Dialectical Behavioral Therapy skills in COVID-19 pandemic Context

Dear Editors:

COVID-19 (Coronavirus Disease 2019) has caused a huge impact on population´s mental health, with the onset of depressive/anxious/stressful symptoms with a moderate to severe intensity ⁽¹⁾. Before this, therapeutical interventions take a significant role in its approach. Dialectical Behavioral Therapy (DBT), is an intervention model aimed to find changes by means of acceptance strategies and leads  the consulting person to his/her personal goals⁽²⁾. Even though it is a first-choice treatment for people with emotional deregulation or limit personality disorders, it also contributes to the remission of depressive/manic symptoms in eating disorders, such as bulimia and posttraumatic stress disorder⁽³⁾.

One of the DBT components is skills training, which consist of group psycho- educational sessions where various strategies are presented to face situations or predicaments in an effective manner, in order to state new behavioral/emotional/cognitive patterns ⁽⁴⁾. Skills training is divided into four modules: a) full consciousness skills aimed to provide strategies for modulating attention, thus taking it to the present; b) emotional regulation skills, aimed to teach people to identify emotions caused by the environment and solve problems; c) interpersonal effectiveness skills, aimed to favor effective responses in social situations; and d) tolerance/discomfort skills, aimed to  prevent  emotional crisis and accept situations that cannot be changes⁽⁴⁾. Skills training, as a single intervention has proved to be effective for depression, attention deficit disorder, hyperactivity and binge eating⁽⁴⁾.

To date, there is no evidence about use of DBT skills in severe situations, as this pandemic. Despite of that, DuBose⁽⁵⁾ recommend to use all the skills in the current context, putting emphasis on full consciousness (mindfulness), radical acceptance and vulnerability reduction to the emotional mind (See Table 1).

Table 1. DBT Skills in the COVID-19 Pandemic context

Adapted from DuBose ⁽⁵⁾

In order to prevent COVID-19 outbreak, it is recommended to provide therapeutical interventions by means of virtual platforms, as these have proved to be effective⁽⁶⁾.

We consider use of these skills in a pandemic context is a novelty and –at the same time—it may be complicated. That is why we additionally recommend the practice of recognition of the internal experiences (emotions and thoughts) in a genuine manner and the effective resolution of problems. Skills related with a “wise mind”, that deals with the synthesis of emotional and rational experiences; “CUIDA”, which orients to the attention of physiological needs; and “opposed action”, which consists of acting in a different manner to non proportional impulses to the situation, and not helping to solve it.

References

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4. Valentine SE, Bankoff SM, Poulin MR, Reidler EB, Pantalone DW. The Use of Dialectical Behavior Therapy Skills Training as Stand-Alone Treatment: A Systematic Review of the Treatment Outcome Literature. J Clin Psychol. 2015;71(1):1–20.
   
5. DBT Skills in the COVID-19 Pandemic Behavioral Tech [Internet]. [citado 3 of julio of 2020]. Disponible en: https://behavioraltech.org/dbt-skills-in-the-covid-19-pandemic/
   
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