Any day of the week, you can find students interacting with their peers in classrooms, on athletic fields, at parties and pubs – and, increasingly, in group therapy.
One of the most popular groups at Rutgers University-New Brunswick is “Manage Your Mood,” based on the principles of dialectical behavior therapy, also known as DBT. The therapy, initially created to treat suicidal individuals with borderline personality disorder, has been adapted for a range of disorders – among them depression, anxiety, substance abuse, self-injury behaviors and eating disorders, all common among college students.
“I’m a big fan of DBT,” says Annmarie Wacha-Montes, a clinical psychologist with Counseling, ADAP, and Psychiatric Services (CAPS) at Rutgers University-New Brunswick. “Students often come in struggling. They have difficulty managing their emotions.” During the 12-week group (there are also six-week groups), Wacha-Montes says, most do better. “They stop bingeing and purging, abusing drugs and alcohol. They do better with schoolwork and relationships. People walk out saying life has changed for them.”
The Manage Your Mood groups, typically led by a clinical psychologist and social worker, last an hour and half and include about 10 students. Students work to identify and change unhealthy behaviors and negative thinking patterns. They are assigned homework to practice behavior skills, such as mindfulness and distress tolerance, and make them part of their lives.
“Many students say it’s like attending a class,” Wacha-Montes says.
CAPS offered its first DBT skills group three and half years ago. Since then, many staff members who provide DBT have received specialized training, and this semester CAPS is running six groups. Last year, more than 100 students participated in Manage Your Mood groups, Wacha-Montes says.
“What I like about DBT is there is a synthesis of helping students validate the emotions that they have, while pushing for positive change,” Wacha-Montes says. The term “dialectical,” she explains, comes from the idea that bringing together two opposites in therapy – acceptance and change – achieves better results than either one alone.
“Many attending DBT groups never learned how to understand their emotions and problem solve. They get overwhelmed and explode – or they bottle emotions up and engage in self-destructive behaviors,” Wacha-Montes says. “In group, students learn that emotions have something important to teach us.”Shireen Rizvi, an associate professor at the Graduate School of Applied and Professional Studies (GSAPP) at Rutgers, studied borderline personality disorder and DBT at the University of Washington under the mentorship of Marsha Linehan, who in the early 1980s developed the DBT treatment model.
“Therapy for a long, long time was stuck in the idea of talking about whatever is on the mind – not focused, skills-based learning,” Rizvi said. “The skills themselves, most would argue, improve long-term functioning. They are concrete, cognitive-behavioral skills that can be applied to almost any situation.”
Rizvi’s study of abbreviated DBT skills training in a university setting, published in the Journal of American College Health, found that participants in eight-week DBT sessions experienced significant gains in regulating their emotions, maintaining a positive mood and incorporating the skills into daily life.
Occasionally, Rutgers students are referred to GSAPP – which has one of the most extensive research and training clinics for DBT and borderline personality disorder in the tristate area – for more intensive treatment. Traditional DBT treatment includes weekly individual therapy, two-hour DBT skills training group, phone coaching and team consultation.
Rizvi recalls the case of a young woman in DBT who had been cutting herself for some time. She asked the patient for a commitment: refrain from self-harm behavior for six months. “The young woman had been in therapy before and she had talked with her therapists about why she cut, how she felt when she cut, but no one had ever asked her simply to stop.” The woman stopped cutting. “It was eye-opening,” Rizvi says. “And, in a sense, so tragic.”
Mike (not his real name), a Rutgers junior, came to DBT his freshman year after a binge-drinking episode landed him “in a ditch on the side of the road looking for a bottle.”
While working with Mike on issues related to alcohol, a CAPS counselor recommended he might find the Manage Your Mood group valuable.
“I have an apocalyptic mindset,” Mike says. “I tend to think the worst, that people are out to get me, cheat me out of something, and so I overreact – it’s especially bad when I’m drinking.”
In the DBT group Mike says he learned acceptance, patience and tolerance – and the difference between reaction and response. “I learned not to jump on a situation, experience or physical sensation, but to contextualize it,” he says.
This year, Mike signed on again for Manage Your Mood sessions after he found himself slipping back into old habits. “DBT skills are like a muscle,” Mike says. “If you don’t use them they’ll weaken.”
He is proud of the changes he’s made while at Rutgers. He’s remained substance free for nearly two years. His relationships have improved, particularly with his mother. “Mom likes to make suggestions about what’s good for me. I used to resent it and would blow up or shut down on her, “ Mike says. “Now, I understand that she does it because she wants the best for me. It’s not even a complex analysis. Just a different perspective.”