I have started in a dialectic behavioral therapy program, where I will both see an individual therapist and attend a skills group with other clients in the program. I had my second appointment today where we discussed some basics of what DBT works on and what kinds of issues it can help resolve – mostly emotional dysregulation.
“Dialectic” is a philosophical term that has been used by many people throughout history. Its basic meaning is that two opposites can coexist, and that there is a balance between the two. It is applied to DBT as finding the balance between emotion and rational minds, which I have mentioned in previous episodes.
The roots of the term “dialectic” are Greek in nature. “Dailect” and “dialectic” come from “dialecktos”, which means “conversation” or “dialect”. They ultimately come from the Greek “dialegesthai”, which means “to converse”.
Historically, there has been a fundamental misunderstanding of the emotional dysregulation that occurs in those with borderline personality disorder. There are three components of this emotional dysregulation, referred to as the biosocial theory aspects: homebase; variability; and attractor strength (return to baseline). It was originally thought that homebase (baseline) with or without BPD was identical, that variability (intensity) was significantly higher in those with BPD, and that return to baseline was the same rate. It can more accurately be summarized by this graph:
This image shows an average baseline for emotions, the straight line on 4 (threshold). The bottom line is the average emotion intensity as it encounters a stressor. The top red line shows a dysregulated emotion intensity, akin to that of someone with BPD. As can be seen, the average initially goes up, but it then returns down with little to no variation. The dysregulated line, however, starts slightly higher, goes up at a faster rate and to a higher degree, and then starts to return to baseline slower – but then, it encounters another trigger that would not have aggravated the average, which shoots it back up again. It continues to go up and down, still much higher than the threshold. This is what BPD emotional dysregulation is like.
DBT was designed by Dr. Marsha Linehan and colleagues, particularly to treat emotional dysregulation caused by BPD. We will continue to learn more about skills and goals in DBT as I continue in individual sessions and skills group sessions.