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For those suffering from depression, hope for change can feel like an unaffordable luxury. Depression is a self-fulfilling mental disease in which negative thoughts and feelings accumulate in a feedback loop; one feels bad for feeling depressed which reinforces the depression, and so on. Fortunately, there are treatments that are incredibly effective in countering the effects of the illness, and they do not necessarily involve the use of medication. Dialectical Behavioral Therapy, or DBT for short, is one such approach. Combining individual counseling with group therapy, research has shown it to be an effective form of treatment, especially for older adults suffering from depression.
DBT and Its History
Originally developed as a treatment for Borderline Personality Disorder, DBT starts with Cognitive Behavioral Therapy (CBT), namely, showing patients how changing their thoughts can improve their feelings and curb self-destructive behaviors. It is a goal-oriented, here-and-now approach that does not emphasize Freudian root causes, but rather how a patient's present-day mental state contributes to their depression. Dr. Marsha Linehan, working mainly with suicidal women stuck in a pattern of self-harm, discovered limitations to CBT. She found too many patients reacting angrily to the treatment or withdrawing from the process, essentially seeing the therapist in an adversarial role.
To the framework of CBT, Dr. Linehan added several meditative elements inspired, at least in part, by Buddhist practices. In addition to changing negative thoughts and behaviors, emphasis was placed on a patient's relational interactions in the outside world, such as with friends or family. This psychosocial aspect of DBT is largely what sets it apart from CBT. The innovative treatment is designed to validate a person's feelings and teach acceptance of them while showing how some do more harm than good. With the maladaptive thoughts, feelings, and behaviors mapped out, alternatives can be presented.
Depressive Symptoms
Dialectical Behavioral Therapy has been shown to effectively treat depression characterized in part by:
• Problems with concentration, thought or memory
• Waning interest in previously enjoyed activities
• Physical problems caused by the depressed mental state
• Suicidal or morbid thoughts
• Inconsolable sadness
For older adults suffering from depression, DBT is particularly effective. Existing medical conditions, side effects from medication, and common effects of aging are all causes for depression in the elderly. The meditative aspects of acceptance, mindfulness and distress tolerance are especially useful. While the physical malady fueling the depression may be incurable, the treatment can at least inspire a sense of peace, allowing the patient to put it into perspective.
Individual and Group Therapy
This treatment involves both individual and group-oriented therapy. The one-on one sessions are used for discussion of issues that may have arisen as well as working toward changing negative thoughts and self-destructive behaviors. One component of CBT is homework, small goals and/or exercises the therapist assigns, and these are discussed as well. Issues are organized according to a hierarchal pattern. Thus, resolving suicidal thoughts takes precedence over improving one's quality of life.
It is during the group sessions that a patient learns to utilize the meditative skills that characterize Dialectical Behavioral Therapy. Organized into so-called modules, they include mindfulness, interpersonal effectiveness, emotion regulation and distress tolerance. Each module involves its own unique set of skills that are learned and practiced as a group. The group setting offers a safe, supportive environment, allowing individuals to open up and share their experiences with others like them.
It's important to remember that there is always hope for people suffering from depression. Each person presents a unique set of circumstances, and in some cases more extreme measures may be necessary. But for a great many people, DBT helps to validate one's experience and, more importantly, it offers a path toward change.
If you or someone you know is suffering from depression or exhibiting symptoms of self-destructive behaviors, author Stephen Daniels highly recommends the expertise of Manhattan DBT therapists for treatment of emotion regulation problems. The counselors there specialize in the use of CBT, MBCT, and DBT in working with their patients.
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