Dialectical Behavior Therapy for OCD

Another Alternative When Exposure Therapy Doesn't Work

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Like exposure-response prevention therapy (ERP), dialectical behavior therapy (DBT) is another form of cognitive-behavioral therapy (CBT). DBT focuses on validation, building trust, mindfulness and acceptance. While ERP is usually the gold standard for obsessive-compulsive disorder treatment, if you find that ERP does not work for you, think about exploring DBT as another alternative.

Dialectical Behavior Therapy's History

DBT is a type of therapy that was developed by Marsha Linehan in the late 1970s at the University of Washington.

Linehan worked with patients who had chronic suicidal thoughts, suicide attempts and self-harming behaviors that are often the result of deep wounds from childhood abuse and/or neglect. Many people who have these traits are diagnosed with borderline personality disorder (BPD), while others may be suffering from post-traumatic stress disorder (PTSD).

At the time that DBT was developed, CBT had been identified as the treatment of choice for pretty much every mental illness. However, Linehan realized that the patients she worked with were unable to benefit from CBT due to the direct nature of the work and the constant focus on change. These patients felt CBT was judgmental, confrontational and invalidating. Linehan wisely adapted traditional CBT to make the approach more validating. Since that time, DBT has been proven effective for a wide array of other mental health problems, particularly mood and anxiety disorders.

DBT Skill Sets

DBT has four primary skill sets that people can learn to apply to their lives: distress tolerance, emotional regulation, interpersonal effectiveness and mindfulness. DBT is generally taught in groups that accompany individual therapy sessions. People who are learning to use DBT skills document how well and how often they apply the skills between group sessions and discuss this in depth with the individual therapist.

DBT Skills for OCD and Anxiety

DBT skills are used to cope with the pain and fear associated with everyday life. DBT draws heavily on the Buddhist concepts of acceptance, non-judgment and mindfulness. These are very useful skills for managing OCD.

Unlike CBT, where the focus is on making and measuring changes in behavior, DBT is focused on acceptance and non-judgment. The therapeutic relationship is critical as people learn to be honest about their behavior and emotions without shame or feeling like they have failed. It is the validation of their efforts to show up and talk about their progress (or lack thereof) that is important for many people. Once trust with the therapist is established, people tend to take more risks in therapy. This step is often necessary before they are ready to make changes.

How to Apply DBT Skills to OCD

Distress Tolerance. These skills are used to either distract or self-soothe when faced with disturbing thoughts or emotions.

Emotional Regulation. By learning skills to manage the anxiety related to obsessions and/or fear, you will begin to realize that your anxiety will lessen with time without having to give in to the usual compulsion or reassurance.

Interpersonal Effectiveness. This set of skills helps you manage your feelings related to interactions with others, which might include needing to seek reassurance.

Mindfulness. This skill helps you to be more present in the moment. Being mindful includes not attaching to distressing thoughts, practicing being non-judgmental (realizing that your thoughts are neither right nor wrong) and redirecting your thoughts to the present moment when intrusive, repetitive thoughts occur.

DBT is an Alternative to ERP

DBT does not directly address obsessions and compulsions, as with exposure in ERP. DBT skills are used to cope with the anxiety associated with fearful thoughts or obsessions that result in compulsive behaviors. 

Additional Treatment May be Needed

Most people need medication in addition to therapy to manage OCD. An evaluation by a psychiatrist is always recommended to determine if medication might be helpful in your treatment plan.

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