Dialectical Behavior Therapy

What is DBT?

DBT (Dialectical Behavior Therapy) is a type of therapy that was originally developed to treat individuals with borderline personality disorder. It is now used to treat a range of mental health conditions, including substance abuse, depression, anxiety, and eating disorders.

DBT emphasizes the development of skills that help individuals regulate their emotions, improve interpersonal relationships, and tolerate distress. These skills are taught through four modules:

  1. Mindfulness: the practice of being present in the moment, without judgment.
  2. Distress tolerance: learning how to tolerate distressing situations without making things worse.
  3. Emotional regulation: learning how to identify and regulate emotions.
  4. Interpersonal effectiveness: learning how to communicate effectively with others, set boundaries, and build positive relationships.

DBT is typically conducted in both individual and group settings, with a trained therapist. It can be a long-term therapy, lasting several months to years, depending on the individual's needs.

How does DBT work?

DBT (Dialectical Behavior Therapy) works by combining several different treatment approaches, including cognitive-behavioral therapy, mindfulness techniques, and elements of Eastern philosophy. The therapy is typically conducted in both individual and group settings and involves several key components.

  • Establishing a therapeutic relationship: The first step in DBT is establishing a trusting and supportive therapeutic relationship between the client and therapist. This helps to create a safe space for the client to explore their emotions and behaviors.
  • Identifying problem behaviors: The therapist works with the client to identify problematic behaviors and patterns of thinking that are causing distress in their lives.
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  • Learning new skills: DBT teaches clients specific skills to manage their emotions, tolerate distress, communicate more effectively, and build healthy relationships. These skills are typically taught in a group setting, with the therapist providing instruction and guidance.
  • Addressing underlying issues: DBT also addresses underlying issues that may be contributing to the client's difficulties, such as trauma, attachment issues, or relationship problems.
  • Practice and application: Clients are encouraged to practice the skills they learn in therapy in their daily lives, and the therapist provides ongoing support and guidance as needed.
  • Monitoring progress: DBT involves regular monitoring of progress, both by the client and the therapist, to assess the effectiveness of the treatment and make adjustments as needed.

What are the core components of DBT?

The core components of DBT include:

  1. Mindfulness: Mindfulness skills help individuals learn to be fully present in the moment and to observe their thoughts and emotions without judgment.
  2. Distress Tolerance: Distress tolerance skills help individuals manage distressing situations without making things worse.
  3. Emotional Regulation: Emotional regulation skills help individuals identify and regulate their emotions, so they can respond in a healthy way to challenging situations.
  4. Interpersonal Effectiveness: Interpersonal effectiveness skills help individuals communicate effectively with others, set healthy boundaries, and build positive relationships.

In addition to these core components, DBT may also include other elements such as individual therapy, consultation with a therapist, and phone coaching outside of therapy sessions to provide support and guidance during difficult times.

What Mindfulness skills are taught in DBT?

Mindfulness is a core component of DBT (Dialectical Behavior Therapy) and refers to the practice of being present in the moment and observing one's thoughts and feelings without judgment. Mindfulness skills in DBT help individuals develop the ability to be fully present in their experiences and to accept things as they are without trying to change or control them. This can be particularly helpful for individuals who struggle with overwhelming emotions or racing thoughts.

Some of the mindfulness skills taught in DBT include:

  1. Observing: This involves simply noticing one's thoughts, feelings, and sensations without judgment or interpretation.
  2. Describing: This involves using language to describe one's experiences in a non-judgmental way. For example, a person might describe the physical sensations they are experiencing without attaching any value judgments to them.
  3. Participating: This involves being fully engaged in the present moment, whether it's engaging in an activity, listening to someone else, or simply taking in one's surroundings.
  4. Non-judgmentally: This involves accepting one's experiences without trying to change or control them. It also involves letting go of value judgments and focusing on what is happening in the present moment.
  5. One-mindfully: This involves being fully present in the current moment, rather than being distracted by other thoughts or concerns.
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Mindfulness skills in DBT help individuals develop greater self-awareness, emotional regulation, and acceptance of themselves and their experiences. They can be applied in many different settings and situations, from managing intense emotions to improving interpersonal relationships.

What Distress Tolerance skills are taught in DBT?

Distress tolerance is one of the core components of DBT (Dialectical Behavior Therapy) and refers to the ability to manage and tolerate distressing situations without making things worse. Distress tolerance skills are particularly helpful for individuals who struggle with intense emotions or who have a history of impulsive behavior in response to stress.

Some of the key distress tolerance skills taught in DBT include:

  1. Accepting reality: This involves accepting difficult situations as they are, rather than fighting against them or trying to change them.
  2. Distracting oneself: This involves finding healthy ways to distract oneself from distressing thoughts or emotions, such as engaging in a pleasant activity, exercise, or mindfulness practices.
  3. Self-soothing: This involves using comforting self-talk, physical touch, or other soothing techniques to calm oneself during times of distress.
  4. Improving the moment: This involves taking steps to make a difficult situation more tolerable, such as finding something positive in the situation, focusing on the present moment, or engaging in a pleasurable activity.
  5. Radical acceptance: This involves accepting a difficult situation without judgment or trying to change it, recognizing that acceptance is the first step toward making positive changes.

Distress tolerance skills in DBT help individuals develop the ability to manage and tolerate difficult situations without resorting to self-destructive or impulsive behaviors. By learning these skills, individuals can build greater resilience and cope more effectively with the challenges that life presents.

What Emotional Regulation skills are taught in DBT?

Emotional regulation is another core component of DBT (Dialectical Behavior Therapy) that focuses on helping individuals identify, understand, and manage their emotions in healthy ways. Emotion regulation skills are particularly helpful for individuals who struggle with intense and difficult emotions, or who have a history of impulsive or harmful behaviors in response to emotional triggers.

Some of the key emotional regulation skills taught in DBT include:

  1. Identifying and labeling emotions: This involves learning to recognize and name different emotions, so individuals can better understand what they are feeling.
  2. Understanding the function of emotions: This involves recognizing that emotions serve a purpose, such as communicating a need or signaling a problem, and learning to respond in a healthy way to these underlying needs.
  3. Modifying emotional responses: This involves changing the intensity or duration of emotions, such as using mindfulness techniques or relaxation exercises to reduce the impact of intense emotions.
  4. Building positive experiences: This involves intentionally engaging in activities that bring joy and positive emotions, such as spending time with loved ones or pursuing hobbies.
  5. Increasing mindfulness: As mentioned earlier, mindfulness is a core component of DBT and is particularly important in emotional regulation. By being fully present in the moment, individuals can better observe and regulate their emotions.

Emotional regulation skills in DBT help individuals develop the ability to manage their emotions in healthy ways, so they can respond to challenging situations with greater resilience and stability. By learning these skills, individuals can also improve their relationships with others and create a more fulfilling life.

What Interpersonal Effectiveness skills are taught in DBT?

Interpersonal effectiveness is another core component of DBT (Dialectical Behavior Therapy) that focuses on helping individuals develop effective communication and relationship skills. Interpersonal effectiveness skills are particularly helpful for individuals who struggle with social anxiety, have difficulty setting boundaries, or have a history of unstable relationships.

Some of the key interpersonal effectiveness skills taught in DBT include:

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  1. Assertiveness: This involves expressing one's needs and opinions in a clear and respectful manner, while also respecting the needs and opinions of others.
  2. Active listening: This involves paying attention to others when they speak, showing interest and empathy, and asking questions to clarify understanding.
  3. Boundary setting: This involves setting healthy boundaries in relationships, including saying "no" when appropriate and setting limits on others' behavior.
  4. Relationship repair: This involves repairing relationships that have been damaged by misunderstandings, conflicts, or other problems, using effective communication and problem-solving skills.
  5. Self-respect: This involves developing a strong sense of self-worth and self-respect, which can help individuals set boundaries, communicate effectively, and build healthy relationships.

Interpersonal effectiveness skills in DBT help individuals develop the ability to communicate effectively, set healthy boundaries, and build positive relationships with others. By learning these skills, individuals can improve their social interactions, increase their confidence and self-esteem, and create a more fulfilling life.

What does a DBT session look like?

A typical DBT session usually lasts about 60-90 minutes and is conducted on a weekly basis. The structure of each session may vary depending on the needs of the individual and the focus of the session, but generally follows a similar format.

Here is a general overview of what a DBT session might look like:

  1. Check-in: At the beginning of each session, the therapist will typically start by asking how the individual is doing, both in general and since the last session. The individual may also have the opportunity to share any updates or significant events that have occurred since the last session, as well as report on assignments from the last session.
  2. Review of diary cards: DBT involves the use of diary cards to track emotions, behaviors, and other important information between sessions. The therapist may review the diary cards with the individual to identify patterns, track progress, and set goals for the upcoming week.
  3. Skill-building: A significant portion of each DBT session is focused on teaching and practicing specific skills related to distress tolerance, emotion regulation, or interpersonal effectiveness. The therapist may introduce new skills, review previously learned skills, or help the individual apply skills to specific situations or challenges they are facing.
  4. Problem-solving: If the individual is facing a specific problem or challenge, the therapist may use the session to help the individual problem-solve and come up with effective solutions. The therapist may use cognitive-behavioral techniques to help the individual identify and challenge negative thought patterns, or role-play different scenarios to practice using new skills.
  5. Wrap-up and homework: At the end of each session, the therapist will typically summarize what was covered, reinforce any new skills learned, and provide homework assignments or recommendations for the upcoming week. The individual may also have the opportunity to ask questions, provide feedback, or share any concerns or challenges they anticipate facing in the coming week.

The goal of each DBT session is to provide a supportive and structured environment for individuals to learn new skills, practice applying these skills to real-life situations, and track their progress over time.

Who is DBT for?

DBT (Dialectical Behavior Therapy) was originally developed to treat individuals with borderline personality disorder (BPD), but it has since been adapted to treat a range of other mental health conditions and difficulties. DBT is typically recommended for individuals who struggle with intense and difficult emotions, impulsive or self-destructive behaviors, relationship problems, and/or difficulties regulating their thoughts and behaviors.

DBT has been shown to be effective in treating a range of mental health conditions, including:

  • Borderline Personality Disorder (BPD)
  • Depression
  • Anxiety Disorders (including Social Anxiety Disorder and Generalized Anxiety Disorder)
  • Post-traumatic Stress Disorder (PTSD)
  • Substance Use Disorders
  • Eating Disorders (including Bulimia Nervosa and Binge Eating Disorder)
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Can DBT be used to help teens?

DBT has also been adapted for use with adolescents and teenagers, and research suggests that it can be an effective treatment option for this population. DBT for teens typically includes modifications to the therapy format and skill-building materials to make them more developmentally appropriate. DBT for teens may be helpful for addressing a range of issues, including emotional dysregulation, impulsivity, self-harm, suicidal ideation, and difficulties with interpersonal relationships.

What are the benefits of DBT?

There are many benefits associated with DBT (Dialectical Behavior Therapy), including:

  • Improved emotional regulation: DBT helps individuals develop skills and strategies for managing intense emotions, which can be particularly helpful for those with mood disorders, anxiety, or borderline personality disorder.
  • Increased mindfulness: DBT emphasizes the importance of being present in the moment and cultivating a non-judgmental awareness of one's thoughts, feelings, and sensations.
  • Better interpersonal relationships: DBT teaches individuals skills for effective communication, conflict resolution, and developing healthy relationships with others.
  • Reduced self-destructive behaviors: DBT provides individuals with specific skills for managing urges to engage in self-harm, substance abuse, or other problematic behaviors.
  • Enhanced self-esteem and self-acceptance: DBT helps individuals develop a more compassionate and accepting attitude towards themselves, which can lead to greater self-esteem and confidence.
  • Improved overall well-being: By providing individuals with the tools and strategies they need to manage their emotions, communicate effectively, and develop healthy relationships, DBT can help improve overall well-being and quality of life.

What are the downfalls of DBT?

While DBT (Dialectical Behavior Therapy) has been shown to be effective in treating a range of mental health conditions and difficulties, there are also some potential downsides or limitations to the approach. Here are a few to consider:

  • Time and resource-intensive: DBT is typically delivered in a structured, long-term format that can require a significant investment of time and resources. This can be challenging for individuals who have other obligations or financial constraints.
  • Not a one-size-fits-all solution: While DBT has been shown to be effective for many individuals, it may not be the best fit for everyone. Depending on an individual's unique needs and circumstances, other forms of therapy or treatment may be more appropriate.
  • Requires active participation: DBT is a skills-based therapy that requires active participation from the individual in order to be effective. This can be challenging for those who struggle with motivation or engagement.
  • Limited availability: DBT may not be widely available in all areas or may be limited to certain types of providers or treatment settings.
  • Requires ongoing practice: DBT skills require ongoing practice and reinforcement in order to be effective. For some individuals, this may be challenging to maintain over time.

It's important to keep in mind that while there are potential downsides to DBT, it is generally a well-regarded and evidence-based approach to treating mental health concerns. 

Case Studies of DBT

DBT (Dialectical Behavior Therapy) was developed in the late 1980s by psychologist Marsha Linehan, who was working at the University of Washington at the time. Linehan was working with individuals who had chronic and severe suicidal ideation and self-injurious behavior, often associated with Borderline Personality Disorder (BPD). She found that traditional therapeutic approaches were not effective in treating these individuals, and that they often dropped out of treatment or required hospitalization.

In response, Linehan developed DBT as a comprehensive, evidence-based treatment approach that combined elements of cognitive-behavioral therapy (CBT), mindfulness-based techniques, and principles of dialectics (the idea that two seemingly opposing concepts can coexist and be reconciled). Linehan's approach emphasized the importance of validating the experiences of individuals with BPD, while also providing structure, support, and specific skills for managing intense emotions, improving interpersonal relationships, and reducing self-destructive behaviors.

Linehan conducted extensive research on the effectiveness of DBT, and her findings showed that the therapy was highly effective in reducing suicidal ideation, self-harm, and other problematic behaviors associated with BPD. Today, DBT is considered one of the most effective treatments for BPD, and has been adapted for use with a range of other mental health conditions and difficulties.

Overall, the development of DBT was a response to the unique needs and challenges faced by individuals with BPD and other mental health conditions, and represents a significant innovation in the field of psychotherapy.

Resources:

If you have a loved one who is a struggling teen and you suspect that they could benefit from DBT therapy, we encourage you to take Havenwood Academy's online assessment. Havenwood Academy is a premier residential treatment center for teens that offers a range of evidence-based therapies, including DBT. Their online assessment is a quick and easy way to determine whether your loved one may be a good fit for their program. By taking this step, you can get one step closer to helping your loved one get the support and treatment they need to overcome their challenges and live a happy, healthy life.

References

Chapman, A. L. (2006, September). Dialectical behavior therapy: Current indications and unique elements. Psychiatry (Edgmont (Pa. : Township)). Retrieved February 22, 2023, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2963469/

May, J. M., Richardi, T. M., & Barth, K. S. (2016, March 8). Dialectical behavior therapy as treatment for borderline personality disorder. The mental health clinician. Retrieved February 22, 2023, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6007584/