Dialectical behavior therapy (DBT) techniques have been used in treatment of bipolar disorder, and there seems to be an inherent logic for their effectiveness.
Studies Show DBT Treatment Effectiveness
Bipolar disorder (BD) is a highly recurrent and disabling condition, marked by major depression and manic/hypomanic episodes.
DBT is a psychotherapy which targets emotional dysregulation, characterized by high sensitivity to emotional stimuli, extreme emotional intensity, and a slow return to baseline emotional state.
In a 1-year trial of DBT treatment for adolescents with bipolar disorder, researchers found significant improvement from pre- to post-treatment in terms of suicidality, nonsuicidal self-injurious behavior, emotional dysregulation, and depressive symptoms.
In another 12-week study of DBT treatment for adults with bipolar disorder, participants showed a trend toward reduced depressive symptoms, and significant improvement in terms of mindful awareness, and less fear toward and more control of emotional states. Furthermore, group attendees had reduced emergency room visits and mental health related admissions in the six months follow-up study.
DBT Techniques Align with Bipolar Symptoms
DBT treatment consists of four core skills training: mindfulness, distress tolerance, emotional regulation, and interpersonal effectiveness. Researchers say that, because all of the DBT skills in some way target emotion dysregulation, it seems logical that DBT would be effective in treating bipolar disorder, in which one of the primary symptoms is mood instability.
The mindfulness skills teach clients to be more aware of their emotions, thoughts and behaviors, and therefore result in an increase in client’s degree of self-control and ability to manage distressing thoughts and emotions.
Distress tolerance skills teach clients alternative ways of coping with urges such as to suicide or self-harm, use drugs or alcohol, gamble or over-spend, and so on. Given the impulsivity associated with bipolar disorder and the behaviors that patients often turn to, especially when in a manic or hypomanic episode, these skills are essential.
The emotion regulation skills help individuals learn to manage their emotions in more effective ways, through learning to validate one’s own emotions to prevent emotional escalation; and through acting opposite to one’s emotions. This latter skill is especially helpful when dealing with episodes of depression or mania/hypomania, and when patients have a tendency to contribute to these mood states through their actions (or lack of action).
Finally, the interpersonal effectiveness skills assist patients in improving relationships in their lives. One of the many consequences of bipolar disorder is that it often results in damaged relationships, whether due to the anger and irritability experienced in depressive or manic episodes; or as a consequence of behaviors people engage in while depressed or manic (e.g., abusing substances, extra-marital affairs, gambling). These skills help patients to repair their relationships when needed, and to act in ways that will minimize or even eliminate the damage that is inflicted in the first place.
Sheri Van Dijk, Janet Jeffrey and Mark R. Katz. 2013. “A randomized, controlled, pilot study of dialectical behavior therapy skills in a psychoeducational group for individuals with bipolar disorder.” In Journal of Affective Disorders, 145(3): 386-393.
Tina R. Goldstein, et al. 2007. “Dialectical Behavior Therapy for Adolescents With Bipolar Disorder: A 1-Year Open Trial.” In Journal of the American Academy of Child & Adolescent Psychiatry, 46(7): 820-830.