What is Dialectical Behavior Therapy?

Dialectical Behavior Therapy (DBT) is a therapy that was initially developed for the treatment of borderline personality disorder. It is a therapy that focuses on replacing impulsive actions with emotional skills, and can be viewed as a means to gain emotional intelligence skills. DBT comprises four main components: Mindfulness, Distress Tolerance, Emotional Regulation, and Interpersonal Effectiveness. Each category addresses essential coping skills that enhance life quality.

Mindfulness: The mindfulness segment of DBT comprises skills that help people connect to the present moment by noticing thoughts, emotions, and bodily sensations. Being grounded in the present moment enables us to respond to our stressors in ways that are aligned with personal values. Mindfulness aids people in being effective when managing triggers and helps us avoid becoming overwhelmed or engaging in unhealthy behaviors. With these skills, we can live with awareness, detach from difficult thoughts and emotions, and feel less judgmental towards ourselves and others.

Deficits/Problems Addressed: Lack of self awareness, unstable sense of self.

Distress Tolerance: The distress tolerance unit of DBT provides skills to utilize when experiencing intense emotions and challenging situations. Oftentimes, there are situations in which we are unable to fix or avoid issues that cause significant distress; distress tolerance skills help us tolerate these difficult situations that we cannot immediately change. Distress Tolerance skills help us manage crises and prevent us from engaging in impulsive or harmful behaviors that have short and long term consequences. Many of the skills focus on how to ride out intense waves of emotions and accept situations for what they are so we can move past feeling stuck or resentful.

Deficits/Problems Addressed: Catastrophizing, emotional meltdowns, engaging in impulsive behaviors (self-harm, substance use)

Emotional Regulation: Emotional regulations comprises skills that help us identify, understand, and reduce the intensity of our emotions. This module of DBT helps us understand how our emotions serve us and gives tools to decrease emotional suffering. Additionally, emotional regulation focuses on factors that can make us vulnerable to emotional instability and provides a map for how we can problem solve situations, sit with difficult emotions, and respond to struggles in effective ways that lead to less harm in our personal lives and relationships.

Deficits/Problems Addressed: Chronic feelings of emptiness or sadness. Emotional instability.

Interpersonal Effectiveness: The interpersonal effectiveness unit of DBT focuses on skills that help people learn how to communicate their needs assertively, set healthy boundaries, and manage conflict in a manner that helps maintain relationships. It focuses on how to be respectful to others when confronting difficult situations, self-advocating, and strategies for creating meaningful relationships.

Deficits/Problems Addressed: Relationship conflict, difficulty viewing conflict in a balanced manner, aggression, loneliness, isolation.

What does DBT therapy look like?

Individual DBT

Individual DBT sessions are a way to work with your therapist to deepen your understanding and application of DBT to your personal life. The therapist and clinician will review problematic behaviors, consider ways to effectively apply or improve DBT skills and use of DBT skills between sessions. Individual DBT sessions are intended to target (in order of concern) life-threatening behaviors, therapy-interfering behaviors, and quality of life interfering behaviors. Sessions targeted at life-threatening behaviors are intended to cope with stressors that increase urges/risk for suicide or self-harm. Sessions targeted at therapy-interfering behaviors are intended to cope with factors that may make treatment less effective or interfere with effective skills use. Sessions targeted at quality of life-interfering behaviors are intended to cope with the range of other factors which may impact a client’s life and require the use of DBT skills application (e.g., emerging stressors, relationship problems, risky behaviors, etc.); when life-threatening and therapy-interfering behaviors have been addressed, sessions focus on quality of life interfering behaviors and consider ways to apply DBT skills to help a client move toward developing a life worth living.

Group DBT

A core element of DBT is the DBT skills training group. Adding in a group component to the individualized work one is doing can be beneficial for a variety of reasons. DBT group provides a non-judgmental environment to learn from one another as individuals share their experiences with utilizing the skills, engage in skill practice with one another, as well as receive support and feedback. Skill acquisition in this context is so impactful because group members are watching their peers apply the DBT lessons in different ways, which allows members to have a greater understanding of how these skills can be useful in their lives. DBT skill groups differ from traditional support or process groups because the emphasis is on sharing content as it relates to specific DBT skill usage.

Who is appropriate for DBT?

DBT has been demonstrated to be effective for adolescents and adults who are struggling with managing intense emotions, which impacts their overall safety, functioning, and relationships. Although it was originally developed as a treatment for the symptoms of borderline personality disorder, including chronic self-injury and suicidality, DBT is also currently recommended to treat depression and other mood disorders, anxiety disorders, post-traumatic stress disorder (PTSD), eating disorders, and substance use disorders.

DBT skills can be effectively taught to individuals as well as to entire family systems to improve functioning by learning more helpful coping skills, rather than relying on unhelpful behavioral patterns that may have contributed to or maintained problems. Furthermore, those who have previously participated in or are still engaged in individual therapy may benefit from enrolling in a DBT group for additional opportunities to practice and generalize their skills with peers. The best results from DBT will come when individuals are fully committed to attending sessions regularly, making positive changes, and completing recommended practice/homework assignments.