Dialectical Behavior Therapy

Therapist-and-girlDialectical behavior therapy (DBT) is a therapy designed to help people change destructive patterns of thinking and behavior by improving their ability to regulate their emotions and develop effective coping skills. Using a cognitive-behavioral approach, DBT helps people learn about the triggers that lead to reactive states and assess which coping skills to apply in order to avoid these adverse reactions (Source). DBT differs from traditional cognitive behavioral therapy (CBT) in its emphasis on validation, in which the patient and therapist work towards “accepting” undesirable thoughts, feelings and behaviors rather than resisting them. Since DBT clients often struggle with change, this powerful tool helps them gradually view the process of change as possible rather than unbearable. (Source)

The term “dialectical” means a synthesis or integration of opposites; in DBT, this term refers to the therapist’s goal of effectively establishing and integrating a balance between acceptance and change (Source). For therapists, “the most fundamental dialectic is the necessity of accepting patients just as they are within a context of trying to teach them to change”, said Dr. Marsha M. Linehan, the psychologist who developed DBT (Source). Dr. Linehan first developed DBT to help treat people with borderline personality disorder (BPD) and chronically suicidal or self-injurious individuals. However, DBT is now used in a variety of psychological treatments, including treatment for traumatic brain injuries, eating disorders, mood disorders and even the trauma associated with sexual abuse. (Source)

Theory behind the Therapy

People who are diagnosed with BPD or similar disorders experience extreme emotional changes and tend to see the world in shades of black-and-white. These individuals always seem to be jumping from one crisis to the next. The theory behind the DBT approach is that some people are prone to react toward certain emotional situations in an intense and uncommon manner. In particular, these reactions can occur in situations involving romantic, family or friend relationships. DBT theory suggests that for these individuals, arousal levels increase more quickly than average leading to a higher level of emotional stimulation and requiring a significant amount of time to return to baseline.

Since few people understand their extreme reactions, they have likely experience invalidation all their lives so haven’t developed any methods for coping with these intense, sudden surges of emotion. Taking this into account, DBT emphasizes the psychosocial aspects of treatment to help individuals identify and manage destructive patterns of thinking and behavior. Clients are often encouraged to use their “wise mind” – a middle ground between their rational and emotional senses. (Source)


Characteristics and Components of DBT

  • Support-oriented: Building upon a strength-based approach, DBT helps individuals identify and build upon their existing strengths to enhance their feelings of self-worth and self-confidence.
  • Cognitive-based: DBT helps clients identify disserving thoughts, beliefs and assumptions and develop different, more productive ways of thinking.
  • Collaborative: DBT requires a collaborative relationship between clients and therapists.  Clients with BPD and similar disorders are often considered the most difficult individuals to work with because they struggle so much with sabotaging relationships, including that with their therapist. For this reason, constant attention must be paid to the client/therapist relationship and both client and therapist must be open to working through problems in the relationship together. (Source)

Generally, DBT employs two main components: individual therapy and group therapy.

  • Individual psychotherapy sessions: These one-on-one sessions between client and therapist emphasize problem-solving behavior, specifically concerning troubles or issues that arose for the client’s life recently. Through this process, clients learn how to identify when they are employing destructive or black-and-white thinking, and learn new ways of thinking. These sessions focus on helping the individual accept situations that displease them and learn how to avoid the reactive mindsets that lead to destructive behavior.
  • Group therapy sessions: Also known as “Group Skills Training”, these sessions provide clients with the opportunity to learn and practice skills from four different modules: interpersonal effectiveness, distress tolerance, emotional regulation, and mindfulness. These are areas with which individuals struggling with BPD and similar disorders specifically struggle. (Source)

The Four Modules of DBT

  1. Interpersonal effectiveness: Since these clients struggle with relationships specifically, skills related to interpersonal response patterns are emphasized. Skills taught include effective strategies for asking for what one needs, saying no, and coping with interpersonal conflict.
  2. Distress tolerance: While many approaches to mental health treatment focus on reducing or changing distressing events and circumstances, DBT focuses on helping clients accept and tolerate distress through the use of coping skills.
  3. Emotional regulation: Individuals participating in DBT are typically emotionally intense – frequently angry, depressed, anxious or intensely frustrated. For this reason, clients are taught skills that help them regulate their emotions, such as: identifying and labeling emotions, increasing positive emotional events, and reducing vulnerability to the “emotional mind”. (Source)
  4. Mindfulness: An essential part of all the skills taught in DBT are core mindfulness skills. Mindfulness teaches individuals to become increasingly conscious of their thoughts and feelings through observation of bodily sensations. With practice, individuals develop the ability to accept distressing thoughts without criticism and to tolerate self-destructive urges (e.g. the desire to self-harm) without acting upon them. (Source)

Recent research suggests that the majority of individuals utilizing a comprehensive DBT program will experience significant and long-lasting periods of symptom remission. While most people will never completely “recover” from BPD or similar disorders (issues may linger surrounding self-esteem and the ability to form and maintain relationships), they will be able to lead more meaningful and happier lives. (Source)