Dialectical Behavior Therapy (DBT) techniques are being used in increasing measure in the treatment of various mood disorders and mental health conditions beyond their original intended use (for Borderline Personality Disorder), including for Bipolar Disorder. Bipolar Disorder is a highly recurrent and disabling condition marked by major depressive state and manic episodes.
The reason DBT shows evidence of success in treatment of Bipolar Disorder is likely because there is growing reason to believe that those with this mental health condition have limited capacity for emotional regulation. Since DBT specifically targets Emotion Regulation as one of its primary modules, it makes sense that improvements in this area can minimize symptoms for those with Bipolar. Improvements in mood symptoms have been shown for those who undergo DBT treatment, with better overall psychological wellbeing and decreased emotional reactivity over time.
Historically, most Bipolar Disorder patients will undergo psychosocial group intervention along with cognitive therapy and medication to minimize their symptoms, but deficits in emotional regulation are not directly addressed through these methods. This is likely why one of the biggest challenges in treatment for Bipolar Disorder is that even after pharmacotherapy assisted treatment for a mood episode, most patients still fail to achieve a long-term, sustainable remission in symptoms and are at great risk for further episodes.
DBT is backed by empirical evidence of success for those seeking to improve their emotion regulation and to decrease their emotional volatility in response to stimuli such as situational stressors and conflict. Core components of DBT skills training include mindfulness and distress tolerance, which can reduce an individual's vulnerability to negative emotions and decrease the likelihood of their turning to self-destructive behaviors.
Over several clinical trials, researchers have found that individuals with Bipolar Disorder who underwent DBT treatment experienced significant improvement with decreases in suicidal ideation, self-harm episodes, substance abuse, emotional dysregulation, and depression. Most of the individuals who participated also reduced the frequency of their need for emergency services and mental health clinic admissions over time.
DBT treatment includes skills training in four key areas: Mindfulness, Distress Tolerance, Emotional Regulation, and Interpersonal Effectiveness. Since all of these modules target the patients’ ability to regulate their emotions in one way or another, it makes sense that DBT is so effective in treating Bipolar Disorder (since the primary symptom of BD is instability of mood/emotions).
With Mindfulness, for example, this skill teaches patients to be more grounded, present, and aware of their emotions, which can increase their ability to enact self control and create a more stable environment in which to manage and address their thoughts and emotions.
Through Distress Tolerance skills training, BD patients can learn better ways to cope with impulsive urges (like suicide, self-harm and substance abuse). Since BD is most often associated with impulsivity and poor self-regulation, improving responses to distress can decrease the likelihood of a patient’s willingness to engage in these behaviors.
Emotional Regulation DBT skills can help patients to accept, address, and manage or change their emotions in better ways through validation, self-soothing, and other techniques. For BD patients prone to episodes of mania/hypomania, this skill can be particularly helpful in heading off depressive symptoms before they escalate.
For most BD patients, Interpersonal Effectiveness skills are critical to improving the health of their relationships. Since the mood swings, impulsivity, emotion dysregulation and self-harm behaviors often associated with BD are so commonly destructive to their relationships, Interpersonal Effectiveness skills can help a patient to repair relationships and to make better choices to minimize damage. In turn, they may experience healthier human connection, a greater sense of community, and less isolation, all of which can improve their mood stability and general quality of life.
Are you struggling with Bipolar Disorder, and is it having a debilitating impact on your life?