Dialectical Behavior Therapy (DBT) is a form of therapy meant to help vulnerable people to empower themselves. Developed by Marsha Linehan to treat suicidal women with Borderline Personality Disorder (BPD), this therapy is commonly used to treat people with PTSD, substance abuse and addiction disorders, and mood disorders as well.
Autistic folks can gain a lot from this from of this form of treatment. DBT uses validating environments to encourage self-driven change meant to improve individual quality of life. It helps us regulate our emotions and navigate social situations.
It gives us skills that equip us for effective self-advocacy.
Quickly, a disclaimer: Though this is a therapy aimed at altering behaviors, it is in no way about conversion or compliance. Instead, DBT focuses on acceptance and mindfulness to build a sense of self that is integrated and accountable, authenticity and imperfection that work together.
During its development as a therapy, DBT was shaped to avoid making people feel criticized or invalidated, something that causes great suffering in people with BPD. The changes encouraged in this treatment are largely driven by the person involved and are geared towards skill building and empowerment.
The Overlap Between Autism and BPD
Traits like emotional dysregulation and social difficulties are present in both. There is likely a biological component to this for both groups, meaning our brains are wired to be more vulnerable to emotional difficulties.
We’re also more vulnerable to things like rejection and experience higher rates of trauma, especially in our early years. In fact, while autism exists before the trauma is experienced, BPD is thought to be directly related to prolonged exposure to trauma, much like complex PTSD.
Another common component with both diagnoses is the increased tendency towards suicidal ideation or self-harm thoughts and behaviors. DBT was developed specifically to address these issues.
The Components of DBT
DBT was built on three tenents:
- Biosocial Theory – Some people are neurologically vulnerable to emotional dysregulation. Invalidating environments makes this worse. This can lead to self-harm, as the strong emotions have nowhere to go in the invalidating environment.
- Dialectical Philosophy – Two opposing forces cannot exist together without balance. Neither is complete without the other. Balance between the two forces heightens the effectiveness of each.
- Acceptance/Mindfulness – Acceptance practices include radical acceptance, distress tolerance, mindfulness, and emotional awareness. It’s a great practice for cultivating a solid sense of identity, an authentic self that allows the person to be flawed and still feel their worth.
There are several areas of focus in DBT that are used to establish lasting skills in a person’s life:
- Mindfulness — This is the act of noticing and being present and in the moment. This practice encourages us to gain understanding of our emotions and personhood through the purposeful act of awareness without judgement. Through this practice we can learn to identify how our needs are expressed by our bodies.
- Regulating emotions and distress tolerance — This is the practice of recognizing and managing emotions as they come up. Emotions are viewed as important parts of our humanity and our survival. By learning to recognize them, we are able to intervene on overwhelm earlier. This can help prevent overwhelm and gives us tools to avoid self-harm when we do become over-stressed. Giving ourselves productive outlets for even our toughest emotions is key to our well-being.
- Interpersonal Effectiveness — DBT teaches people about boundaries and how to gauge the intensity of a situation. For example, If a person asks a favor of me, and I don’t want to do it, I can say no. This is a low intensity situation, though it may feel differently. However, when a person ignores my no, they have increased the intensity, so the degree that I assert my no should increase. The ability to set and respect good boundaries is essential to healthy relationship building.
- Crisis Intervention — Part of DBT involves establishing care plans for when emotions do overwhelm. There are group and individual therapy environments geared towards learning and practicing these skills. Support is provided for moments of crisis as well, so that you don’t have to navigate challenging environments with brand new skills alone.
How This Applies To Autism
While developed with BPD patients in mind, the theories transfer to autism-specific issues. This focus on balance, awareness, nonjudgement, and calculated change can provide a structured, approachable way for autistic folks to unmask.
Acceptance and emotional regulation practices help us develop care plans to use as interventions when our emotions begin to get overwhelming. These include things like changing the environment to suit our sensory needs to prevent meltdown, as well as how to deal with a meltdown and the care required after having one.
Focusing on social navigation reduces the vulnerability autistics struggle with in social settings. The breakdown on boundary setting is especially helpful, as is the concept of wise mind. These concepts teach us to recognize red flag behavior and protect ourselves from those who target us. They can also help us navigate conflicts and prevent us from alienating people who are not abusive, but are still upsetting or misunderstanding us.
Improving our emotional and social lives will go a long way to protect us from self-harm and suicidality.
Do This Instead of ABA
The heart of DBT is the assumption that we are capable beings. Treatment is geared towards building up those capabilities and generalizing them outward, multiplying them through guided practice and mindful effort.
Linehan sought to dismantle the stigmas surrounding BPD and to humanize the people who needed these interventions. She built this treatment from within a world that wrongly assumed people with BPD were beyond help. Her research shows what can happen when people’s struggles are seen as valid, but not defining.
Her work has reshaped how we view BDP and has saved many lives.
Imagine what life would look like for an autistic kid exposed to Linehan’s mindset as they developed. Imagine the independence this could give to autistic adults– the healing potential, the stigma-busting power. This is a social support worth investing research and resources in.
Chapman A. L. (2006). Dialectical behavior therapy: current indications and unique elements. Psychiatry (Edgmont (Pa. : Township)), 3(9), 62–68.
Dudas, R. B., Lovejoy, C., Cassidy, S., Allison, C., Smith, P., & Baron-Cohen, S. (2017). The overlap between autistic spectrum conditions and borderline personality disorder. PloS one, 12(9), e0184447. doi:10.1371/journal.pone.0184447
Van der Kolk, B. A., Hostetler, A., Herron, N., & Fisler, R. E. (1994, December). Trauma and the development of borderline personality disorder. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/7533284
- Teenage Rebellion: An Autistic Teenager’s Guide to Revenge Through Self Care — March 13, 2020
- 10 Good Boundaries to Have as an Autistic Advocate so Haters Don’t Burn You Out — February 7, 2020
- Unemployable Part 2: An Autistic Woman Sticks to Her Plan Anyway — January 16, 2020