Dialectical Behavioral Therapy

What is Dialectical Behavior Therapy (DBT)?

Dialectical Behavior Therapy (DBT) is a special kind of therapy that helps people manage strong emotions and improve their relationships. The word “dialectical” means balancing two ideas that seem opposite – in DBT, this means accepting yourself while also working to change.

Who uses DBT?

DBT was first created to help people with borderline personality disorder, but now it helps many people who struggle with controlling their emotions, including those with:

  • Depression
  • Anxiety
  • Eating disorders
  • Substance use problems
  • Self-harm behaviors

The four main skills in DBT

1. Mindfulness

Mindfulness teaches you to pay attention to what’s happening right now without judging it as “good” or “bad.” It’s like learning to be a friendly observer of your own thoughts and feelings.

For example, instead of thinking “I’m having the worst day ever!” you might notice “I’m feeling frustrated right now, and that’s okay.”

2. Distress Tolerance

These skills help you get through difficult situations without making them worse. It’s like learning what to do when your emotions feel like a storm.

For instance, if you’re very upset, you might:

  • Hold an ice cube in your hand to focus on a different sensation
  • Count backward from 100
  • Take a short walk
  • Practice deep breathing

3. Emotion Regulation

These skills help you understand, experience, and change your emotions. You learn:

  • How emotions work in your body and mind
  • How to identify what you’re feeling
  • Ways to reduce painful emotions
  • How to increase positive emotions

4. Interpersonal Effectiveness

These skills help you communicate better with others. You learn how to:

  • Ask for what you need
  • Say no when necessary
  • Keep your self-respect during conflicts
  • Keep relationships healthy while still respecting your own boundaries

How DBT therapy works

A full DBT program usually includes:

  1. Individual therapy – Meeting one-on-one with a therapist who helps you apply DBT skills to your specific problems
  2. Skills training groups – Learning DBT skills with other people in a class-like setting
  3. Phone coaching – Getting help from your therapist between sessions when you’re facing a crisis
  4. Therapist consultation team – Your therapist meets with other DBT therapists to make sure they’re providing the best care

The special DBT balance

The most important idea in DBT is the balance between two things that seem opposite:

  1. Accepting yourself exactly as you are right now
  2. Working to change behaviors that cause problems in your life

This balance helps people stop seeing things as all-or-nothing and find a middle path forward. For example, you can think “I’m doing the best I can AND I can learn to do better.”

Research Review

Recent advances in Dialectical Behavior Therapy (DBT) have expanded its applications beyond borderline personality disorder to address various conditions involving emotion dysregulation (Chapman & Hope, 2018; Rizvi et al., 2013). DBT’s comprehensive approach includes individual therapy, skills training, phone coaching, and therapist consultation (Dimeff & Linehan, 2001). Research supports DBT’s efficacy for treating suicidal behaviors, substance abuse, eating disorders, and other mental health issues (Robins & Chapman, 2004; Soler et al., 2016). Adaptations have been developed for specific populations, including adolescents and incarcerated individuals (Miller, 2015). The core components of DBT focus on mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness (McKay et al., 2007). Recent developments include streamlining treatment, exploring mechanisms of change, and integrating DBT with other therapies, such as exposure therapy for PTSD (Chapman & Hope, 2018; Choi-Kain et al., 2017). These advancements aim to make DBT more accessible and effective across various clinical settings.

References Link 

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