Content Descriptions
Dialectical Behavior Therapy
Dialectical Behavior Therapy (DBT) was created specifically for the treatment of chronically suicidal patients. Therefore, it can help the college students that experience suicidal ideations. Validation is an important part of DBT, so that the patients do not feel like their feelings aren’t being taken seriously. This kind of emotional validation is something everyone needs, as we all need to know that what we feel is okay.
DBT is also effective in the treatment of people with Borderline Personality Disorder (BPD), something that many college students show symptoms of; symptoms include dangerous/risky behavior such as drinking to excess or relationship violence. In general, DBT covers five types of dysregulation; these are emotion, self, behavior, relationship, and cognitive dysregulation. The article goes on to describe how these problems affect people with BPD, but I intend to prove that they also affect most students on a college campus.
DBT has four main goals. These are to get the patient to control behavior, experience emotions, experience ordinary happiness and unhappiness (as opposed to these emotions to a degree that causes problems), and to form a sense of freedom and joy. These are accomplished primarily through group and individual therapy and phone coaching that help the patient develop skills, work through obstacles to skill use, help translate skills to daily life, and to help the therapist stay motivated and skilled. Obviously, the average college student doesn’t need this extensive of treatment, but one-on-one work with a therapist such as that which I have done could benefit them greatly.
Courtship Violence Among College Students: A Comparison of Verbally and Physically Abusive Couples
The researchers distributed 2000 surveys about relationship violence and students’ pasts with drinking and abuse, and used 572 to gather their data. This found that 82% of college students admitted to using verbal violence against a partner, and 21% admitted to the use of physical violence. Emotional/verbal violence is so often overlooked, especially among young people, but this statistic shows that it should not be so. These types of emotional and relationship dysregulation that cannot be ignored.
The violence, whether verbal or physical, often came from a place of darkness in the student’s far or recent past. Many of the abusers had experienced abuse at home as children, and many had admitted to drinking prior to violence. Regardless of reason, this dysregulation cannot be excused or ignored, but it can be prevented. Students who had learned to deal with their emotions in a healthy way, and knew how to maintain a healthy relationship, would not have committed relationship violence. DBT teaches people how to assertively, but not abusively, communicate thoughts and feelings. This could have prevented many cases of abuse on campus.
Correlates of College Student Binge Drinking
This study was conducted in 1993 nationwide and included over 17000 students. The researchers define binge drinking as five or more drinks at once for men and four or more for women. The results were that 44% of college students were binge drinkers, with factors such as race and belonging to a fraternity or sorority playing a role.
While this is not a majority, it is still a number to be concerned about. This type of impulsive behavior is a textbook example of behavior dysregulation, often implemented to “treat” emotional dysregulation. Again, if the students knew how to properly handle emotions (i.e. if they were taught DBT skills) this could be avoided all together.
Dialectical Behavioral Therapy (2nd article with this title)
DBT has four main principles, carried out by four main modules of treatment. It prioritizes the patient-therapist relationship, a nonjudgmental approach to treatment, teaching effective behaviors (and how they differ from the ineffective) and teaching dialectical thinking. These are carried out by teaching mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness. DBT is designed to treat people with various mood disorders. However, DBT can help many everyday problems such as stress and mood-dependent choices, and can reduce the risk of self-harming behaviors.
Depression, Desperation, and Suicidal Ideation in College Students: Results from the American Foundation for Suicide Prevention College Screening Project at Emory University
This national study found that 11.1% of college students experiences suicidal ideation in the past four weeks. It also found that 16.5% of students had a past suicide attempt in their lifetime. While these numbers are not overwhelmingly high, they are too high not to do anything. It was found that 85% of the students who admitted to suicidal ideation were not receiving treatment. The solution? Treat them, it’s simple. These are prime examples of students who need DBT desperately, especially considering it is aimed at those with self-destructive tendencies.
Treatment Failure in Dialectical Behavior Therapy
This article is essentially the complaints of a novice therapist unable to properly administer DBT, and I have so many problems with it. But those can be found in my “Rebuttal Argument” section, along with many specifics about this case. Basically, this researcher, who is a therapist, had a patient for a few months (which is not enough time to make that much significant progress) who was resistant to DBT treatment. She chronically overstepped the therapist-patient boundary and caused the therapist a lot of distress. So instead of reaching out and helping her patient, the therapist withdrew the treatment she so shoddily tried to give. She failed to validate her patient’s emotions on multiple occasions and did not take into account that a rigid DBT schedule may not be right for the patient. She needs more experience. This source shows how DBT must be administered correctly and that not all therapists are reliable.
Don’t Let Your Emotions Run Your Life for Teens
This is a workbook for teenagers that teaches Dialectical Behavior Therapy in a simple and accessible way. It includes definitions of the different aspects of DBT, such as mindfulness, assertive speaking, and the difference between the wise, reasoning, and emotional minds. Each chapter has stories of different people’s problems and how DBT could help them solve said problems. The chapters also have exercises for the reader to complete in order to start applying DBT to their own life. It does not focus on any specific disorder, but focuses on the every day emotions that everyone feels and how to deal with them, making it a great book for college students that have not been diagnosed.
1. Working Hypothesis 1
DBT could benefit the majority of college students, not just those with diagnosed mental illnesses.
1a. Working Hypothesis 2
DBT can be very helpful, but only when the person administering it is extensively trained and knows how to properly execute treatment.
2. Topics for Smaller Papers
Definition/Classification Argument
How DBT is seen as too much for BPD patients, but it isn’t!
Initial Argument
It seems like multiple therapy sessions a week and phone calls in between is a lot, especially for someone who struggles with their everyday life in the first place. So how do we get people characterized as being hard to motivate and unpredictable to conform to this model? We don’t. DBT doesn’t have to be this rigid, overwhelming program that takes up someone’s entire life. Even in the most extreme cases that seem to require this, it could actually do more harm than good.
BPD patients already often suffer from social isolation, so taking time out of their life that they could be part of society for therapy sessions could be detrimental. The constant doctors’ appointments turn a person into a stigma of the person who is always at therapy. While other’s judgement should not be considered, it often is, especially in BPD patients who so often rely on outside validation. So, when a person only has a few close peers and they never get to see her because she is always doing DBT work, it further isolates her and stigmatizes her, creating a vicious cycle of problems to therapy to more problems.
I learned DBT from weekly 45-minute therapy sessions and one workbook. Now, I haven’t even received a BPD diagnosis (let’s say I’m on the borderline of being borderline) but the therapy was prescribed for my anxiety and depression, and it worked. The small amounts of information I was receiving and putting into practice were just enough to be useful, but not overwhelming. It helped me become, essentially, a whole, functioning person.
What I’m trying to say from this anecdote is that small doses (for lack of a better term) of DBT can be effective, especially when treating immediate crises. A therapist could bring up, say, one skill per session that pertains to what a patient has described as their most recent problem. Classifying a problem into a category of dysregulation should be easy for anyone trained, and finding a skill to match is simple from there. That way, the patient is literally learning DBT as it applies to their life, making them feel validated and like there is something that can help them immediately. This gives them opportunity to use the skills right then and there, making them more effective and more likely to be remembered. Overall, this more relaxed approach to DBT would most likely solve people’s misconceptions about the practice.
A08 Argument
In its purest form, Dialectical Behavior Therapy (DBT) is very regimented and time-consuming. Clive J. Robbins and Zachary Rosenthal describe the therapy, originally developed by Marsha Linehan, as requiring multiple group and individual therapy sessions weekly, skills training, phone coaching, and meetings among a person’s team of therapists. I do not subscribe to this definition, described in the DBT section of Acceptance and Mindfulness in Cognitive Behavior Therapy. DBT is, essentially, whatever dialectical behavior skills a person needs in order to improve their life.
The workbook Don’t Let Your Emotions Run Your Life for Teens breaks down DBT perfectly to fit most people’s lifestyle. It teaches individual skills and outlines which situations call for which skills, giving exercises on how a person is going to apply said skills. It builds upon itself, starting with the basics that apply to everyday life and getting more specific as it goes. That is how DBT should be, and that is how I learned to apply it to my own life.
For a person with BPD, life is hard enough already. The disorder is almost entirely made up of life-interfering behaviors such as impulsive actions, dysregulated relationships and emotions, and some symptoms of depression such as lack of motivation. We cannot expect such individuals to keep up a schedule like Robbins and Rosenthal require.
For someone without BPD, say, a college student who still shows many signs of dysregulation, life is incredibly busy. No college student has time for class, homework, and a social life in general let alone when paired with multiple therapy sessions a week with phone coaching in between. Along with the lack of time, society still stigmatizes going to therapy as a sign of weakness, which may deter many college students from such a regimented form of DBT. Students will still need to go to therapy, but at a more relaxed pace, giving them more time for it and welcoming less judgement.
A less intense form of DBT is an effective compromise for all recipients of the therapy. Going to therapy once a week and working from a book like Don’t Let Your Emotions Run Your Life for Teens was enough to make a difference in my life, and could do the same for many others. For BPD patients, it requires less effort and is not as overwhelming. For college students, it takes up less time and welcomes less stigma. DBT can be redefined, and this new definition will help many people.
Cause/Effect Argument
College life causes dysregulation by nature, but said dysregulation is seen as part of the college experience
Initial Argument
It is common knowledge that at college, people experience change. This change can cause dysregulation in students, but often that dysregulation is overlooked. In general, there are a good amount of college students who party and are in relationships. I’m not going to say that these are inherently unhealthy or cause dysregulation, but it is interesting to see the related statistics.
82% of college students have admitted to using verbal violence against a romantic partner, often brought on by the use of drugs or alcohol. In that vein, 44% of college students have been classified as binge drinkers. This means that, in those relationships and parties seen as part of the college experience, relationship, emotional, and behavior dysregulation exist.
I think that the immense change that college students are undergoing, and the immense pressure felt by many of them causes this dysregulation. If a person is under almost constant stress and/or feels lost in life, and they are not receiving any type of help, dysregulation is bound to happen. This brings me to my original point; college students need DBT. Once we stop looking at dysregulation as a part of being at college and see it as a real problem that has a clear solution, we are on the path to fixing it.
A09 Argument
It is common knowledge that at college, people experience change. According to Brian Harke of the Huffington post, students come to college “overly optimistic and confident in their ability to manage the challenges they will encounter at college.” This can cause an amount of stress that student have never dealt with before, and therefore do not know how to manage in a healthy way. Many students may look to partying or other relationships to cope with their stress. These relationships and parties are not inherently problematic, but when they are forced or done with the wrong people, they can create dysregulation.
First off, of course, there is the academic side of college, which is the main cause of stress. Students think that they can handle college academics, and often get a reality check in the form of a failed test or paper. There are entire textbooks dedicated to teaching students how to deal with college-level academics, such as “College Success” created by the Extended Learning Institute and Lumens Learning. This book describes college as being inherently stressful, and attempts to guide students in the right direction towards success. It is interesting that even an academic source sees the immense pressure felt by students in all aspects of life. But stress is not limited only to academics in college.
Many students know only what other people have told them in terms of college. For many students, information and stories come from their parents, who have most likely been out of college for many years and are focusing only on the good. They talk about the “College Experience” as if there is a standard for activities in college, like partying or falling in love. This puts pressure on students to not only achieve academically in the ways they have been encouraged to, but also to achieve socially. The wild and sometimes-exaggerated stories set even more expectations for students to fulfill, so forced relationships and parties with acquaintances occur. These non-organic interactions can cause dysregulation simply by nature, they did not happen naturally, they are forced, and they are unhealthy. This is not to say that to say that all relationships and parties are inherently unhealthy or cause dysregulation, but it is interesting to see the related statistics.
82% of college students have admitted to using verbal violence against a romantic partner, often brought on by the use of drugs or alcohol. In that vein, 44% of college students have been classified as binge drinkers. This means that, in those relationships and parties seen as part of the college experience, a good amount of relationship, emotional, and behavior dysregulation exist.
The immense change that college students are undergoing, and the pressure felt by many of them causes the dysregulation described by the earlier statistics. Not only academic pressure, but that to somehow “succeed” socially, if that is even possible. If a student is under almost constant stress and/or feels pressure to succeed and they are not receiving any type of help, dysregulation is bound to happen. This brings me to my original point; college students need DBT. Once we stop looking at dysregulation as a part of being at college and see it as a real problem that has a clear solution, we are on the path to fixing it.
Rebuttal Argument
Initial Argument
Therapists themselves have had many failures in implementing DBT, stating that in some extreme cases of BPD and emotional dysregulation, it doesn’t work. In one case, Shireen L. Rizvi had a patient named Barbara who was not affected, and whose disorder may have been worsened, by DBT. Barbara had BPD, social anxiety, severe depression, PTSD, and was an abuse survivor.
Over the course of six months, Rizvi struggled to treat Barbara, often blaming her “therapy-interfering behaviors” such as not making eye contact, asking her very personal questions, and calling her in crisis almost daily. The response to these behaviors is what makes the argument that DBT didn’t work here completely invalid. Rizvi admitted to outright ignoring some of these behaviors, when the very basics of DBT state that a patient must feel validated in order to receive treatment. Instead of indulging and therefore validating these behaviors, maybe partially answering a question or asking her why she didn’t make eye contact, Rizvi let them agitate her and obstruct her own practice.
While Barbara did overstep the patient-therapist line (she had had a romantic affair with a previous therapist, so she didn’t understand it in the first place) the response should have been one of understanding and willingness to help, not one of agitation and rejection. Rizvi admitted to being a “novice therapist”, but as someone who is not even a therapist yet, I can see that that is no excuse. She saw someone who clearly had a mistrust of authority and no concept of patient boundaries, and did not take that into account. The bottom line is, she didn’t try hard enough to understand Barbara as a person rather than as a set of symptoms. It is these therapists who most often fail with DBT. It is not the therapy’s fault; it is the fault of the therapist administering it.
A10 Argument
Therapists themselves have had many failures in implementing DBT, stating that in some extreme cases of BPD and emotional dysregulation, it doesn’t work. In one case, Shireen L. Rizvi had a patient named Barbara who was not affected, and whose disorder may have been worsened, by DBT. Barbara had BPD, social anxiety, severe depression, PTSD, and was an abuse survivor.
Over the course of six months, Rizvi struggled to treat Barbara, often blaming her “therapy-interfering behaviors” such as not making eye contact, asking her very personal questions, and calling her in crisis almost daily. The response to these behaviors is what makes the argument that DBT didn’t work here completely invalid. Rizvi admitted to outright ignoring some of these behaviors, when the very basics of DBT state that a patient must feel validated in order to receive treatment. Instead of indulging and therefore validating these behaviors, maybe partially answering a question or asking her why she didn’t make eye contact, Rizvi let them agitate her and obstruct her own practice.
While Barbara did overstep the patient-therapist line (she had had a romantic affair with a previous therapist, so she didn’t understand it in the first place) the response should have been one of understanding and willingness to help, not one of agitation and rejection. Rizvi admitted to being a “novice therapist”, but as someone who is not even a therapist yet, I can see that that is no excuse. She saw someone who clearly had a mistrust of authority and no concept of patient boundaries, and did not take that into account. The bottom line is, she didn’t try hard enough to understand Barbara as a person rather than as a set of symptoms. It is these therapists who most often fail with DBT. It is not the therapy’s fault; it is the fault of the therapist administering it.
Therapists themselves need to take into account the state of their patients and how to best treat them. They cannot look at every patient as the same textbook set of symptoms, they have to see the patient as a whole person. Though a person may fit the criteria for rigorous DBT, the person may not be able to handle it. This is another issue with the Rizvi case. Barbara most likely would have done better under a less structured form of DBT, as one who has had little structure in her life to begin with. She is not familiar with such intense dedication to one thing, a thing which she is not even convinced is worthwhile yet. So, giving her small tidbits of DBT in her therapy sessions would have not only given the therapy more meaning to her, but may have made her more receptive to it.
But obviously not all college students are Barbara and not all therapists are Rizvi. However, they may still have therapy interfering behaviors and not be the most eager to start DBT. That is why a very relaxed form of it is best. If someone doesn’t want to do something, it makes no sense to completely immerse them in it against their will. Introducing DBT slowly in small pieces makes much more sense. The therapist doesn’t even have to officially declare “We’re going to do DBT now.” They can simply give skills that pull from DBT and mention the name, intriguing the patient. If they see that these skills are helping them, and they know they come from DBT, they will be more eager to dive deeper into the practice.
But of course, the person has to be willing to use the skills in order for them to help. If someone completely ignores their skills and makes no progress, then what? That’s where the emotional validation comes in. As Robins and Rosenthal say, that is one of the core principles of successful DBT. Patients have to believe that the skills will help them, and that they can implement them successfully. The safer and more empowered a patient feels, the more likely they are to use therapy skills outside of the office.
The bottom line is, it all comes down to the proficiency of the therapist. If they look at patients as textbook sets of symptoms who all need the same thing, no progress is going to be made. However, if they change their style to meet each patient’s needs, looking at them as a human being, it makes all the difference. This kind of care could benefit everyone, from the most resistant BPD patient to the scared college student. Therapists just have to be willing to try.
3. Current State of Research Paper
I’m getting there. I need more sources, which I will gather. A lot of my arguments are based on personal experience, which I guess I’m proud to say I have a lot of. I’d also like to get more patient’s opinions rather than therapists describing patients’ experiences. I think the patient perspective is very important, I mean, they’re the ones we’re treating after all. But I feel like some of this, with revision, is going to go directly into my paper. The information I’ve found so far has been fascinating, and I’m both excited and terrified to fall further down the DBT rabbit hole. Wish me luck, maybe send me a rope or something so I can get out eventually.
Rowan Counterintuitive 