The treatment helps patients strike a balance between accepting their problems and working to change them for the better.

By Amanda MacMillan
October 11, 2018

Selena Gomez is seeking treatment for both her physical and mental health. The singer was hospitalized twice within the last few weeks, according to People, both times for low white blood cell counts. Gomez has lupus, and her current blood-cell irregularities may be a side effect of the kidney transplant she received last year.

While she was in the hospital, a source told People, the 26-year-old also suffered a panic attack. Gomez has previously sought treatment for anxiety and depression, and she decided once again to get help. “She has had a tough few weeks and the panic attack in the hospital was the tipping point,” said the source.

Gomez is reportedly undergoing dialectical behavior therapy (DBT), a type of talk therapy that helps people identify and change negative thinking and behavioral patterns. Health spoke with Adam Carmel, PhD, clinical assistant professor of psychology at the University of Washington, to learn more about this type of treatment.

What is dialectical behavior therapy?

DBT is a type of cognitive behavioral therapy (CBT), also known as psychotherapy or talk therapy, that teaches people new ways of regulating their emotions and tolerating distress, says Carmel, who has not treated Gomez. “It incorporates a lot of mindfulness," he says, "and skills for being able to control your thoughts, rather than your thoughts controlling you."

That may sound pretty vague, but DBT is actually very structured. It was designed as a yearlong program and includes weekly group appointments, weekly individual meetings, and phone coaching with a therapist between sessions. Patients learn specific techniques for coping with painful or stressful situations, which they can call upon indefinitely, even after they’ve completed the program.

“You can make a big difference in someone’s life in just a year,” says Carmel. “Sometimes people come back for a refresher after their initial treatment—but generally, after going through the program, they have a lot of skills to be able to cope effectively with a crisis and to communicate more effectively in relationships.”

This type of treatment isn't new to Gomez. Last year, she told Vogue that she'd been seeing a therapist five days a week, and that "DBT has completely changed my life."

What do DBT sessions entail?

The term “dialectical” is a reference to opposing forces. In the case of DBT, those forces are acceptance and change. During DBT sessions, patients learn to strike a balance between accepting their struggles and actively working to change them for the better, says Carmel.

These goals are targeted in several different ways. For example, therapists teach mindfulness exercises to help patients be fully aware and present in the moment and techniques to tolerate pain in difficult situations. “We’re not saying that you have to like where you’re at,” says Carmel. “But sometimes just fully seeing that it’s happening can be a way to get through it—we call that radical acceptance.”

At the same time, DBT therapists help patients communicate more effectively with people around them—like asking for help and saying “no” when they need to—and decrease their vulnerability to feelings of pain and rejections. They can also help them change their patterns of impulsive behavior and intense emotional reactions.

One technique taught in DBT is self-soothing, which involves using the five senses to de-stress. This could involve listening to soft, peaceful music, eating a favorite meal, or taking a bubble bath, for example. Hot and cold temperatures can also be used in various ways to regulate the body’s stress response.

“A lot of times, people who come to DBT don’t have a lot of ways to regulate their emotions,” says Carmel. “If you teach them crisis survival skills, they learn better ways to cope, and they can get through that crisis without making things worse.”

Who should try DBT?

Originally, DBT was developed to treat suicidal people who were diagnosed with borderline personality disorder. It’s considered the gold standard of treatment for BPD, but it’s also sometimes prescribed for people struggling with self-harming behaviors, substance abuse, depression, post-traumatic stress disorder, eating disorders, and other mental health problems.

In fact, DBT has been studied in more than 35 randomized controlled trials and has been shown to be effective for a variety of mental health conditions. “It’s often recommended for people who don’t respond to traditional treatments, and people who have trouble struggling with regulating their emotions,” says Carmel.

Not all therapists are licensed in DBT, but you can search for one in your area by visiting the DBT Linehan Board of Certification website. You can also talk to your primary care doctor or a mental health professional about whether this type of therapy—or another type of psychotherapy—might be helpful for you.

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