Dialectical Behavior Therapy (DBT)

What is Dialectical Behavior Therapy (DBT)?

Dialectical Behavior Therapy (DBT) is a form of Cognitive Behavioral Therapy (CBT) designed to help individuals regulate their emotions, build healthy coping strategies, and improve relationships. Initially developed to treat individuals with Borderline Personality Disorder (BPD), DBT is now widely used to address various mental health conditions, including mood disorders, self-harm, eating disorders, and chronic suicidal ideation. The term “dialectical” refers to the idea of balancing two opposing forces — acceptance and change — which is a core principle of DBT.

What to Expect from DBT Treatment?

Structured Therapy Program: DBT is usually offered in a structured format, combining individual therapy sessions with group skills training. The treatment focuses on helping individuals develop skills to manage intense emotions, reduce harmful behaviors, and improve their relationships.
Weekly Individual Therapy: In individual therapy, the focus is on personal issues, applying DBT skills to current challenges, and staying committed to treatment. The therapist helps the client balance the need for acceptance with the need for change, working collaboratively toward both goals.
Group Skills Training: Group sessions usually occur once a week and teach four essential DBT skill modules: mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness. Group training provides a supportive environment where clients can practice and refine their skills.
Phone Coaching: DBT also includes phone coaching, where clients can contact their therapist between sessions to receive guidance on how to apply DBT skills in challenging real-life situations.

Key Components of DBT

Mindfulness: Mindfulness is the foundational skill in DBT, teaching individuals to be present in the moment without judgment. Clients learn to observe their thoughts, feelings, and behaviors with awareness and detachment, which can reduce impulsivity and reactivity.
Distress Tolerance: This module helps individuals develop healthy coping strategies to tolerate emotional pain and distressing situations without resorting to harmful behaviors like self-injury or substance use. Techniques such as distraction, self-soothing, and radical acceptance are introduced to help manage crises effectively.
Emotion Regulation: Emotion regulation skills help clients identify, understand, and manage their emotions. Through this module, individuals learn to reduce emotional vulnerability and intensity, increase positive emotional experiences, and navigate difficult emotions more effectively.
Interpersonal Effectiveness: This module focuses on improving relationships by teaching assertiveness, setting boundaries, and navigating interpersonal conflicts. Individuals learn how to communicate their needs while maintaining respect for themselves and others, which can reduce relationship distress and improve overall social functioning.

Common Conditions Treated with DBT

Borderline Personality Disorder (BPD): DBT is the most empirically supported treatment for BPD, particularly in reducing self-harm, suicidal ideation, and emotional dysregulation.
Mood Disorders: DBT is effective in treating mood disorders such as depression and bipolar disorder by helping individuals manage intense emotions and improve emotional stability.
Self-Harm and Suicidal Ideation: DBT’s focus on building healthy coping mechanisms and distress tolerance makes it a powerful intervention for individuals who engage in self-harming behaviors or struggle with suicidal thoughts.
Eating Disorders: DBT has been adapted to treat individuals with eating disorders, particularly those who use disordered eating behaviors as a way to manage overwhelming emotions.
Post-Traumatic Stress Disorder (PTSD): DBT can be effective in treating complex PTSD, helping individuals regulate emotions and process trauma in a safe and structured manner.
Substance Use Disorders: DBT can be used to treat substance use disorders, focusing on reducing harmful behaviors and increasing healthy coping mechanisms.

DBT Skills Modules

Mindfulness Skills: These skills help clients stay grounded in the present moment, allowing them to experience emotions without becoming overwhelmed by them. Techniques such as deep breathing, body scans, and non-judgmental observation are common mindfulness practices in DBT.
Distress Tolerance Skills: This module teaches clients how to endure painful situations without making them worse. Techniques like distraction (activities, contributing to others), self-soothing, and radical acceptance (accepting reality as it is) are key.
Emotion Regulation Skills: This module teaches clients how to reduce the intensity of emotional reactions. Techniques include identifying and labeling emotions, reducing vulnerability to negative emotions, and implementing strategies to increase positive emotions.
Interpersonal Effectiveness Skills: These skills focus on improving communication and relationships. Clients learn to ask for what they need, set boundaries, and handle conflict in ways that maintain self-respect and preserve relationships.

The Dialectical Process in DBT

The core of DBT is the balance between two opposing forces: acceptance and change. While traditional CBT emphasizes changing unhelpful thoughts and behaviors, DBT uniquely integrates the need to accept painful realities, especially when circumstances cannot be changed immediately. The therapist supports the client in both accepting their current experiences while encouraging them to make positive changes in their lives.

Duration of DBT Treatment

DBT is typically a long-term treatment that can last six months to a year or more. Clients usually attend weekly individual therapy and group skills training sessions for several months. Some individuals may benefit from continued participation in DBT programs to further solidify their skills, particularly if they face chronic emotional dysregulation or interpersonal difficulties.

Why is DBT Effective?

Skill-Based Approach: DBT equips clients with concrete skills they can use to manage emotions, navigate relationships, and tolerate distressing situations, leading to practical improvements in daily life.
Focus on Acceptance and Change: DBT’s unique dialectical approach balances acceptance of difficult realities with the need for change. This balance fosters self-compassion and resilience, empowering clients to transform their lives.
Research-Backed: Numerous studies support the effectiveness of DBT, especially in reducing self-harming behaviors, suicidal ideation, and emotional dysregulation. DBT is considered the gold standard for treating BPD and is highly effective for other mental health conditions.
Holistic Support: DBT not only focuses on individual therapy but also includes group support and phone coaching, providing clients with a comprehensive treatment package that addresses multiple aspects of their life.

FAQs about DBT

Is DBT only for individuals with Borderline Personality Disorder (BPD)?

No, while DBT was originally developed for BPD, it is highly effective for a range of mental health conditions, including mood disorders, PTSD, eating disorders, and substance use disorders.

How long does DBT take?

DBT is often a longer-term therapy, typically lasting 6-12 months. The duration of treatment depends on the severity of symptoms and how well the client engages in learning and applying DBT skills.

Will I be able to manage intense emotions on my own?

Yes, one of the primary goals of DBT is to teach individuals skills to manage intense emotions independently. By the end of treatment, clients are equipped with a toolbox of strategies to navigate emotional crises and improve relationships.

What if I struggle to apply DBT skills between sessions?

DBT includes phone coaching, which allows clients to contact their therapist between sessions for guidance on applying skills in real-time situations. This support ensures that clients feel capable of using DBT techniques when challenges arise.