Lindner Center of HOPE Dialectical Behavior Therapy Program: Successful and continuing to expand

Byline: Robin Thompson Arthur, PsyD, Lindner Center of HOPE, Chief of Psychology University of Cincinnati, Assistant Professor, University of Cincinnati College of Medicine Department of Psychiatry Xavier University, Adjunct faculty for the Department of Psychology

Lindner Center of HOPE brought a comprehensive Dialectical Behavior Therapy (DBT) program to the Cincinnati Region when it opened six years ago. DBT is an empirically validated treatment that has helped thousands of patients at Lindner Center of HOPE. DBT, originally created by Marsha Linehan, Ph.D., was designed to be used for patients suffering with Borderline Personality Disorder. And while 30 years of research proves this to be true, it has also been empirically validated for other diagnosis, including but not limited to, treatment for substance abuse, eating disorders, and depression and other personality disorders. Research proves it to be effective in decreasing suicidal gestures, lowering inpatient hospital days, and shortening the length of treatment. DBT helps patients learn to calm their emotions and live more mindfully, thus making better decisions and improving relationships. Often times, patients can decrease the number of medications they are prescribed after DBT treatment.

Outpatient DBT is a treatment that synthesizes Zen tradition and behavior therapy. DBT is a comprehensive treatment that serves five functions. These functions are enhancing patient capabilities, increasing patient motivation, structuring the environment to increase the likelihood of success, working to assure generalization from therapy to the natural environment, and finally to enhance the therapists capabilities and motivation to treat the patients effectively.

 

DBT consists of four modules:

Mindfulness: paying attention to your world in a more intentional way which enables you to act from a balanced state of mind.

Distress Tolerance: tolerating a short term crisis without the impulse to escape in unhealthy ways or making the situation worse with unhealthy coping skills.

Emotion Regulation: decrease mood lability and mood dependent behavior.

Interpersonal Effectiveness: asking for your wants and desires to be met without compromising your relationships or self- respect.

 

Each patient in DBT has an individual therapist who acts as the lead clinician for the patient’s team of treatment providers. The individual therapist sets the goals of treatment with the patient in accord with the DBT targets, monitors progress, integrates all of the modes of therapy, and balances acceptance and validation of the patient with being a catalyst for change. A key here is to validate the patients emotional suffering and also move the patient towards changing their reactions to the suffering.

Patients attend a weekly skills group that is classroom in nature. It is not designed to be a psychotherapy group. This often enables patients to have less anxiety about attending a group when they know that personal things need not be shared as a psychotherapy group would mandate. It usually takes only a couple weeks before the group is comfortable and supportive of one another using the DBT skills they are acquiring. The groups at Lindner Center of HOPE are not homogenous in diagnosis.

Patients receive coaching phone calls (5-10 min) as needed to effectively utilize the skills when needed. The purpose of phone coaching is to enhance the likelihood of effective behavior, to coach the use of skills, and to decrease the likelihood of problematic behaviors. This differs changes the dynamic of emergency phone calls to a skills based approach to handling the crisis at hand.

DBT therapists ask patients to fill out a daily diary card that keeps track of targeted behaviors including acts of intentional self-injury, suicidal urges, important emotions, and anything else the patient and therapist feels is significant. The DBT diary card serves several functions including helping the therapist figure out what needs to be targeted in session, increasing mindfulness and understanding of problem behaviors, and actually changing targeted behavior.

DBT is used in every facet of treatment at Lindner Center of HOPE, including Outpatient, Partial Hospital, Inpatient and Residential care. The Center’s clinical team believes strongly in the research behind DBT as well as the remarkable results seen at Lindner Center of HOPE.

As the Chief of Psychology at Lindner Center of HOPE, I think DBT should be taught in every 9th grade class in America, and in some cities they are currently conducting research related to this idea. “These are practical skills that we all should learn. They are taught in a very understandable format and, they improve relationships and the quality of life, and significantly reduce emotional suffering for those who learn DBT.” So DBT, while researched with people of a variety of mental illnesses, can be useful for most of us. I have had a number of patients in my groups that have a more mild form of mental illness, but chose to enroll in DBT for themselves as well as to teach it to their family. They report their family has better communication and less conflict with the new skills.

At Lindner Center of HOPE, we currently have grown from one weekly group to four ongoing groups for beginner DBT, one graduate group for those who finish beginner group, and one group for adolescents. These groups remain filled with 8-10 patients throughout the year. The average wait time to begin a group is 4-6 weeks. Patients need an individual therapist with some DBT training for optimal results. If a patient does not have a DBT therapist, they could change to a DBT therapist during the DBT treatment and then return to their original therapist.

To refer a patient to our DBT program or for questions, please call Kelly Bernens at 513-536-0634. A screening and commitment session will be set with one of our intensively trained DBT psychologists.