The Need for DBT on Campus

A freshman in college sits in her dorm, swallowed by assignments and wanting some kind of escape. She gets a text from her boyfriend; there’s a party going on. That’s perfect, she thinks, I need a night where I don’t have to worry about anything. At the party, both she and her boyfriend get a bit carried away. Six shots isn’t that many, she thinks, trying to rationalize her consumption.

Afterwords, she gets in a fight with her boyfriend. She barely remembers what it was about, she just knows that she was incredibly hurt by some of the things he said. He called her worthless, saying that he was the only one who would ever like her. She didn’t realize he could get so nasty. After all this, she is much more stressed than before that night, and all the assignments are still there waiting to be done. She comes out of the experience with a lot of regret and no progress at all.

What this girl experienced is actually quite common. As a college student, I hear stories like this all the time. I once heard a fight like the one described above get physical outside my dorm. It was obvious the two students were drunk. A night that was supposed to be fun had gotten very dangerous very fast. It’s a common problem; student’s don’t know how to deal with the stress of college so they turn to parties and relationships without thinking, and it can actually hurt more than it helps.

The point of these stories was to give an example of a very common issue among college students called dysregulation. This can occur in many forms, the most prevelant among students being emotional dysregulation and relationship dysregulation. Basically, these aspects of student’s lives become unhealthy and stressful, causing negative effects on student’s lives. But there is a way to treat dysregulation, called Dialectical Behavior Therapy.

In its original, most intensive 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, when used most efficiently, is whatever dialectical behavior skills a person needs in order to improve her life.

Marsha Linehan (this information was relayed to me by Clearviewtreatment on borderlinepersonalitytreatment.com) found that five different types of dysregulation occur in patients with Borderline Personality Disorder (BPD). These are emotion dysregulation, interpersonal dysregulation, self dysregulation, behavioral dysregulation, and cognitive dysregulation. Each type reveals some sort of dysfunction in each aspect of a person’s life. DBT was created to treat this dysregulation, which, though commonly found in patients with BPD, can affect anyone at any time.

The website of Sierra Tucson describes four main principles of DBT: “1. The primacy of the therapeutic relationship, 2. A non-judgmental approach, 3. Differentiating between effective and ineffective behaviors, and 4. Dialectical thinking.” These principles, specifically the first two, apply to both patient and therapist, assuring that all parties are comfortable with and prepared for what is to come. The third and fourth dictate what the patient will learn. Dialectical thinking leads to radical acceptance by teaching patients to become aware of their own judgments and accept them, according to Rachel Gill of ilovedbt.com.

Four treatment modules go along with DBT’s principles: “1. Mindfulness, 2. Distress Tolerance, 3. Emotion Regulation, and 4. Interpersonal Effectiveness.” These go hand in hand with the principles, teaching patients through various methods to accept and handle the reality in front of them. Mindfulness leads to learning distress tolerance and so on, each skill building on the next, teaching patients how to handle their life’s dysregulation.

The workbook Don’t Let Your Emotions Run Your Life for Teens breaks down DBT perfectly to fit most people’s lifestyle. The book 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.

People with BPD struggle enough with everyday life. 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. However, we should supply them with the skills necessary to improve their daily lives.

College students who show many signs of dysregulation lead incredibly busy lives. None of us have 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.

This relaxed form of DBT would be absolutely perfect for college students, as previously stated. They suffer from serious dysregulation. But why?

At college, new students experience immense 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.” They struggle to manage new, unprecedented stress. Students who attempt to cope by delving into extreme parties or unhealthy relationships radically dysregulate.

Of course, there is the academic side of college, 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. College academics can get so stressful that experts write entire books on how to deal with said stress, such as “College Success” created by the Extended Learning Institute and Lumens Learning. But stress is not limited only to academics in college.

Many students know only the positive stories they’ve heard from their parents about “The College Experience” of decades ago. Talking about the “College Experience” as if there is a standard for activities in college does not help students in the least. Instead, pressure is put on them to achieve not only academically but also socially. The wild and sometimes-exaggerated stories set even more expectations for students to fulfill, so forced relationships and parties with unfamiliar and possibly unhealthy people occur. Non-organic interactions can cause dysregulation, as they did not happen naturally, they are forced, and they are unhealthy. Obviously, not all relationships and parties are inherently unhealthy or cause dysregulation, but it is important to consider 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. In those relationships and parties seen as part of the college experience, a good amount of dysregulation exists.

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. A student under almost constant stress who is not recieving help is bound to suffer from dysregulation. 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.

But of course there are naysayers. Therapists whose patients don’t improve with DBT complain that it doesn’t work in extreme cases of BPD and emotional dysregulation. In one case, Shireen L. Rizvi had a patient named Barbara whose condition was not improved, and whose disorder may have been worsened, by the improper application of DBT. Barbara had BPD, social anxiety, severe depression, PTSD, and was an abuse survivor. Rizvi’s treatment was incompetent.

Over the course of six months, Rizvi struggled to treat Barbara, later blaming her failure on the “therapy-interfering behaviors” of her patient such as asking her therapist very personal questions, calling her in crisis daily, and not making eye contact. Rizvi’s response to these behaviors is what makes her argument that DBT didn’t work here completely invalid. Rizvi admitted to outright ignoring some of Barbara’s behaviors in many ways. She failed to indulge in and therefore validate the behaviors. The very basics of DBT state that a patient must feel validated in order to receive treatment. Maybe partially answering a question or asking her why she didn’t make eye contact would have been an improvement. Rizvi instead 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) Rizvi’s 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 looked at Barbara and saw not a person but a set of symptoms: mistrust of authority, boundary blindness, disassociation, crippling anxiety. Well-administered DBT could have helped Barbara; her therapist did not.

Therapists 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. Barbara may fit the criteria for rigorous DBT, but would not be able to handle it. She 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 not only have given the therapy more meaning to her, but made her more receptive to it.

Another example of DBT failure is one I found on a forum for people with BPD. This time, we see the patient perspective on the issue. A user we’ll call Cabdriver gave a list of explanations on why DBT wasn’t working for him and how it was flawed. The list consisted of a combination of him not practicing his skills and his therapist punishing him for it. He found the skills boring and unhelpful, and would lie to avoid punishment and say that he did them when he hadn’t.

Therein lies the problem: a therapist should never punish a patient. Apparently, Cabdriver’s therapist would become irreverent or even take breaks from therapy when Cabdriver didn’t practice his skills regularly. This is probably an extreme case, but it is troubling. Again, I reference that one of the key principles of DBT is validation, and a patient cannot possibly feel validated if he is constantly fearing punishment. A person can’t fear his therapist; therapy is supposed to be a safe space where someone can admit to anything without judgement. He may be held accountable for his actions, but he shouldn’t have to fear a slap on the wrist. Patients are adults; treat them as such.

The solution here lies in both the patient and the therapist trying a bit harder. The therapist needs to try to convince Cabdriver that the skills are worthwhile, as the punishment approach is ineffective and downright patronizing. Maybe Cabdriver needs a new therapist altogether. But he also must realize that the skills are there to help him, and they aren’t as black-and-white as they seem. Cabdriver often said things along the lines of “Have a problem? Practice your skills!” However, “practice your skills” can simply mean applying a new approach to a situation or changing thinking. It doesn’t always mean “sit and be mindful and all the world’s problems will disappear.” In the end, everyone involved with DBT just has to be open minded and accepting, and go from there.

Obviously not all college students are Barbara or Cabdriver 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. Reluctant patients shouldn’t be completely immersed in the therapy, or shut out like failures. 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.” She can simply give skills that pull from DBT and mention the name, intriguing the patient. Patients who recognize the value of DBT are receptive patients.

Patients have to believe that the skills will help them, and that they can implement them successfully. Emotional validation, as Robins and Rosenthal say, is one of four core principles of successful DBT. The safer and more empowered a patient feels, the more likely they are to use therapy skills outside of the office, as I stated when giving cabdriver a solution. But of course, the person has to practice the skills in order for them to help. If someone completely ignores their skills and makes no progress, then what?  Successful therapists guide their patients through that process, from belief, to validation, to empowerment, to practice. The unsuccessful, who treat their patients like children throwing fits, drive patients away.

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.

So, with the right therapist, the correct form of DBT, and a little effort, college dysregulation can be a thing of the part. Obviously I’m not offering a magic way to make student’s problems go away; I simply want to offer them a healthy alternative to the common coping mechanisms. Parties and relationships can be great, but only when they are done right. Often they become stressful, defeating their purpose of trying to relieve stress. Teaching college students DBT would give them coping mechanisms that work for them and benefit them in every way. If the girl from the story had DBT, her life would be vastly improved. Hopefully in the future, we can give the proper help to her and all students like her.

Works Cited

@DbtPeers. “An Introduction to Dialectical Thinking According to DBT.” DBT Peer Connections. N.p., 18 Oct. 2013. Web. 21 Nov. 2016.

Clearviewtreatment. “Five Areas of Dysregulation in People with BPD – Borderline Personality Treatment.” Borderline Personality Treatment. N.p., 12 Oct. 2011. Web. 21 Nov. 2016.

“Dialectical Behavioral Therapy & Treatment – Clinical Excellence at Sierra Tucson.” Sierra Tucson. N.p., n.d. Web. 21 Nov. 2016.

Ed.D., Brian Harke. “High School to College Transition, Part 1: The Freshman Myth.” The Huffington Post. TheHuffingtonPost.com, 22 June 2010. Web. 06 Nov. 2016.

ELI (Extended Learning Institute at NOVA), Lumen Learning. “College Success.” Candela Learning. N.p., n.d. Web. 06 Nov. 2016.

Rizvi, Shireen L. “Treatment Failure in Dialectical Behavior Therapy.” Cognitive and Behavioral Practice 18.3 (2011): 403-12. Science Direct. 2011. Web. 13 Nov. 2016.

Robbins, Clive J., and Zachary Rosenthal. “Dialectical Behavior Therapy.” Acceptance and Mindfulness in Cognitive Behavior Therapy. John Wiley & Sons, n.d. Web. 30 Oct. 2016.

Shook, Nancy J., Debora A. Gerrity, Joan Jurich, and Allen E. Segrist. “Courtship Violence Among College Students: A Comparison of Verbally and Physically Abusive Couples.” SpringerLink. N.p., Mar. 2000. Web. 06 Nov. 2016.

User Cabdriver. “DBT: How Is It Working for You?” RSS. N.p., 19 Sept. 2010. Web. 23 Nov. 2016.

Van Dijk, Sheri. “Don’t Let Your Emotions Run Your Life for Teens.” Google Books. Instant Help Books, n.d. Web. 30 Oct. 2016.

Wechsler, Henry, George W. Dowdall, Andrea Davenport, and Sonia Castillo. “Correlates of College Student Binge Drinking.” American Journal of Public Health, n.d. Web. 06 Nov. 2016