This means, that therapists, on the one hand accept patient as they are and provide validation for their thoughts, emotions and behaviors, while on the other hand therapists acknowledge the need for change and foster the learning of new skills to deal with problems and to reach personal goals ( Linehan and Wilks, 2015). This led to one of the most important features of DBT, the “ dialectic” of acceptance and change. On the other side, focusing on acceptance and validation has also been perceived as problematic by patients since their problems and behaviors did not change. To that time, these patients had been considered as “untreatable.” A focus on problem solving or cognitive restructuring, according to standard cognitive behavioral therapy (CBT), had been experienced as potentially invalidating by the patients and had led to frustration, angry reactions, resistance and treatment drop outs. Background and Theory Dialectical Behavior Therapy (DBT)– Background and Theory Development of Dialectical Behavior Therapy and the Dialectic of Acceptance and ChangeĭBT was developed in the late 1980s by Linehan (1993a, b), originally for chronically (para)suicidal patients, then extended to patients with BPD. Similarities and differences of the two methods are highlighted and illustrated with a case example. Further it is discussed how DBT and ST concepts and techniques map onto the process model of emotion regulation from James Gross ( Gross, 2015). This paper provides an overview of background and theory of both treatment approaches, a model how both methods conceptualize emotion dysregulation and the major therapeutic techniques with respect to emotion regulation. Although both, ST and DBT, have a cognitive-behavioral background, there are major differences in how both methods deal with emotions and emotion dysregulation. Major ST techniques for trauma processing, emotional avoidance and dysregulation are limited reparenting, empathic confrontation and experiential techniques like chair dialogs and imagery rescripting.ĭialectical behavior therapy (DBT) and Schema therapy (ST) have both shown to be effective treatment methods especially for borderline personality disorder (BPD) ( Zanarini, 2009 Stoffers et al., 2012), a disorder that is specially associated with emotional dysregulation. ST assumes that when these underlying problems are addressed, emotion regulation improves. These negative experiences have led to unprocessed psychological traumas and fear of emotions and result in attempts to avoid emotions and dysfunctional meta-cognitive schemas about the meaning of emotions.
In ST problems in emotion regulation are seen as a consequence of adverse early experiences (e.g., lack of safe attachment, childhood abuse or emotional neglect). DBT assumes that improved skills and skills use will result in better emotion regulation. All DBT-modules (mindfulness, distress tolerance, emotion regulation, interpersonal effectiveness) are intended to improve emotion regulation skills and patients are encouraged to train these skills on a regular basis. A core difference of the two approaches is that DBT directly focusses on the acquisition of emotion regulation skills, whereas ST does seldom address emotion regulation directly. This article gives an overview of the major therapeutic techniques used in ST and DBT with respect to emotion regulation and systematically puts them in the context of James Gross' process model of emotion regulation. However, there are major differences in the terminology, explanatory models and techniques used in the both methods. Both, ST and DBT, have their roots in cognitive behavioral therapy and aim at helping patient to deal with emotional dysregulation. Schema therapy (ST) and dialectical behavior therapy (DBT) have both shown to be effective treatment methods especially for borderline personality disorder.
1Department of Psychiatry and Psychotherapy, University of Luebeck, Luebeck, Germany.Eva Fassbinder 1 *, Ulrich Schweiger 1, Desiree Martius 2, Odette Brand-de Wilde 2 and Arnoud Arntz 3
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