Dialectical Behavioral Therapy

Developed by Marsha M. Linehan, PhD (1993) from Washington University, and based on a significant number of researches, Dialectical Behavioral Therapy (DBT) uses behavioral strategies associated with Zen Buddhism / contemplative practices and dialectical philosophy. It is a comprehensive treatment developed initially to handle with suicidal situations in women. As many suicidal issues occur often in borderline personality disorder patients, this treatment becomes known as an intervention for this psychopathology, specially in the most severe cases. However, in the past two decades, this model started to be used in many other clinical settings and different contexts such as depressive, bipolar, anxiety and food and feed disorders, etc. There are some publications with DBT in suicidal adolescents, elderly, forensic contexts and couples with complex behavior problems. Suicidal crisis, repeated hospitalization, self-injuries behaviors, substance abuses are some of the problems observed in patients with complex problems and multiple psychiatric comorbities. The biosocial model understands that the biological vulnerabilities associated with the invalidating environments are the key point to the high emotional arousing. The emotional deregulation leads to a cognitive, interpersonal, self and behavioral deregulation. There is one pre-treatment stage and other four stages of treatment, and each one has some specific objectives to be reached. The emotional regulations and generalization of the skills that were learned is one of the main objectives in the beginning of the treatment. It involves individual psychotherapy associated to coaching phone calls, weekly skills training group sessions, consultation team meetings for therapists and auxiliary treatments (i.e. hospitalization team, physicians, nutritionist, social worker, pharmacologist, personal trainer, etc.). The skills training group sessions focus in teaching mindfulness, emotional regulation, distress tolerance and effective interpersonal skills. Comprehensive, integrative and supported by results, DBT has aroused great interest among current psychotherapists worldwide. Although it is an evidence based intervention, many cultural adaptations are needed when we adopt the standard model in different countries. These adaptations include group settings, economic issues, family members´ participation, etc. This speech aims to discuss the adaptations made in Latin America, especially in Brazil. It also discusses the difficulties in starting a DBT program and the need to adapt instead of adopting the model in some cases. 

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