Use of DBT in OCD Treatment by Fugen Neziroglu, PhD
Brief Description
Dialectical behavioral therapy (DBT) is a form of psychological treatment with the goal of helping people learn how to respond effectively to difficult feelings, relationships, and life situations. It was initially developed to treat borderline personality disorder, but has been shown to sometimes be helpful for a range of mental health conditions, including obsessive compulsive disorder (OCD).
DBT does not replace exposure response prevention (ERP), which is the gold standard treatment for OCD. But, DBT can be used as a supplement to ERP because it involves learning a range of different skills to respond effectively more when urges to engage in compulsions arise.
The “dialectical” part of DBT is the idea of bringing together opposing positions (for example, when people disagree about something). By acknowledging what is valid in each position, we enter into a deeper understanding of the truth and are able to develop a more effective response to the situation.
This same process happens within us when we have mixed feelings about something. For example, a person engaging in an OCD ritual is doing so for valid reasons: completing the ritual can help to reduce anxiety in the short term by providing a sense of assurance that the feared consequence won’t happen. At the same time, there is also validity to the idea that rituals reinforce OCD and have a negative impact on quality of life. So, from a dialectical perspective it is important for the person to understand why they engage in the ritual, and also to understand that in order to break free from their OCD they need to try harder and learn to respond differently to their urge to engage in compulsions.
DBT is therefore about replacing unhelpful, ineffective behaviors with more helpful behaviors. The skills fall into four categories. The first is mindfulness skills, which focus on helping people learn to be non-judgmentally aware of the present moment and to respond wisely to it. The second category is emotion regulation skills, which involve changing unwanted or unhelpful emotions and reducing one’s vulnerability to being emotionally triggered. The third category is distress tolerance skills. These are skills to help one accept and respond to very distressing situations and feelings without making them worse. The last is interpersonal effective skills, which are skills to help us effectively meet goals in interactions with other people.
Why/How It Works
As the name suggests, DBT is a therapy which focuses on behavior. It is based on the underlying principle that our behavior affects how we feel and think.
Behaviors can be divided into two types: overt behaviors and covert behaviors. Overt behaviors are behaviors which can in principle be seen by others, such as raising my hand or walking across a room. Covert behaviors are behaviors which others cannot observe; for example, mental behaviors such as how I am relating to my thoughts and feelings.
What makes DBT helpful in addressing OCD is OCD involves both types of behaviors. The rituals that are being addressed in OCD treatment can be either physical or mental. DBT involves learning to engage in more effective behaviors, both overt and covert, in response to the thoughts and feelings which trigger the compulsions.
Summary of Research Support
A growing number of studies have examined the effectiveness of DBT as an aspect of OCD treatment, and many of the workbooks and treatment manuals for OCD incorporate skills used in DBT. Although the studies are not the most rigorous types of designs and often have small sample sizes, the research generally suggests that DBT can reduce OCD symptoms and result in reductions in depression, anxiety and stress symptoms, and improvements in skills such as self-compassion and mindfulness. Importantly, there is still a need for randomized controlled trials (the most rigorous types of treatment studies) with large samples and compared with exposure and response prevention.
Age Considerations
Versions of DBT have been effectively used in the treatment of children, adolescents, and adults.
Other Important Considerations
In order for the skills taught in DBT to be internalized, they must be repeatedly practiced in all situations where they apply. In other words, the work must be taken out of the therapy session and applied to real-life challenges. This involves making a commitment to learn and implement the skills. If a person is not in a position to follow through with this, then the treatment will be limited in its helpfulness.
When To Try This Treatment
DBT does not replace exposure response prevention (ERP), which is the gold standard treatment for OCD. But, DBT can be used as a supplement to ERP because it involves learning a range of different skills to respond effectively more when urges to engage in compulsions arise.