132 CHAPTER 4
developed to treat people, generally women, who regularly hurt themselves physi-
cally (such as by cutting or burning themselves) or who make suicidal gestures or
attempts (Linehan, 1993), and for whom other forms of therapy—including CBT—
had not been successful. DBT has also been used with patients who have signifi -
cant diffi culty regulating their emotions and containing their impulses, such as some
people with drug dependence (van den Bosch et al., 2005) and some people with
bulimia nervosa (Safer, Telch, & Agras, 2001).
DBT, which generally involves individual and group therapy, includes elements
of CBT, such as skills building, cognitive restructuring, and a warm and strong col-
laborative bond between patient and therapist. DBT adds three other components:- An emphasis on validating the patient’s experience. It is assumed that the patient’s
thoughts, feelings and behaviors in a given situation make sense in the context of
his or her life, past experiences, and strengths and weaknesses. The therapist helps
the patient recognize the context of the patient’s experience. - A Zen Buddhist approach. Patients are helped to identify and then, without judg-
ment, accept any painful realities of their lives. Patients are encouraged to “let go”
of emotional attachments that cause them suffering. Mindfulness—nonjudgmental
awareness—is the goal. Patients entering DBT are often full of self-loathing and
judge themselves harshly, which only serves to make them feel worse and resort
to impulsive behaviors to soothe themselves; treatment is intended to reduce such
unproductive judgments. - A dialectics component. This therapy is a process of acknowledging and coming to
terms with opposing elements—feelings, beliefs, desires. The therapist helps the pa-
tient to change what can be changed but also to accept what cannot be changed
(Robins, Ivanoff, & Linehan, 2001). Patients entering DBT tend to see themselves
and others in rigid all-or-nothing terms. The dialectics component helps them become
less rigid in how they see themselves and others. For instance, they learn to see that
most people—including themselves—can be generally good people, who sometimes
make mistakes; mistakes don’t necessarily indicate that people are bad or evil.
Incorporating Technology Into Treatment
In their efforts to make treatment more effective and efficient, researchers and
clinicians have been inspired to incorporate technologies into treatment—usually as
part of between-session work—and to broaden the ways that treatment can occur
so that it need not always involve having the patient and therapist in the same room
(Gega, Marks, & Mataix-Cols, 2004).Using Technology for Between-Session Work
Patients in CBT often perform signifi cant between-session work, such as completing
self-monitoring logs, challenging their irrational or automatic thoughts, constructing
hierarchies of fear and avoidance, and trying out new behaviors. Several kinds of
technology can help make these between-session tasks easier to remember and to per-
form and can make it easier to collect and analyze the data obtained from the tasks:- Self-monitoring is made easier with hand-held devices—such as PDAs and
smartphones—or computer software. An alarm can be set to go off at programmed
or random times, reminding patients to:
° assess their thoughts, mood, and symptom level (such as anxiety);
° perform certain mental tasks (such as coming up with a rational response to an
automatic thought); or° perform certain physical behaviors (such as trying a relaxation technique).
- Computer software or Web sites can be used to facilitate cognitive restructuring
or provide educational information or blank forms that can be completed online
(Carroll et al., 2008; Eisen et al., 2008; Kurtz et al., 2007; Litz et al., 2007).