Dialectical Behavior Therapy (DBT)

Dialectical behavior therapy is a form of cognitive behavioral therapy (CBT) used to treat various psychological disorders including borderline personality disorder, trauma-related issues, anxiety, and depression. It was developed by researcher Marsha Linehan as a means of incorporating skills from Eastern mindfulness practices with Western psychotherapeutic concepts and philosophy.

At its core, DBT seeks to help people increase their psychological flexibility and build skills for coping with distress and managing emotions. It helps them learn how to balance change and acceptance through dialectics—a philosophical concept that involves two seemingly opposing ideas or views coming together to create a synthesis. The therapist helps the client bridge polarizing perspectives into a workable solution, which is often referred to as “the middle path” or “the wise mind.” 

The practice of DBT involves four skill modules: Mindfulness, Distress Tolerance, Emotion Regulation, and Interpersonal Effectiveness. Through learning these skills, clients can develop greater self-awareness, more adaptive coping mechanisms for dealing with stressors, improved communication skills for interacting with others in relationships, and the ability to make behavioral changes when needed. 

In addition to the skills modules mentioned above, DBT also includes general principles that guide therapy sessions. These include validating client experiences; providing guidance while still allowing autonomy; helping clients find meaning in their experiences; fostering collaboration between therapist and client; utilizing behaviorism techniques such as reinforcement, punishment and extinction; problem-solving techniques; improving communication between therapist and client; setting goals based on individual needs rather than just symptom reduction; accepting mistakes as part of the learning process; recognizing the possibility for growth even when progress seems slow or nonexistent; using praise to reinforce positive behaviors; emphasizing self-care over any other activity during therapy sessions; encouraging out of session practice of learned skills between counseling sessions outside of treatment sessions with loved ones or peers that can assist in recovery efforts or serve as a sounding board for clients when they need assistance in navigating difficult situations related to the skill sets gained during therapy work.

Additionally, psychoeducation around specific topics related to mental health can be used as needed throughout treatment, depending on individual issues presented by each person receiving services. 

Studies have indeed been conducted to assess the effectiveness of Dialectical Behavior Therapy (DBT) as a treatment for various mental health issues. A systematic review and meta-analysis published in 2015 and conducted by researchers at Oxford University, for example, concluded that DBT was an effective intervention for Borderline Personality Disorder (BPD). Other research has found DBT to be successful in decreasing symptoms of depression, improving social functioning, and assisting with anger management.

Multiple studies have also suggested that DBT can reduce self-harm behaviors among those with BPD and reduce anxiety symptoms among participants suffering from a generalized anxiety disorder. Additionally, numerous reviews have pointed out that when compared to other therapies, such as Cognitive Behavioral Therapy (CBT), there is evidence suggesting that DBT may be slightly more effective than CBT in reducing symptoms related to BPD. The efficacy of DBT has also been supported through randomized controlled trials, indicating the long-term benefits associated with this type of therapy over time.

Specifically, these studies suggest that individuals who undergo at least one year of treatment experience more significant improvements in overall psychological functioning compared to those who receive shorter periods of treatment or no treatment at all. Lastly, the results from the various research studies conducted on Dialectical Behavior Therapy (DBT) support its potential use as an effective therapeutic intervention for a wide range of mental health issues, including depression and anxiety disorders.

One of the key advantages of DBT is its focus on teaching essential skills, such as mindfulness, emotion regulation, distress tolerance, and interpersonal effectiveness. These skills help individuals better manage their emotions, navigate difficult situations, and improve their relationships.

Another significant benefit of DBT is its emphasis on validation and acceptance. Therapists using DBT provide nonjudgmental support and validation, creating a safe and empathetic environment for clients to explore their emotions and experiences. This validation can be particularly powerful for individuals who have struggled with self-acceptance and self-esteem issues. Overall, DBT’s skill-building and validation components make it a valuable therapeutic approach for those seeking to enhance their emotional well-being and lead more fulfilling lives.

DBT is recommended for individuals who are struggling with emotional dysregulation, impulsivity, and difficulties in managing their emotions and behaviors. It is effective in treating a wide range of conditions including:

• Borderline Personality Disorder (BPD)
• depression
• anxiety disorders
• substance abuse 
• eating disorders
• post-traumatic stress disorder (PTSD)

People who should consider DBT therapy often exhibit symptoms such as intense mood swings, self-harming behaviors, suicidal thoughts, and unstable relationships.

DBT is particularly beneficial for individuals who have not responded well to other forms of therapy or have experienced relapses in their mental health conditions. It offers a structured and skills-based approach that equips individuals with practical tools to cope with emotional turmoil and build healthier interpersonal relationships. Additionally, those who struggle with chronic feelings of emptiness, identity issues, and difficulties in regulating their emotions may find DBT therapy especially helpful in addressing these challenges and improving their overall quality of life.

Cognitive Behavioral Therapy (CBT) and Dialectical Behavior Therapy (DBT) are both widely used therapeutic approaches, but they have distinct differences in their focus and techniques. CBT primarily centers on identifying and challenging irrational or negative thought patterns and beliefs that contribute to emotional distress and behavioral issues. It helps individuals develop more adaptive thoughts and behaviors through cognitive restructuring. CBT is versatile and effective for a wide range of mental health conditions, including depression, anxiety, and phobias, making it a go-to choice for many therapists.

On the other hand, DBT was originally developed to address Borderline Personality Disorder (BPD) and focuses on emotional regulation, distress tolerance, interpersonal effectiveness, and mindfulness. DBT incorporates validation and acceptance techniques, creating a nonjudgmental therapeutic environment. It is particularly suited for individuals who struggle with intense emotions, impulsivity, self-harm, and unstable relationships. DBT’s emphasis on teaching specific skills for managing emotions and navigating difficult situations sets it apart from CBT, making it especially useful for those with complex emotional challenges.

Learn about DBT therapy techniques, here! 

DBT can be conducted online or in person, offering flexibility to meet each individuals’ needs. Online DBT provides comprehensive access to therapy, including individual sessions and group skills training, making it a practical option for those unable to attend in person. The choice between online and in-person DBT depends on personal circumstances and preferences.

DBT (Dialectical Behavior Therapy) addresses self-harm and suicidal behaviors through a targeted approach that includes:

1. Validation: Recognizing and acknowledging the person’s feelings and experiences without judgment, helping to build trust and understanding.
2. Skill Development: Teaching and practicing skills in mindfulness, emotion regulation, distress tolerance, and interpersonal effectiveness to manage intense emotions and reduce urges to self-harm or engage in suicidal behaviors.
3. Behavioral Analysis: Examining the events and thoughts leading up to self-harm or suicidal incidents to understand and interrupt these patterns.
4. Crisis Intervention: Providing strategies for effectively managing and surviving crisis situations without resorting to self-harm or suicidal actions.

DBT emphasizes creating a life worth living as a fundamental goal, helping individuals develop coping mechanisms that promote safety, stability, and well-being.

Phone coaching in DBT offers real-time support for clients to apply learned skills during crises or challenges outside therapy sessions. It’s a brief, focused interaction that reinforces skill use in everyday situations, enhancing the client’s ability to cope effectively and independently.

Some common misconceptions about DBT (Dialectical Behavior Therapy) include:

1. It’s only for borderline personality disorder (BPD): While DBT was initially developed for BPD, it’s effective for a wide range of mental health issues, including depression, anxiety, eating disorders, and substance abuse.
2. DBT is just a type of CBT: Though DBT is rooted in cognitive-behavioral principles, it uniquely incorporates mindfulness and dialectical strategies, focusing on acceptance and change.
3. DBT is all about group therapy: While group skills training is a core component, DBT also includes individual therapy, phone coaching, and consultation teams for therapists.
4. DBT therapy takes too long: The length of DBT can vary based on individual needs; some people may see significant improvements in a relatively short period.
5. DBT is only for adults: DBT has been adapted for different age groups, including adolescents, with specialized programs addressing their unique needs.