What is Dialectical Behavior Therapy (DBT)?

DBT is a comprehensive, evidenced-based psychotherapy that incorporates mindfulness and acceptance with traditional cognitive behavioral therapy techniques.

Dialectical behavioral therapy (DBT) is a type of cognitive behavioral therapy (CBT) used to address borderline personality disorder and other mental health conditions. This treatment method helps people deal with difficult emotions and reduce struggles in their relationships by teaching them various coping skills in four main areas including mindfulness, distress tolerance, emotion regulation and interpersonal effectiveness.

What Is Dialectical Behavioral Therapy?

DBT is an evidence-based, comprehensive psychotherapy treatment program that uses a cognitive-behavioral approach. It helps people improve their ability to regulate their emotions, stay in the moment, effectively manage relationships and tolerate moments of distress.

By providing structure and improving coping skills, DBT helps enhance progress and deter problematic behaviors. DBT is a treatment that is focused on emotion and operates on the assumption that acceptance and change, two opposites in therapy, can be united together.

DBT is most commonly used to address borderline personality disorder and chronic suicidal behavior, but it can also be utilized to treat eating disorders, mood disorders, anxiety disorders and other mental health conditions. The entire duration of care typically lasts for at least six months.

Origins and History of DBT

Dialectical behavioral therapy originated from the work of psychology researcher Marsha Linehan at the University of Washington. Linehan developed DBT in the early 1990s while working with patients who were chronically suicidal and diagnosed with borderline personality disorder. Through research on various interventions and treatments for other mental health conditions, Linehan created evidence-based cognitive behavioral strategies that addressed suicidal behavior.

Linehan taught her patients different ways to react in various situations while stressing acceptance of their emotions and experiences. As acceptance was incorporated into treatment, a dialectical philosophy emerged where therapists needed to balance and unite acceptance and validation with interventions that promoted change. Linehan’s work resulted in a comprehensive behavioral treatment program for patients with borderline personality disorder.

Difference Between DBT and CBT

There are several differences between CBT and DBT. CBT focuses on changing a person’s irrational and maladaptive thought patterns that negatively impact their feelings and behaviors. DBT is a modified version of CBT that combines mindfulness and acceptance with traditional cognitive behavioral techniques.

CBT and DBT differ in the conditions treated, as CBT is typically used to treat individuals with anxiety, depression, eating disorders, addiction and social skills impairments, while DBT is most often utilized for borderline personality disorder and suicidal behavior. CBT can be used with children, teenagers and adults, while DBT is only used with adolescents and adults. CBT is usually conducted through weekly individual therapy sessions, while DBT uses other modalities such as individual therapy, skills groups and phone coaching. CBT is a short-term treatment, while DBT is a long-term treatment.

DBT Treatment Modalities

There are several DBT modalities, including:

1. Individual Therapy: Individual DBT therapy focuses on identifying and understanding maladaptive thoughts, feelings and behavior patterns. During individual therapy, new skills are taught and strengthened to help the client better regulate their thoughts and emotions. There is a strong focus on motivation, appropriate behaviors, engagement in treatment and minimizing behaviors that interfere with treatment.
2. Group Skills Training: DBT group therapy is typically undergone on a weekly basis to teach new skills of mindfulness, distress tolerance and interpersonal effectiveness. DBT group therapy also focuses on applying these skills in everyday life.
3. Phone Coaching: DBT phone coaching may occur between sessions if a DBT client is in the midst of crisis. Phone coaching helps support a person when they have difficulty coping with their symptoms. Phone coaching is most helpful during moments of crisis, heightened emotions and suicidal thinking when distress tolerance can be practiced.
4. Consultation Team: A DBT consultation team is a group of treatment providers who provide DBT. These teams attend weekly meetings to help build up and strengthen their skill sets. Consultation teams were developed to help prevent burnout in DBT treatment providers who work with high-risk individuals with intensified emotions.

How DBT Works

In DBT A person is taught how to accept their thoughts, feelings and experiences without judgment. Individuals learn how to focus on one thing at a time while being aware of their thoughts and senses. People develop the skill of identifying, verbalizing and understanding their emotions while observing, describing and experiencing them fully. Distress tolerance skills teach people how to accept and handle distress without acting impulsively to prevent distress from worsening in the long-term. Individuals learn about emotional regulation skills, which helps people understand, identify and handle emotional responses. Interpersonal effectiveness skills help people learn how to communicate with others with assertive communication. People also learn how to navigate and manage conflict that occurs in relationships.

DBT Skills

DBT skills are broken down into DBT modules to help people learn healthier ways to interact with their environment. Weekly groups teach and review how to apply these skills in everyday life.

The four modules of DBT include:

1. Mindfulness: DBT mindfulness teaches clients how to pay attention to and focus on the current moment while regulating attention. People are encouraged to observe, describe and participate in the moment in an effective and non-judgmental manner.
2. Distress Tolerance: DBT distress tolerance educates a person how to cope with crises without worsening them. People learn how to effectively accept a situation and find meaning in it while tolerating and working through distressing moments. Distraction, self-soothing, weighing the pros and cons and improving the moment in healthy ways are all techniques taught within this module.
3. Interpersonal Effectiveness: DBT interpersonal effectiveness educates individuals about healthy interpersonal relationships and teaches clients how to handle conflict and use assertive communication techniques. This module focuses specifically on interpersonal situations where the individual has to make requests of others or resist changes others are trying to make.
4. Emotion Regulation: DBT techniques for emotional regulation are taught to help people identify and work through negative emotions. DBT and emotional regulation help decrease a person’s emotional vulnerability by enhancing positive emotional episodes, increasing awareness of current emotions and employing distress tolerance techniques.

What to Expect During a DBT Session

Individuals often wonder what to expect in DBT therapy. DBT treatment is comprised of individual therapy sessions and group sessions where skills are taught and practiced. Individual therapy sessions are conducted with a DBT therapist who assists individuals with maintaining motivation, managing obstacles during treatment and applying skills learned in therapy into everyday practice.

DBT group therapy is conducted by a DBT therapist. Weekly sessions serve to educate people on the various DBT skills and allows them to practice and apply them in a supportive group setting. Sessions usually last for two hours. During group therapy, members are prompted to share their experiences and support each other. In many cases, homework is assigned to be completed between sessions and encourage the use of DBT skills in daily life.

Benefits of Dialectical Behavioral Therapy

Although DBT was originally developed to help high-risk women with borderline personality disorder and chronic suicidality, it is now used to help individuals with mental health issues that are associated with emotional dysregulation. Some of these mental health conditions include depression, eating disorders and addiction.

DBT helps people learn how to regulate intense emotions while reducing impulsivity and destructive actions. Skill modules and treatment modalities give providers an opportunity to adapt DBT to a wide range of mental health conditions, broadening who benefits from DBT.

Goals of DBT

DBT treatment goals seek to reduce maladaptive responses while encouraging healthy coping. DBT encourages mindfulness to counteract emptiness and disconnection from self and others, interpersonal skills to combat loneliness, emotional regulation to address overwhelming emotions and distress tolerance to curb impulsive and destructive behaviors.

DBT also attempts to increase the client’s overall quality of life. Other DBT goals and objectives include increasing confidence, self-esteem and motivation.

Effectiveness of DBT

The efficacy of DBT has been proven to address problems such as suicidality, self-harming behavior, depression, anger management, emotional dysregulation and anxiety. Enhancements with emotional regulation and assertive anger have accounted for positive outcomes with addiction, depression and socialization during DBT. These findings point to DBT effectiveness, as it enhances a person’s ability to practice healthy coping skills as well as show, experience and monitor extreme emotions.

DBT success rate is high in borderline personality disorder cases. DBT was the first treatment proven to be effective in treating borderline personality disorder in controlled research studies. DBT has a large body of research and is viewed as one of the best treatments for borderline personality disorder.

DBT in Addiction and Mental Health Treatment

DBT is known to help with the following mental health conditions:

• DBT for Addiction: DBT can be modified to help people who are living with addiction. DBT uses concepts and interventions to promote abstinence and decrease relapses. DBT in this setting can be used to decrease substance abuse, minimize physical discomfort, reduce urges and cravings and resist triggers. DBT skills are based on the premise of dialectical abstinence, which unites harm reduction and abstinence as important and co-existing in a person’s recovery.
• DBT for Borderline Personality Disorder: DBT was originally created to treat borderline personality disorder and focuses on teaching skills to help with emotional regulation. DBT seeks to address distressing emotional pain and reactivity. DBT also helps strengthen mindfulness, distress tolerance and interpersonal effectiveness skills in those with borderline personality disorder.
• DBT for Anxiety: DBT helps people with anxiety, as it provides them with mindfulness skills to help them live in the current moment. These skills make it easier for people to identify, understand and change the way that they feel. Individuals learn how to tolerate extreme feelings and moods to create more positive emotional experiences. DBT skills provide individuals with strategies to alleviate worries about the past or future by focusing on the present moment.
• DBT for Depression: DBT addresses depressive symptoms by empowering people to foster positive emotional experiences to improve the quality of their relationships and add happiness to their lives. DBT offers tools that people can use when feeling depressed, which helps empower them.
• DBT for Eating Disorders: Individuals with eating disorders can learn DBT skills to help them regulate and understand emotions that trigger them to engage in harmful behaviors. DBT sees restricting food, binging and purging as a poor way to cope with negative emotions. DBT teaches skills to help people learn how to effectively manage negative emotions.
• DBT for Bipolar: DBT assists people with bipolar disorder, as it teaches them skills for distress tolerance and managing emotions. Individuals can benefit from learning DBT skills to help them manage stressors that can reduce the chance of depressive or manic episodes.

Finding Dialectical Behavioral Therapy Near Me

There are several ways to find a DBT therapist. The Substance Abuse and Mental Health Services Administration (SAMHSA) has an online treatment finding tool where you can research inpatient and outpatient facilities to see if they offer DBT. You can also contact your insurance company to inquire about DBT treatment providers in your area. Finally, you can conduct an internet search to inquire about DBT therapy near me.

At The Recovery Village, we want to make sure our clients are receiving the most effective, cutting-edge treatments available for addiction and co-occurring disorders. That’s why we offer DBT at many of our centers. If you or a loved one are living with addiction and want to explore the ways DBT can aid in recovery, reach out to a representative at The Recovery Village today for more information.

Editor – Megan Hull

Megan Hull is a content specialist who edits, writes and ideates content to help people find recovery. Read more

Medically Reviewed By – Tracy Smith, LPC, NCC, ACS

Tracy Smith is a Licensed Professional Counselor, a Nationally Certified Counselor, an Approved Clinical Supervisor, and a mental health freelance and ghostwriter. Read more