Dialectical Behavior Therapy (DBT)

The idea behind dialectical behavioral therapy (DBT) stems from cognitive behavioral therapy (CBT). Dialectical behavior therapy approaches mental health conditions with the idea that all is interconnected, and change is constant and inevitable. The modality is unique in that it combines acceptance (learning to live with situations as they are) and change (learning to adjust to events that do not serve you). The primary skills taught in DBT are mindfulness, interpersonal effectiveness, emotion regulation, and distress tolerance.

Often, DBT is taught as a skills training course, somewhat similar to a class. It may be done in an individual, couples, or group format, but it is most common in groups. A therapist can provide or suggest that the client purchase the DBT workbook, which offers handouts and worksheets to guide clients in each lesson. At the end of the workbook, clients may “graduate” from DBT and receive a reward for completing the modules.

Mindfulness

At the core of DBT, mindfulness focuses on being present and fully experiencing the moment. Instead of becoming overwhelmed by the past or anxiously anticipating the future, mindfulness teaches individuals to observe their thoughts, feelings, and sensations without judgment. This grounding technique may help individuals become more self-aware, promoting more transparent decision-making and improved emotional responses.

Interpersonal effectiveness

The interpersonal effectiveness module of DBT provides individuals with the tools and skills to communicate, negotiate, and maintain healthy relationships. It may guide them in saying no, requesting favors, and resolving conflicts. By mastering these skills, individuals can strengthen their relationships, communicate their needs, and set healthy boundaries, which may improve their quality of life.

Emotion regulation

Emotion regulation techniques can help individuals understand and manage their emotions. When you recognize what causes your emotions, you may be able to manage your responses more effectively. This process can prevent becoming overwhelmed by strong emotions. Emotional regulation skills may create a more balanced emotional life, giving individuals the tools to avoid extreme emotional highs and lows.

Distress tolerance

Life can present challenges and painful situations. Distress tolerance may help individuals cope with difficult situations without resorting to unhelpful or destructive behaviors. Individuals can learn to tolerate distress instead of impulsively reacting or turning to harmful coping methods. Acceptance and patience may reduce emotional pain and improve the ability to overcome adversity.

Individuals can learn these skills in different ways, such as one-on-one therapy, group classes, and coaching over the phone. Therapists sometimes use a particular order in the workbook to decide which skills to focus on first.

When starting dialectical behavior therapy, it may be helpful to know what to expect. Below are some of the formats this modality may take. 

Individual therapy 

When you begin DBT, you can expect a combination of individual therapy and group skills training. During individual therapy, you can work closely with a therapist to resolve specific challenges related to your mental health. The therapist can help you apply DBT techniques to better understand and regulate emotions, maintain mindfulness, and improve communication skills. 

Often, individual DBT therapists use a technique called “diary cards,” which requires daily mood and behavior tracking. This technique can help clients understand the connections between behavior and mood and how to reduce maladaptive coping skills. It can also keep the therapist informed on how the client feels daily. 

Group skills training

In group skills training sessions, you might learn about different DBT components and practice new skills alongside others undergoing therapy. In a group setting, you may practice the core DBT skills of emotion regulation, distress tolerance, mindfulness, and interpersonal effectiveness. Here, you may also learn practical strategies to apply to everyday situations.

Phone coaching 

Throughout DBT, you may also have the ability to participate in phone coaching for crises between therapy sessions. Phone support may provide guidance on using your skills during challenging moments or when you want help with an immediate crisis, such as a desire to self-harm. Your therapist may set clear boundaries with their clients about a time range that is acceptable to call.

Consultation team

A DBT therapist often belongs to a consultation team, which serves as a support system for therapists. The team is there to assist DBT professionals who work with individuals with serious, multifaceted disorders that are challenging to manage. The purpose of the consultation team is to help therapists maintain their motivation and expertise. 

Active participation and commitment to the therapy process can promote the best outcome for individuals and professionals. DBT is often a journey that can be transformative for those willing to put in the effort and focus on personal growth.

DBT can be beneficial to a wide range of individuals who struggle with mental health challenges, emotional regulation, and interpersonal challenges. One group of individuals who may benefit from DBT is those with borderline personality disorder (BPD), as DBT was initially developed for people with this condition. DBT has been proven to be effective in helping people with BPD manage their emotions, which can be challenging for them due to emotional symptoms.

DBT has also been proven useful for people struggling with other mental health challenges, such as the following: 

• Suicidal thoughts or self-harm behaviors
• Substance use disorders
• Borderline personality disorder (BPD)
• Eating disorders
• Post-traumatic stress disorder (PTSD)
• Depression or bipolar disorder
• Chronic anger and irritability
• Impulse control challenges 
• Chronic anxiety and excessive worry
• Interpersonal relationship challenges 

DBT can provide valuable support and guidance for people who face various conditions and symptoms, ranging from eating disorders to anxiety and beyond. This therapy modality teaches individuals how to regulate their emotions, maintain healthier relationships, and navigate life's difficulties. While DBT can be helpful for various groups, needs can vary. Consult a mental health professional to determine the best treatment approach.

DBT is a type of individual therapy that involves directly helping people better manage their feelings and respond to life's challenges. Although people using DBT may share common goals, there can be differences in how each person approaches and achieves their treatment goals. Everyone's struggles are unique. However, DBT can be flexible and tailored to fit individual needs. Goals for therapy may include the following:

• Living in the moment: DBT helps people develop mindfulness skills, which focus on being present and fully engaged in the current moment. This practice encourages individuals to keep from dwelling on past experiences or worrying about the future.
• Coping with stress: DBT teaches various techniques for managing stress. These can include strategies such as deep breathing exercises and progressive muscle relaxation, which may reduce tension in difficult situations.
• Regulating emotions: One of the main goals of DBT is to assist individuals in managing their emotions. Developing emotional regulation skills can help people identify and change unhelpful emotional responses, which may lead to a more stable and balanced emotional state.
• Improving relationships: Interpersonal effectiveness is a crucial aspect of DBT. By learning effective communication skills, individuals may better assert their needs, create boundaries, and develop relationships with others.

DBT may not be appropriate for everyone. However, if you often find it difficult to control your emotions, have trouble interacting with others, or are extremely sensitive to emotional events, DBT could be beneficial.

DBT has shown promise in treating various mental health conditions. Though developed for BPD, research continues to explore the efficacy and adaptability of DBT for other mental health disorders.

One study, which examined data from 1980 to April 1st, 2022, found that DBT may improve several core symptoms of bipolar disorder. The review included 11 studies involving patients in various mood states except for mania. All the studies supported the feasibility of DBT-based interventions for people with bipolar disorder. However, more extensive controlled trials are needed to confirm DBT’s effectiveness in treating bipolar I disorder. 

Another study compared two types of therapy for people with severe cases of post-traumatic stress disorder resulting from childhood abuse. The study found that both dialectical behavior therapy for PTSD (DBT-PTSD) and cognitive processing therapy (CPT) significantly reduced symptom severity. However, DBT-PTSD showed stronger results than CPT. Over half of the people (58%) treated with DBT-PTSD saw their symptoms wholly resolved, compared to 41% of those treated with CPT. While both therapies were helpful, DBT-PTSD proved more effective for these patients.

As DBT continues to be recognized for its effectiveness in treating various mental health conditions, ongoing research may provide insight into potential improvements. With new research, mental healthcare providers can find updated information on providing the most effective care to clients.