Dialectical Behavior Therapy (called “DBT”) is a type of psychotherapy that was initially developed by Dr. Marsha Linehan. DBT was first created to specifically help individuals struggling with suicidal thoughts and behaviors as well as those diagnosed with borderline personality disorder. Borderline personality disorder is an emotion dysregulation condition that can sometimes develop as a result of traumatic or other extremely distressing life events. Although DBT is directly helpful in treating that diagnosis, it was also found to be beneficial for other concerns. Specifically, research has demonstrated that DBT – Dialectical Behavior Therapy can be effective for self-harm, substance abuse, impulsive judgment, managing emotions, and navigating volatile relationship patterns. DBT has origins within the philosophical idea of “dialectics.” This is the principle that opposite positions can each have truth and meaning. Dialectics help us see the grey areas and accept that multiple points of view can be valuable and interconnected. For example, one of the primary dialectics utilized in DBT is the idea of acceptance versus change. DBT teaches that we can both accept and love who we are while still seeking to make changes and improvements. Ultimately, DBT aims to help improve one’s motivation to make changes, as well as to provide coping skills and strategies that can eventually be generalized and used when under immense stress.
How does DBT work?
Dialectical Behavior Therapy (DBT) has borrowed and adapted many of its core concepts from a variety of evidence-based therapies. It is actually a variation of cognitive behavioral therapy (CBT), one of the most effective types of treatment for many concerns, especially anxiety-related difficulties. Although CBT works to connect your thoughts and behaviors, DBT emphasizes the influence of your emotions on your problems. Mainly, DBT focuses on effecting change while accounting for one’s safety and harmful urges. When engaging in Dialectical Behavior Therapy, it is especially important that you trust your therapist and feel understood. There are several methods of receiving DBT that can all be effective. The most strict or adherent form of DBT includes formalized programs with individual therapy as well as multiple types of group therapy. However, many individuals find it helpful to learn DBT in a less formalized way. For example, you may participate in a DBT group, receive structured individual DBT therapy, or simply learn about and practice DBT skills with your therapist in session. You should work closely with your therapist to determine if it would be best to participate in a formalized program versus a more integrated and individualized approach.
Regardless of the formality, Dialectical Behavior Therapy treatment generally involves structure and multiple stages. First, a client’s needs are prioritized based upon the most pressing and risky concerns. Suicidal behaviors or intense suicidal urges are addressed first, followed by self-injury or substance abuse. These difficulties are assessed and prioritized on a session-by-session basis before moving on to other skills and techniques. If these risks are not present, therapy is then focused on any struggles that could be getting in the way of one’s quality of life or ability to effectively engage in the Dialectical Behavior Therapy education. This is where the DBT skills are introduced. There are a variety of structured skills that target four different areas: mindfulness, distress tolerance, emotion regulation, and interpersonal skills. Mindfulness skills help to remain present, responsive, and expose ourselves to being with our emotions. These skills can decrease impulsive behavior and increase our ability to feel connected to our experiences. Distress tolerance skills are in place to make better decisions when feeling overwhelmed. For example, these skills can help decrease suicidal urges or other harmful urges. Emotion regulation skills provide a better understanding of how our feelings function and skills are geared towards helping to navigate our wants and needs in various relationships. These skills are useful for establishing boundaries, maintaining self-worth, and making effective connections.
Through learning and independently practicing the principles as well as the specific skills learned in the four areas of DBT, individuals usually feel more fulfilled, increase their self-respect, and achieve their individual goals.
Who can benefit from DBT?
DBT was originally developed by Dr. Marsha Linehan to help those struggling with suicidal thoughts and self-injurious behaviors. It became specifically geared for individuals diagnosed with borderline personality disorder, a mental health condition impacting one’s worldview, relationships, and ability to regulate emotions.
Although that was the original application of DBT, research has shown that it can also help with more generally impulsive or risky decision-making. DBT is an effective treatment for substance use, mood instability, unsafe or dangerous behaviors, intense anger, fears of abandonment, and patterns of unhealthy interpersonal relationships. DBT skills can even be useful for distracting from anxiety or generally managing emotions.
Do I have to be diagnosed with borderline personality disorder to benefit from DBT?
Definitely not. When you initially research DBT, you will see a lot of information about treating borderline personality disorder. However, DBT is helpful for a variety of other issues including suicidal thoughts or self-harming. Please refer to our “who can benefit from DBT” section for more information.
How frequent are the therapy sessions?
At minimum, therapy sessions should be weekly. However, work with your therapist to determine if longer or more frequent sessions would help further teach and reinforce the DBT approach.
Will I have to do “homework” outside of therapy?
Although not a requirement when participating in informal DBT, practicing the skills outside of therapy will be very important. Your therapist may give you worksheets or activities to do at home so that you can reap the maximum benefit of the skills and learn when and how to use them on your own.
Can I still benefit from learning DBT skills without being part of a formalized program?
Absolutely. In fact, research shows that participating in a strict program has almost no impact on achieving better outcomes as compared to less formal learning. Thus, learning DBT skills with your therapist can still result in noticeable improvements.