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Dialectical Behavior Therapy (DBT) is a therapeutic approach that was developed by Marsha Linehan to help individuals with borderline personality disorder and other conditions that involve intense emotions and difficulty regulating behavior. DBT is a form of cognitive-behavioral therapy that emphasizes the balance between acceptance and change. It is based on the idea that individuals with these conditions have a biological vulnerability to intense emotions, and that this vulnerability is exacerbated by an invalidating environment. DBT aims to help individuals learn to regulate their emotions and behaviors, and to gain more control over their life.

DBT is composed of four main modules: mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness.

  • Mindfulness is the practice of being present in the moment and accepting things as they are without judgment.
  • Distress tolerance is the ability to tolerate difficult situations without making them worse.
  • Emotion regulation is the ability to manage and change intense emotions.
  • Interpersonal effectiveness is the ability to build and maintain healthy relationships.

DBT is a comprehensive therapy that is typically delivered in a group format, with weekly individual therapy sessions, and regular phone coaching. It requires a high level of commitment from the patient and therapist, and typically takes several months to complete. It has been shown to be effective in treating a wide range of mental health conditions, including borderline personality disorder, post-traumatic stress disorder, and substance abuse disorders.

How is DBT used to help treat DID?

DBT has been adapted to be used in treating Dissociative Identity Disorder (DID) by providing a structured and consistent approach to managing the symptoms associated with DID. DBT can be used to help individuals with DID to:

  • Improve emotional regulation: DBT can help system members identify and label their emotions and learn strategies for managing intense emotions.
  • Increase mindfulness: DBT can help system members to be more present in the moment and to accept their experiences without judgment.
  • Build distress tolerance: DBT can help system members tolerate difficult situations without making them worse, and to develop coping strategies that they can use when they are feeling overwhelmed.
  • Enhance interpersonal effectiveness: DBT can help system members to build and maintain healthy relationships and to communicate effectively with others.
  • Increase self-awareness: DBT can help system members to understand their own behavior and emotions, and to identify patterns of behavior that are associated with their dissociative symptoms.
  • Create a consistent and safe therapeutic relationship: DBT can help plurals to have a stable and secure therapeutic relationship with their therapist, which is essential for progress in treatment.

DBT can be integrated with other therapeutic approaches, such as psychodynamic therapy, and EMDR, which can be effective in treating DID.

--Above created with assistance from ChatGPT.

DBT in Reality

One challenge with DID folk working in DBT groups is that they're often expected to present as singular in group settings. Some professionals who run DBT groups seem to think that presenting as plural, or different headmates fronting during groups (and sometimes in 1:1 adjunct therapy) is undesirable "Dissociative" behavior and counter to the goals of DBT. Thus for some plural or DID systems, we're forced to be inauthentic or mask during DBT groups.

This idea comes from the thought that conflates switching in itself as dissociative (and thus maladaptive) behavior. When a system becomes increasingly co-conscious, they continue to switch without dissociation symptoms such as disorientation, amnesia, feeling distant or detached, or losing time. It may help for plural & DID systems to seek out DBT from more knowledgable practitioners — unfortunately sometimes we have to take what we can get. Other options include joining plural-only DBT peer-run practice groups or discussing DBT internally with one another as a system i.e. having a DBT group internally while working in an external DBT group.

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