What is Dialectical Behavior Therapy (DBT)?
Dialectical Behavior Therapy (DBT) is a type of cognitive-behavioral therapy (CBT) that was developed by psychologist Marsha Linehan in the late 1980s. DBT was originally created to treat individuals with borderline personality disorder (BPD), but has since been adapted for use with a variety of other mental health diagnoses, including depression, anxiety, PTSD, eating disorders, and substance use disorders.
Key Features of DBT:
Dialectical Philosophy:
The term "dialectical" refers to the concept of finding a balance between opposites. In DBT, this often means the balance between acceptance and change. The therapist helps the client accept themselves as they are while also working to change harmful behaviors and thought patterns.
The central dialectical idea in DBT is that two seemingly opposing things can be true at the same time. For example, a person may feel low motivation, but at the same time, continue . This concept can help individuals balance acceptance of their current struggles while helping to motivate for improvement.
Skills-Based Approach: DBT teaches clients four core sets of skills to help manage intense emotions, improve relationships, and navigate distressing situations. These skills are learned in individual therapy, skills training groups, and through phone coaching with therapists.
The four main skills taught in DBT are:
Mindfulness:
Mindfulness skills help individuals become more aware of their thoughts, feelings, and surroundings in the present moment. This helps clients stay grounded and focused, reducing impulsive reactions and increasing emotional regulation. Mindfulness involves observing, describing, and participating in the present experience without judgment.Distress Tolerance:
Distress tolerance skills teach individuals how to tolerate and manage intense emotions or crisis situations without resorting to harmful behaviors (e.g., self-harm, eating disorder behaviors, substance use). These skills include techniques like distraction, self-soothing, TIPP (temperature, intense exercise, paced breathing, and paired muscle relaxation) and radical acceptance (fully accepting reality as it is, even if it is painful).Emotion Regulation:
Emotion regulation skills focus on understanding and managing emotions more effectively. This includes recognizing and labeling emotions, increasing positive emotions, and decreasing vulnerability to negative emotions (e.g., by engaging in healthy activities and creating a balanced lifestyle).Interpersonal Effectiveness:
Interpersonal effectiveness skills help individuals improve their relationships with others by teaching assertiveness, setting boundaries, and communicating needs clearly and respectfully. These skills help clients navigate conflicts and avoid damaging behaviors, such as people-pleasing or aggression.
Validation: A key component of DBT is validation, where therapists help clients acknowledge and validate their emotions and experiences. Validation doesn’t mean agreeing with everything the person says or does, but it shows understanding and empathy for their internal experience. This approach helps build trust and a therapeutic relationship and reduces emotional escalation.
Individual Therapy + Skills Training: DBT typically involves a combination of individual therapy sessions and group skills training. In individual therapy, the therapist works with the client on specific problems they are facing, helping them apply DBT skills to real-life situations. In group skills training, the client learns and practices the core DBT skills in a supportive group setting.
Phone Coaching: DBT therapists offer phone coaching outside of regular therapy sessions to help clients apply skills in real-time situations. This support is especially useful when the client is facing a crisis or experiencing intense emotions, allowing them to reach out to their therapist for guidance on how to cope in the moment.
Structured, Collaborative Approach: DBT is structured, but it is also collaborative. The therapist works alongside the client to set goals, develop treatment plans, and tailor interventions based on the client's needs. This collaborative aspect is particularly important because many individuals with the conditions treated by DBT may have difficulty trusting others or may struggle with treatment engagement.
Who Benefits from DBT?
DBT was initially developed to treat individuals with borderline personality disorder (BPD), a condition characterized by intense emotions, difficulty in maintaining stable relationships, a fear of abandonment, impulsive behaviors, and self-destructive tendencies (such as self-harm). However, it has since been adapted to treat a variety of other conditions, including:
Suicidal ideation and self-harm: DBT is particularly effective for individuals who engage in self-destructive behaviors or who have frequent suicidal thoughts.
Mood disorders: DBT has been found helpful for treating conditions like depression and bipolar disorder, especially when the person experiences intense mood swings.
Anxiety disorders: Individuals with anxiety, especially those with complex anxiety or trauma, can benefit from DBT’s emotion regulation and distress tolerance skills.
Post-traumatic stress disorder (PTSD): DBT can help individuals who have experienced trauma manage emotions, triggers, and the stress associated with traumatic memories.
Eating disorders: DBT has been adapted for eating disorders, helping individuals develop healthier relationships with food, body image, emotions and more.
Substance use disorders: DBT is also effective for people struggling with substance use, as it teaches emotion regulation and coping skills that reduce the need to self-medicate.
