Selena Gomez, DBT, and Popular Conceptions of Mental Illness

According to reports from TMZ and People magazine, celebrity Selena Gomez is currently in a “mental health facility” after suffering an “emotional breakdown.” The performer has been open about her history of struggling with borderline personality disorder, and the relief she received from dialectical behavior therapy (DBT). This latest articles provide us an opportunity to examine how such issues are discussed in popular media.

“Emotional breakdown… we're told Selena had "a meltdown" and "freaked out."

Dramatic, vivid, headline grabbing… but also insensitive and belittling. It is true, however, that persons who have difficulties with emotion regulation (such as persons with borderline personality disorder) can experience discrete period of incredibly intense emotions, and have difficulty calming down. For persons unfamiliar with such experiences, it can be overwhelming to witness. The articles mentioned the presence of panic attacks as well, which can also be confusing and frightening to witness, if you do not understand what is happening.

We're told Selena is currently at an East Coast psychiatric facility and is receiving dialectical behavior therapy -- DBT. The therapy treats various mental health disorders. Selena has received DBT in the past. 

This seems to imply that DBT is a short intervention received in a hospital like setting, and conjures up images of something like electroconvulsive therapy. While DBT is commonly offered in inpatient mental health treatment centers, most DBT is conducted on an outpatient basis. Rather than a short term intervention, first time patients should commit at least a year. Presumably, Ms. Gomez has an outpatient DBT therapist. Time in the hospital would be focused on stabilization, and she could likely continue to participate in DBT while inside, but the majority of her DBT “work” would take place with her regular therapist.

Selena Gomez is seeking an unusual talk therapy treatment…

DBT is certainly not unusual. It is the gold-standard treatment for borderline personality disorder, with providers available in every major city. There are regional variations in popularity, but as the research evidence for DBT continues to grow, other less effective treatments will likely be gradually replaced by DBT.

…a therapy method designed to help identify, and then change, negative thinking and behavioral patterns.

This sounds like a generic description of therapies based in the cognitive-behavioral theories of human behavior. DBT does belong to this group, but so many other and very different forms of therapy.

DBT treatment focuses on acceptance and change as its ultimate goals.

Sort of, but it is complicated. These two concepts are not goals, because they are, in fact, opposites. You are not trying to achieve each, but balance each. The primary “dialectic” in DBT is the synthesis of acceptance and change. How do you accept yourself as you are, while also realizing you must change? Humans are complex, and can achieve this balance through work. That is what DBT focuses on.