Publication date: Available online 9 January 2019
Source: Cognitive and Behavioral Practice
Author(s): Lauren Bonavitacola, Alec L. Miller, Lata K. McGinn, Emma Zoloth
Abstract
Cognitive dysregulation, often characterized by extreme, nondialectical thinking, is a core problem area identified in dialectical behavior therapy (DBT) and is posited to contribute to pervasive emotional and behavioral dysregulation. However, cognitive flexibility is understudied and rarely considered a direct treatment target in DBT. This paper provides clinical guidelines for increasing dialectical thinking with patients in DBT. We review the historical context of dialectical thinking in DBT and present the results of a survey examining DBT therapists’ perspectives on nondialectical thinking as a treatment focus. We describe cognitive restructuring strategies from cognitive therapy models, and compare these with techniques targeting cognitive dysregulation in DBT. We highlight the rationale for incorporating dialectical thinking as a direct treatment focus in DBT, and offer strategies derived from cognitive restructuring to incorporate directly targeting dialectical thinking in conceptualization, treatment planning, and in session. These strategies are demonstrated with clinical vignettes and examples.