapy. Can you tell us more about this?

A) Dialectical behavioural therapy (DBT) is a somewhat modified form of cognitive behavioural therapy which has been the most commonly used form of therapy when dealing with mental health for some time now. Both of theses therapies are forms of psychotherapy, probably better known as “talk-therapy” and have been well established as effective and safe treatments for many types of psychological disorders. Its goals are to teach people how to live with stress, control their emotions better, improve the various relationships with others and help the individual to live “in the moment”.

It was originally developed to treat borderline personality disorder but over time it has been found to be an effective intervention in numerous other conditions such as post-traumatic stress disorder (PTSD), eating disorders, substance abuse disorders, ADHD and depression among others.

The word dialectical is derived from the idea of bringing together two opposites when it comes to traditional therapy approaches, that is acceptance and change. The hope is that enhancing both can bring better results than focussing on either alone. As such, patients work with their therapist to uncover harmful/ negative thought patterns, accept them as part of their experience, and then they are taught how to react to them differently than they have before.

Standard DBT has three parts:

· Individual therapy-where a patient’s learned behavioural skills are adapted to their personal life challenges.

· Group therapy-where they are taught behavioural skills in a small group setting

· Phone coaching- where patients call their therapist in between sessions when they are dealing with a difficult session and need immediate help to avoid a relapse.

Patients enrolled in this program engage in “homework” in which they practice their new skills. This can include filling out daily “diary cards on which they track more than 40 emotions, urges and behaviours such as self-injury, lying and low self-esteem.

Some of the areas tackled in DBT include focusing on

· Mindfulness- This is also known as being present, a term we hear a lot about these days. This helps the individual to pay attention to both what’s happening inside of you (such as thoughts, sensations and emotions) while using your senses to tune in to the world around you. It helps you to slow down, stay calm and avoid turning back to impulsive and destructive behaviours. One such technique that is taught is to focus on one’s breathing, a lesson familiar to those who practice meditation.

· Tolerating Stress- When facing a crisis, DBT teaches several techniques to safely get one’s self out of it including:

1. Distraction
2. Self-soothing
3. Thinking of the pros and cons of not tolerating distress.

· Interpersonal Effectiveness- This helps the individual to become more assertive (e.g. in vocalizing their needs or being able to say “no”) while still keeping the relationship healthy. It helps them to communicate more effectively and deal better with the people in their life that are challenging for them.

· Emotion Regulation – this teaches the individual to recognize and cope with negative emotions (e.g. anger) thereby, reducing their emotional vulnerability and limiting the damage to their life that these outburst can have.

DBT is divided into four stages:

· In Stage 1- the most serious and self-destructive behaviours are the first ones addressed.

· In Stage 2- treatment now focusses on issues that affect a person’s quality of life such as their ability to live with stress and control their emotions

· In Stage 3– the focus turns to improving self-esteem and the important relationships in their life

· In Stage 4- treatment is aimed at helping people now get the most out of their lives, finding pathways to increased happiness and hopefully helping them to start to pursue their life goals.

Like all other “talk-therapies”, DBT is not for everyone. Criticisms include that it is overly complex, that it doesn’t necessarily involve any form of processing one’s trauma and that because a great deal of its techniques involve mindfulness which is rooted in Zen-Buddhist teachings its teachings may be antithetical to those with more conservative religious backgrounds. Still, for those mired in the struggle for better mental health, it does provide yet another option to eventually finding peace of mind. For more information about this or any other health related questions, contact your pharmacist.