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Reining in negative thoughts and emotions can be tough for anyone. For those who struggle with mental health challenges, doing so can be even more complicated.

Talk therapy, also known as cognitive behavioral therapy, can provide a much-needed solution. This type of therapy centers on talking through problems to frame them differently.

One type of talk therapy, dialectical behavioral therapy (DBT), has been proven to change destructive and unhealthy thought patterns, particularly for those more at risk for self-harm. People learn to cope with distressing thoughts more calmly and logically.

"DBT is a structured, behavioral therapy program," explains Laura Castle, a licensed professional counselor with Sentara Halifax Regional Hospital who co-facilitates a DBT group with Matt Owen, licensed professional counselor. "Along with others, our clients learn to manage and change these frustrating and potentially harmful patterns. DBT works best when people consistently engage in group and individual sessions."

Who can benefit from DBT?

American psychologist Marsha Linehan developed DBT more than 30 years ago. She wanted to find a way to treat her own borderline personality disorder (BPD). BPD refers to a mental illness that significantly impacts people’s ability to regulate their emotions. People with BPD are more likely to self-harm.

Therapists use DBT to treat people with many conditions, including:

• Bipolar disorder
• Depression and anxiety
• Eating disorders
• Post-traumatic stress disorder
• Substance abuse
• Suicidal thoughts and self-harm

How does dialectical behavioral therapy work?

Overall, dialectical behavioral therapy centers on how your thoughts, feelings and behavior interact with each other. Dialectical (the D is DBT) means "opposite." With this practice, your therapist will help you combine both change and acceptance.

"Our goal through using DBT is to help our patients learn to accept themselves and their circumstances but also give them the tools to regulate their emotions and potentially destructive or harmful behaviors," Castle says.

Focusing on four traits

When clients learn the techniques of DBT, they will focus on four skills.

• Mindfulness – Mindfulness helps us quiet the noise in our heads and around us to focus on the present. This shifts your attention away from anxiety-inducing thoughts rooted in the past or future. When you enter a state of mindfulness, the other concepts of DBT work more effectively.
• Distress tolerance – You may be coping with an underlying stress like an illness, death of a family member, job loss or relationship loss. Then, on top of that, an irritating daily event occurs – bad traffic, a bad grade or a home emergency like a leaking pipe. These situations exacerbate the underlying problem. That’s where techniques like distraction (focusing on something other than the distress), self-soothing (comforting activities) and radical acceptance (accepting the reality) can help.
• Emotion regulation – This step teaches you to recognize your emotions when stress triggers them. You may feel worried, disappointed or frustrated. Recognizing and labeling your feelings will make you less vulnerable to emotional swings and less likely to act in harmful ways.
• Interpersonal effectiveness – You will learn to build and maintain positive relationships. You will develop skills to manage conflicts better by communicating needs and desires effectively and constructively. Let’s say a child blows a curfew you had both discussed. You can learn to talk with your child calmly, listen to their side of the story and devise a reasonable plan.

How can I participate in DBT?

A mental health or primary care provider can refer you to a DBT skill-building group. Another option is to schedule an appointment with a licensed behavioral health therapist at Sentara Behavioral Services for screening and assessment.

After the assessment, we will determine if the program is a good fit for you. If it is, Sentara Behavioral Health Services provides a DBT skills-building group through a 13-week program. You’ll meet with a small group to practice and apply the four elements of DBT. Clients meet twice a week on Mondays and Fridays for 1 ½ hours. They will also receive weekly homework assignments.

"With the support from facilitators and peers, participants try to find a middle ground between emotion and reason, change and acceptance, to decrease harmful and impulsive behaviors," Castle adds. "We, ultimately, hope this will increase meaning and purpose in their lives. " 

For further information or to receive this service, please contact Sentara Behavioral Health Services at 434-517-3651 or visit sentara.com/halifaxbehavioralhealth.