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Effectiveness

Dialectical Behaviour Therapy (DTB) is an inclusive and evidence-based treatment commonly used on Borderline Personality Behavior (BPD). The most significant patient population with the disorder has the most empirical support. It consists of parasuicidal women with BPD, depressed adult patients, individuals using substances, and individuals experiencing binge-eating disorder (Flynn, 2021). DTB has various similarities as compared to other cognitive-behavioral therapies. However, various critical elements must be placed when it comes to implementing the therapy on patients. Such elements include serving the five functions of treatments, biosocial theories, consistent dialectical psychology, mindfulness, and acceptance-oriented interventions. The work of Marsha Linehan is what prompted the use of DTB as she was researching ways of helping suicidal mothers (Brinton Clerk, 2018). Through science and practice, Marsha was able to develop a long-term solution of helping patients accept their emotions, themselves, and the world around her. Her work managed to culminate a comprehensive, evidence-based cognitive-behavioral treatment for BPD.

On the other hand, Acceptance and Commitment Therapy (ACT) is the most current psychotherapy that has, over the years, attracted various research and clinical interests. The methodology mainly treats test anxiety, depression, social anxiety, workplace stress, and obsessive-compulsive disorder (Hacker et al., 2016). It is termed an action-oriented methodology to psychiatric therapy that comes from traditional behavioural therapy and cognitive behavioural therapy. ACT aims at making patients stop being in denial and helps them in their inner struggles with their emotions (Arch et al., 2012). It further helps them accept the deeper feelings that are appropriate responses of specific situations that will assist them in moving forward with their lives. With such an understanding, patients will be more willing to accept the hardship and issues they are facing and commit to making the necessary changes in their behaviour. This paper aims at analyzing the effectiveness, similarities, criticisms, and differences between DTB and ACT to distinguish which is the most effective.

According to Heydari et al. (2018), ACT has over the years been proven to be effective in various disorders, including depression and anxiety. The method focuses on increasing psychological flexibility, which increases mental the health of individuals. Psychological flexibility, in this case, can be termed as the aptitude of one to acknowledge and embrace a wide range of situational demands and shift mindsets when the strategies compromise their personal and social functioning. ACT has various essential components that emphasize on patients to take different steps that can help them accept their issues and perceive less stress and anxiety, which significantly enhances individuals' health (Gloster et al., 2020). The method is viewed as a limit range in that it creates the skill for a real-world choice among different alternatives that are more pertinent. ACT also attempts to increase the psychological acceptance of a patient in regards to their subjective experiences like stress and further decreases ineffective control practices. Additionally, patients using ACT are taught various actions that they can use to prevent and control the unwanted mental experiences which exacerbate them (BT, 2016). Therefore, the therapy works in that it makes the experience ultimately acknowledged without any interior or external reactions to eliminate them. Mental experiences which patients may experience include aspects like frustrations, chronic sadness, loneliness, and emotional ambience. ACT also motivates patients to act dutifully to the values and actions they have recognized with adopting the mental involvements.

Criticism of The Two Therapies

DBT, on the other hand, works by improving symptoms for patients with BPD during the initial phase of treatment may be shadowed by a treatment period, which is usually 12 months (Chapman & Owens, 2020). Various research and experiments that have been conducted have demonstrated that there have been reduced cases of suicidal thoughts and self-injuries among patients using DBT during their hospital stay. DBT mainly works with five phases and defines the initial phase of therapy. The main focus of the steeps is for easy and strong obligation for therapy from the patient. According to Stiglmayr (2014), there has been a significant decrease in self-reported depressive symptoms and BPD during the initial phase. Individuals should, however, note that the initial phase should be included for more extended periods for some cases. Thus, the information of the obtainability and accessibility of therapy even after long durations may significantly help in the improvement of the symptoms. Therapists also use various strategies to ensure that their methods make positive progress. Such strategies include weekly long-hour individual therapy, weekly group training sessions, telephone consultation, and weekly therapist consultation (McMain et al., 2018). Various research and experiments results have supported the therapy's effectiveness relative to the treatment as usual for decreasing self-injurious treatments and behaviours among BPD patients. Some of the recent MTA analyses have further demonstrated that DBT is linked to medium to significant effects in terms of improvements when it comes to anger and mental health.

With the increased popularity of ACT as a treatment for various disorders, various criticism of the method has been criticised. Some criticisms have argued that it provides relatively minor variations than traditional Cognitive-Behavioural Therapy (CBT). Such aspects, according to opposers, may not guarantee the prevalent of clinical and research that the treatment is effective (Gaudiano, 2011). Secondly, the method focuses on changing the contexts and functions of the behavior. Although ACT carries forward the behavioural therapy tradition, it disregards its primary commitment to first-order change. Additionally, it embraces more conceptualizing assumptions and intricate change strategies. Thirdly, the technique used does originate from basic science research (Decou & Carmel, 2020). There are significant differences between the actual techniques used and the primary research science. When one analyzes the standard techniques developed in ACT, none of them is linked to basic science laboratories. The fourth criticism is that the component analysis studies do not support it (Whittingham & Coyne, 2019). Component analysis often attempts to define the efficacy of the multi-component treatment through isolating and systematically testing the impacts of its elements separately. The studies for ACT have unsuccessfully been able to find support for the implication of direct cognitive change strategies. ACT methods can neither be supported nor refuted since the cognitions may change without focusing on the treatment methods. Additionally, the cognitive components are not essential for cognitive changes.

Similarities of DBT and ACT

Although few, there are various critics when it comes to DBT. The first critique is that although it was initially developed to treat patients with BPD, it has over the years become ineffective for other mental illnesses. Additionally, some individuals who might have benefited from dialectical behaviour therapy believe that it is complex, and therefore, they are unwilling to try the treatment (Valentine et al., 2020). DBT does not also involve any trauma processing. Therefore, it should not be considered a stand-alone treatment for trauma. The basis of the treatment is also rooted in mindfulness practice that is solely based on Zen’s philosophies. Therefore, individuals from other religions like Muslims, Christians, and jews may object to some aspects of the treatment based on eastern religious philosophies. Secondly, each individual is different (Valentine et al., 2020). Therefore, they will have unique needs in regards to mental health treatment. Although it has been proven to be initially effective, it does not imply that it will resonate with each individual diagnosed with BPD. The same case applies to individuals diagnosed with other mental health disorders since the therapy may be effective for some while ineffective for others.

Both ACT and DBT therapies are considered effective methods of treating depression. Each form of the two enables individuals to tackle the idea of suffering head-on and further avoid suppressing both unpleasant and uncomfortable feelings (Harris, 2019). Both promote psychological flexibility and encourage patients to behave effectively and consciously towards their lives while choosing the direction required for their growth. Both practices are mindful and play a significant role in ensuring that individuals are well aware of their goals, values, and emotions. Secondly, both methods have been described as the third wave of Cognitive-behavioral therapy, consisting of mindfulness-based cognitive therapy and integrative behavioural couple therapies. The new set of therapies is considered to have focused their commitments towards empirical evaluation and science (Luoma, n.d). The third wave has the aptitude of helping individuals change their relations to private experiences instead of changing the form, situational sensitivity, and content of such experiences. The two therapy methods also focus on being effective in the lives of patients and helping them learn to feel valuable in their lives (Klein et al., 2012). Another similarity among the two is the notion of suffering among patients that are perceived as a product of trying to avoid and suppress uncomfortable attachments and experiences to rules on how things are supposed to work (Luoma, n.d). They also emphasize creating a life that is viewed as being valuable, worth living, and integration of changes and acceptance. Both treatments utilize functional analysis, experimental exercises, and metaphors to assist their patients in reframing their experiences (Krawitz & Miga, 2017). They also have specific strategies that help make them unique and target functional classes of internet behaviours of their clients. Another similarity is they both emphasize the transaction between the behaviour of the patient and therapists and the parallels that exist between clients during the session and outside the sessions. They target the client’s in-session behaviour and utilize it to strengthen the behaviours that are useful and can be generalized to the natural environment. The two also use self-disclosure more moderated fashion and for additional purposes (Shumlich, 2017). Lastly, the exercises suggested in bot therapies encourage developing the "what if" skills that enable patients to handle various challenges they face effectively. They both offer procedures that directly target behavioural, cognitions, and emotions. As a result, they can unify the mindful-base strategies to assist the patient in achieving acceptance and improving their dysfunctional behaviours.

There are variations between ACT and DBT. The first difference is DBcesT tends to lean more on an educative approach, whereas ACT emphasizes the experimental ones. Regarding various perspectives, DBT embraces a more biosocial perspective on behaviour, whereas ACT embraces a more contextual behavior (Palmer & Birchall, 2015). Additionally, the underlying philosophy that forms the foundation of the two therapies is different. The philosophy that focuses on DBT is dialect since it uses both logical reasoning and analysis, whereas ACT's philosophy is functional contextualism (Shumlich, 2017). The second difference is that they both use different methods to treat anxiety. ACT mainly uses acceptance and diffusion as practical tools for coping with threat-related thoughts. CBT, on the other hand, uses cognitive restructuring. It mainly focuses on dealing directly with the surface-level threats appraisals to modify the behaviours of patients (Westrup, 2014). The ACT model tends to counter anxious thoughts by judging and modifying the content, which intensifies the struggle of riding oneself from anxious thinking.

Another difference is that DBT mainly focuses on helping the patient find a balance between change and acceptance. Patient and the therapist work towards finding new methods of addressing their unhealthy behaviours and thoughts by developing new and effective coping methods. With the improved new methods, individuals can easily avoid dangerous behaviours in the long term, which will assist them in their road to recovery (Shumlich, 2017). On the other hand, ACT helps patients re-discover how their actions and thoughts may conflict with their goals and objectives in life (Rivzi & Roman, 2017). Therapists, in this case, use different examples and cases to demonstrate how the patient can establish healthier relationships between their memories, thoughts, and feelings.

Conclusion

Both therapy methods have, over the years, proved to be effective and have their limitations and advantages. However, the most effective method that can be used is ACT. Present studies have been able to analyze and compare the effects of the individualized treatments provided by various therapists based on ACT and DBT. The research proved that more patients reported better symptom improvement when it came to ACT as compared to DBT. On the other hand, CBT is more capable of improving the self-confidence of patients more rapidly than ACT. However, ACT  improved acceptance than DBT. Although improvement is guaranteed when using both methods, ACT is a highly viable treatment, especially when it comes to anxiety disorders. 

References

Arch, J. J., Wolitzky-Taylor, K. B., Eifert, G. H., & Craske, M. G. (2012). Longitudinal treatment mediation of traditional cognitive behavioral therapy and acceptance and commitment therapy for anxiety disorders. Behaviour Research and Therapy, 50(7-8), 469-478. https://doi.org/10.1016/j.brat.2012.04.007

Brinton Clarke, L. (2018). Dbt. The Oxford Handbook of Dialectical Behaviour Therapy, 532-544. https://doi.org/10.1093/oxfordhb/9780198758723.013.62

BT, A. (2016). Biochemical effect of artemisin-based combination therapy (ACT) antimalarial drugs on enzymatic antioxidants in pregnancy. Advances in Clinical Toxicology, 4(1). https://doi.org/10.23880/act-16000151

Chapman, A. L., & Owens, L. (2020). Mechanisms of change in dialectical behavior therapy. The Handbook of Dialectical Behavior Therapy, 51-69. https://doi.org/10.1016/b978-0-12-816384-9.00003-8

DeCou, C. R., & Carmel, A. (2020). Efficacy of Dialectical Behavior Therapy in the Treatment of Suicidal Behavior. The Handbook of Dialectical Behavior Therapy, 97-112. https://doi.org/10.1016/b978-0-12-816384-9.00005-1 

Flynn, D., Kells, M., & Joyce, M. (2021). Dialectical Behavior Therapy: Implementation of an Evidence-based Intervention for Borderline Personality Disorder in Public Health systems. Current Opinion in Psychology, 37, 152-157. https://doi.org/10.1016/j.copsyc.2021.01.002

Gaudiano, B. (2011, January 1). (PDF) Evaluating Acceptance and Commitment Therapy: An Analysis of a Recent Critique. ResearchGate. https://www.researchgate.net/publication/275724336_Evaluating_Acceptance_and_Commitment_Therapy_An_Analysis_of_a_Recent_Critique

Gloster, A. T., Walder, N., Levin, M. E., Twohig, M. P., & Karekla, M. (2020). The Empirical Status of Acceptance and Commitment Therapy: A Review of Meta-analyses. Journal of Contextual Behavioral Science, 18, 181-192. https://doi.org/10.1016/j.jcbs.2020.09.009

Hacker, T., Stone, P., & MacBeth, A. (2016). Acceptance and Commitment Therapy – Do we Know Enough? Cumulative and Sequential Meta-analyses of Randomized Controlled Trials. Journal of Affective Disorders, 190, 551-565. https://doi.org/10.1016/j.jad.2015.10.053

Harris, R. (2019). ACT Made Simple: An easy-to-Read Primer on Acceptance and Commitment Therapy. New Harbinger Publications.

Heydari, M., Masafi, S., Jafari, M., Saadat, S. H., & Shahyad, S. (2018). Effectiveness of Acceptance and Commitment Therapy on Anxiety and Depression of Razi psychiatric Center Staff. Open Access Macedonian Journal of Medical Sciences, 6(2), 410-415. https://doi.org/10.3889/oamjms.2018.064

Klein, A. S., Skinner, J. B., & Hawley, K. M. (2012). Adapted group-based dialectical behaviour therapy for binge eating in a practicing clinic: Clinical outcomes and attrition. European Eating Disorders Review, 20(3), e148-e153. https://doi.org/10.1002/erv.2165

Krawitz, R., & Miga, E. M. (2017). Cost-effectiveness of dialectical behaviour therapy for borderline personality disorder. The Oxford Handbook of Dialectical Behaviour Therapy, 496-514. https://doi.org/10.1093/oxfordhb/9780198758723.013.41 

Luoma, J. (n.d.). Differences/Similarities between ACT/DBT. https://contextualscience.org/differencessimilarities_between_actdbt

McMain, S. F., Chapman, A. L., Kuo, J. R., Guimond, T., Streiner, D. L., Dixon-Gordon, K. L., Isaranuwatchai, W., & Hoch, J. S. (2018). The Effectiveness of 6 Versus 12-months of Dialectical Behaviour Therapy for Borderline Personality Sisorder: The Feasibility of a Shorter Treatment and Evaluating Responses (FASTER) Trial Protocol. BMC Psychiatry, 18(1). https://doi.org/10.1186/s12888-018-1802-z

Palmer, B., & Birchall, H. (2005). Dialectical behaviour therapy. Handbook of Eating Disorders, 271-277. https://doi.org/10.1002/0470013443.ch16

Rizvi, S. L., & Roman, K. M. (2017). Dialectical behavior therapy. Oxford Medicine Online. https://doi.org/10.1093/med/9780199997510.003.0016 

Shumlich, E. J. (2017). Dialectical Behaviour Therapy and Acceptance and Commitment Therapy for Eating Disorders: Mood Intolerance as a Common Treatment Target. Canadian Journal of Counselling and Psychotherapy /. https://file:///C:/Users/USER/Downloads/admin,+2ndProof-2905.pdf

Stiglmayr, C., Stecher-Mohr, J., Wagner, T., Meiβner, J., Spretz, D., Steffens, C., Roepke, S., Fydrich, T., Salbach-Andrae, H., Schulze, J., & Renneberg, B. (2014). Effectiveness of Dialectic Behavioral Therapy in Routine Outpatient Care: The Berlin borderline study. Borderline Personality Disorder and Emotion Dysregulation, 1(1), 20. https://doi.org/10.1186/2051-6673-1-20

Valentine, S. E., Smith, A. M., & Stewart, K. (2020). A Review of the Empirical Evidence for DBT Skills Training as a Stand-alone Intervention. The Handbook of Dialectical Behavior Therapy, 325-358. https://doi.org/10.1016/b978-0-12-816384-9.00015-4

Westrup, D. (2014). Advanced acceptance and commitment therapy: The experienced practitioner's guide to optimizing delivery. New Harbinger Publications.

Whittingham, K., & Coyne, L. W. (2019). Integrating Acceptance and Commitment Therapy with Other Interventions. Acceptance and Commitment Therapy, 377-402. https://doi.org/10.1016/b978-0-12-814669-9.00014-x 

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