Dialectical behavior therapy (DBT) is an evidenced-based psychotherapy approach. It was developed in the late 1980s by Marsha M. Linehan, who was at the time a psychology/ suicide researcher at the University of Washington, as a means to help better treat chronically suicidal individuals diagnosed with borderline personality disorder (BPD). BPD, according to the DSM-5 (Diagnostic and Statistical Manuel of Mental Disorders, Fifth Edition), is a mental condition characterized by pervasive mood instability (e.g., impulsiveness, distorted self-image, unstable relationships, severe difficulty regulating emotions, etc.). DBT is based on the principles of cognitive behavioral therapy (CBT), but places greater emphasis on the psychosocial aspect of treatment. It combines standard CBT techniques for emotional regulation and reality testing with concepts derived from Buddhist meditative practice such as awareness, mindfulness, and attentiveness to current situations and emotional experiences to encourage acceptance.
DBT: A Closer Look
DBT has a multifaceted approach as it includes individual psychotherapy sessions, group skills sessions, and phone coaching. Each therapeutic setting has its own distinct structure and goals. There will often be out of session requirements (e.g., group skills homework) to help an individual continue to integrate and practice implementing the information learned into his or her daily life. The DBT group skills sessions focus on the following four skill modules, provided by Behavioral Tech:
- Core Mindfulness: the practice of remaining fully present in the moment at any given time.
- Distress Tolerance: learning to tolerate pain in challenging situations, without changing it or escalating it.
- Interpersonal Effectiveness: increasing one’s self-awareness and authentically advocating for one’s own wants and needs in a relationship in a way that is both self-respecting and non-damaging.
- Emotion Regulation: decreasing emotional impulsivity, learning to manage and shift intense, problematic emotions.
Individual therapy sessions enable a client to process one-on-one issues that may arise during the group skills sessions, clarify any confusion surrounding a skills assignment, and/ or practice applying and implementing the DBT skills into his or her own life. The phone-coaching component is intended to provide additional support should crisis arise between individual and group sessions. The entire DBT program typically lasts about six months long, as six weeks are allocated to focusing on each of the four DBT skills modules.
When It’s Used
Nowadays, DBT is primarily used for people who struggle with emotional dysregulation, also known as severe emotional instability (e.g., suicidal thoughts, self-harming behaviors, etc.). Psychology Today explains that the “goal of DBT is to transform negative thinking patterns and destructive behaviors into positive outcomes.” DBT remains the gold standard form of treatment for individuals diagnosed with BPD, but according to Behavioral Tech has also been found to be effective in treating other mental health conditions. The National Alliance on Mental Illness (NAMI) indicate that DBT may be an effective method of treatment for:
- Bipolar disorder
- Attention-deficit/ hyperactivity disorder (ADHD)
- Generalized anxiety disorder (GAD)
- Eating disorders
- Obsessive-compulsive disorder (OCD)
- Major depressive disorder
- Substance use disorder
- Post-traumatic stress disorder (PTSD)
Research has concluded that DBT can be effective regardless of a person’s gender identity, sexual orientation, age, and ethnicity/ race. DBT focuses on finding a balance in opposing forces. DBT has become a mainstream form of psychotherapy, with providers spanning all over the world. Specifically, Southern California is home to a plethora of mental health clinicians that are qualified DBT providers.
The information above is provided for the use of informational purposes only. The above content is not to be substituted for professional advice, diagnosis, or treatment, as in no way is it intended as an attempt to practice medicine, give specific medical advice, including, without limitation, advice concerning the topic of mental health. As such, please do not use any material provided above to disregard professional advice or delay seeking treatment.