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When it comes to Dialectical Behavior Therapy (DBT) treatment, choosing the right program can feel like an overwhelming task. The DBT treatment program that is right for you depends on your diagnosis, the severity of your symptoms, your treatment goals, your life situation, and a variety of other factors you may not have even considered.

You may not know what type of Dialectical Behavior Therapy treatment program will be right for you until you start talking to DBT treatment centers. As you start considering DBT treatment programs, here are the types of programs you will most frequently come across:

Residential DBT Treatment Programs

At a residential, or inpatient, DBT treatment program, you will live in a home or other residence and receive 24-hour support and care as you participate in DBT therapy. In residential DBT treatment, you will live among your peers while you participate in individual and group therapies. A residential Dialectical Behavior Therapy treatment program is appropriate when you need a high level of support and structure.

Day DBT Treatment Programs

While the type of treatment you receive at a DBT day treatment program is similar to that of a residential DBT treatment program, your living situation will differ. With a day treatment program for Dialectical Behavior Therapy, you are able to live at home or in another supportive living environment while participating in DBT therapy for several hours each day.

Outpatient DBT Treatment Programs

An outpatient DBT treatment program will provide you the most flexibility, as you will only participate in a set number of individual and group sessions each week. Outpatient DBT treatment is most appropriate when you don’t need a lot of structure or your daily life doesn’t allow you the time needed for residential or day treatment.

Comprehensive vs. Informed DBT

In addition to considering the level of care you’ll participate in, you may also think about the type of Dialectical Behavior Therapy you will receive. There are two types of Dialectical Behavior Therapy: comprehensive DBT and informed DBT.

Comprehensive DBT: If you choose a comprehensive DBT treatment program, often referred to as DBT-adherent, you will be in a program that uses all of the modes of Dialectical Behavior Therapy: individual DBT sessions, DBT skills groups, phone coaching, and a DBT consultation team for the therapists.

Informed DBT: If you choose a DBT-informed treatment program, you will be in a program that only uses a few of the modes of Dialectical Behavior Therapy.

Whether you participate in comprehensive DBT or DBT-informed treatment also depends on a variety of factors, which you can read about here.

DBT Treatment

Regardless of the setting or type of program, Dialectical Behavior Therapy will provide you a number of valuable skills that will help you to better manage your symptoms and create a life worth living.

If you are unsure about which type of Dialectical Behavior Therapy treatment program is most suited to you, call the DBT Center of Southern California at (800) 573-0770 to get more information and a free assessment.
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Dialectical Behavior Therapy (DBT) has been shown to help people diagnosed with a variety of disorders, including Borderline Personality Disorder and substance abuse, experience long-lasting periods of symptom remission during their lifetimes.

Dialectical Behavior Therapy relies on the core principles of mindfulness, emotional regulation, distress tolerance, and interpersonal effectiveness. DBT can help those who experience overwhelming emotions, live in environments that may be invalidating, engage in self-harmful behaviors, or who have thinking patterns that contribute to destructive or unhealthy ways of living.

DBT is offered in a variety of clinical settings, including residential treatment. But how do you know when to seek residential Dialectical Behavior Therapy treatment?

When Residential DBT Treatment Is Appropriate

A Dialectical Behavior Therapy residential treatment center is most appropriate for those who need more structure and support than private therapy, or even outpatient or day DBT treatment. You should consider residential DBT treatment after talking with a therapist about your particular diagnosis and treatment needs.

If you have an especially severe pathology, a residential Dialectical Behavior Therapy program would be a good choice for treating the unhealthy behaviors that accompany your diagnosis. The nature of a residential DBT program, which is comprehensive and supportive, provides an ideal setting in which to learn DBT skills while recovering from your symptoms.

In a comprehensive residential DBT treatment center, you’ll live in a comfortable home-like environment while you receive individual DBT therapy, participate in DBT skills groups, and receive phone or in-person coaching as needed. You will also participate in other groups and activities that will help you to strengthen your DBT skills and other coping skills before returning to your everyday life.

A mental health professional and a Dialectical Behavior Therapy treatment center can ultimately help you decide if residential DBT treatment is right for you. Many DBT treatment centers will have you participate in one or two pre-treatment sessions before entering treatment to make sure you are ready and willing to participate in a residential DBT treatment program.

Why Residential DBT Treatment

A residential DBT treatment program provides a high level of support and structure for those who need it most. In a residential setting, you will be removed from the daily stressors of life and given an opportunity to focus on your treatment without distractions.

In a residential Dialectical Behavior Therapy program, you will live with others who understand what you are going through. This level of support provides a safe space for you to share your concerns, fears, and successes. It also provides a great opportunity for you to practice the skills you are learning with others who are learning them with you.

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Dialectical Behavior Therapy is a research-based, cognitive-behavioral treatment originally developed by Marsha Linehan at the University of Washington, to help clients with the suicidal and self-harm behaviors often seen in Borderline Personality Disorder.

DBT has since then been modified as a treatment for other complex and challenging mental disorders that involve emotional dysregulation, such as dual diagnoses, PTSD, eating disorders and severe mood disorders. Clients with these disorders often have great difficulty managing the emotional and relational crises of their lives because they lack the needed behavioral coping skills.

Using both acceptance and change strategies, DBT asks both patient and therapist to find a balance between accepting reality as it is, and maintaining a strong commitment to change. Such treatment is ideally offered in an environment that is warm and validating, while attempting to offer enough challenge and guidance to effect behavioral change and reduction of harmful behaviors. The goal is to help clients create “a life worth living.”

Research has shown that DBT treatment is most effective when it includes 1. individual therapy, 2. a weekly skills training group and 3. help with skills application by phone with the individual therapist between sessions. At MTA, we offer all three components. For information about individual DBT therapy or skills application and coaching, please contact us (click here).

Weekly DBT skills training groups are didactic groups that use a step-by-step format to teach four sets of skills: mindfulness, interpersonal effectiveness, emotion regulation, and distress tolerance.
◾Mindfulness: The ability to take control of your mind instead of having your mind control you. Mindfulness helps direct your attention through the process of observing, describing and participating from a nonjudgmental perspective. This allows for more objective, effective, and meaningful experiences in the here and now.
◾Interpersonal Effectiveness: The ability to communicate and express yourself effectively while maintaining an understanding and a commitment to your objectives, your relationship to the person(s) and your self-respect.
◾Emotion Regulation: The ability to regulate your emotions by understanding the relationship between thoughts, feelings, body sensations and behaviors. As well as, being aware of vulnerability factors related to emotional states such as; adequate sleep, balanced eating, appropriate medication usage, self-care, exercise and incorporating positive experiences in your daily life.
◾Distress Tolerance: The ability to get through an already difficult time without making it worse. Self-destructive behaviors are often a result of ineffective ways of dealing with painful emotions. Distress tolerance teaches the use of distraction, radical acceptance and pros/cons as alternatives.

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Prescription and OTC sleeping pills

Battling insomnia night after night can leave you frustrated and exhausted. Sleeping pills may help, but they’re not without risks. Get the scoop on the pros and cons of sleep aids.
By Mayo Clinic Staff

You’ve followed the usual tips for getting enough sleep — sticking to a regular schedule, avoiding caffeine and daytime naps, exercising regularly, and managing stress. Still, it’s been weeks and a good night’s sleep remains elusive. Is it time to consider sleeping pills?

Over-the-counter sleep aids

Before you pick up over-the-counter sleeping pills, check in with your doctor. Your doctor can evaluate whether an underlying medical disorder is contributing to or causing your sleep problems.

It’s also a good idea to ask your doctor if over-the-counter sleeping pills will interact with medications you take or complicate existing health problems.

Here’s a list of common choices and potential side effects:
•Diphenhydramine (Benadryl, Unisom SleepGels). Diphenhydramine is a sedating antihistamine. Side effects might include daytime drowsiness, dry mouth, dizziness and memory problems.
•Doxylamine (Unisom SleepTabs). Doxylamine is a sedating antihistamine. Side effects are similar to diphenhydramine, including daytime drowsiness, dry mouth, dizziness and memory problems.
•Melatonin. The hormone melatonin helps control your natural sleep-wake cycle. Some research suggests that melatonin supplements might be helpful in treating jet lag or reducing the time it takes to fall asleep — although the effect is typically mild. The most common melatonin side effects include daytime sleepiness, dizziness and headaches.
•Valerian. Supplements made from this plant might reduce the amount of time it takes to fall asleep as well as promote better sleep overall. However, the active ingredient isn’t clear and potency can vary. Side effects of valerian supplements might include headache, abdominal discomfort, excitability or uneasiness, and heart disturbances.

If your sleep problems continue after trying over-the-counter sleep aids, see your doctor. He or she can evaluate whether prescription sleeping pills might be appropriate for you.

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Insomnia treatment: Cognitive behavioral therapy instead of sleeping pills

Insomnia is a serious disorder, and effective treatment can be crucial to getting the sleep you need. Explore safe, effective, nondrug insomnia treatments.
By Mayo Clinic Staff

Insomnia is a common problem characterized by trouble falling asleep, staying asleep or getting restful sleep, despite the opportunity for adequate sleep. Cognitive behavioral therapy for insomnia, often called CBT-I, is an effective insomnia treatment for chronic sleep problems.

Cognitive behavioral therapy for insomnia is a structured program that helps you identify and replace thoughts and behaviors that cause or worsen sleep problems with habits that promote sound sleep. Unlike sleeping pills, CBT-I helps you overcome the underlying causes of your sleep problems.

To make effective changes, it’s important to understand sleep cycles and learn how beliefs, behaviors and outside factors can affect your sleep. To help decide how to best treat your insomnia, your sleep therapist may have you keep a detailed sleep diary for one to two weeks.

How does cognitive behavioral therapy for insomnia work?

Cognitive behavioral therapy for insomnia aims to improve sleep habits and behaviors. The cognitive part of CBT-I teaches you to recognize and change beliefs that affect your ability to sleep. For instance, this may include learning how to control or eliminate negative thoughts and worries that keep you awake. The behavioral part of CBT-I helps you develop good sleep habits and avoid behaviors that keep you from sleeping well.

Depending on your needs, your sleep therapist may recommend some of these CBT-I techniques:
•Stimulus control therapy. This method helps remove factors that condition the mind to resist sleep. For example, you might be coached to set a consistent bedtime and wake time and avoid naps, use the bed only for sleep and sex, and leave the bedroom if you can’t go to sleep within 20 minutes, only returning when you’re sleepy.
•Sleep restriction. Lying in bed when you’re awake can become a habit that leads to poor sleep. This treatment decreases the time you spend in bed, causing partial sleep deprivation, which makes you more tired the next night. Once your sleep has improved, your time in bed is gradually increased.
•Sleep hygiene. This method of therapy involves changing basic lifestyle habits that influence sleep, such as smoking or drinking too much caffeine late in the day, drinking too much alcohol, or not getting regular exercise. It also includes tips that help you sleep better, such as ways to wind down an hour or two before bedtime.
•Sleep environment improvement. This offers ways that you can create a comfortable sleep environment, such as keeping your bedroom quiet, dark and cool, not having a TV in the bedroom, and hiding the clock from view.
•Relaxation training. This method helps you calm your mind and body. Approaches include meditation, imagery, muscle relaxation and others.
•Remaining passively awake. Also called paradoxical intention, this involves avoiding any effort to fall asleep. Paradoxically, worrying that you can’t sleep can actually keep you awake. Letting go of this worry can help you relax and make it easier to fall asleep.
•Biofeedback. This method allows you to observe biological signs such as heart rate and muscle tension and shows you how to adjust them. Your sleep specialist may have you take a biofeedback device home to record your daily patterns. This information can help identify patterns that affect sleep.

The most effective treatment approach may combine several of these methods.

Cognitive behavioral therapy vs. pills

Sleep medications can be an effective short-term treatment — for example, they can provide immediate relief during a period of high stress or grief. Some newer sleeping medications have been approved for long-term use. But they may not be the best long-term insomnia treatment.

Cognitive behavioral therapy for insomnia may be a good treatment choice if you have long-term sleep problems. You may want to try it if you’re worried about becoming dependent on sleep medications, if medications aren’t effective or if they cause bothersome side effects.

Unlike pills, CBT-I addresses the underlying causes of insomnia rather than just relieving symptoms. But it takes time — and effort — to make it work. In some cases, a combination of sleep medication and CBT-I may be the best approach.