What Is Dialectical Behavioral Therapy?

Dialectical behavior therapy (DBT) is an evidenced based therapy that has its roots in cognitive behavior therapy. Evidenced-based means that there is research that proves the therapy is effective. The main goals are to teach people how to live in the moment, develop healthy ways to cope with stress, and regulate their emotions. Regulating emotions means that the individual learns how to manage their emotions effectively rather than being controlled by their emotions. When an individual is controlled by their emotions, they act on their emotions quickly and without thinking.

DBT was originally created to treat suicidal clients. During the creation of the treatment, Linehan noted that most of the suicidal clients she was treating met the criteria for borderline personality disorder (BPD), so she considered DBT to be a treatment for BPD. Now, DBT can be helpful in many ways to many people, and DBT skills can be used to help develop emotional intelligence in youth. It’s being taught in many schools.

DBT is effective with individuals who have an undercontrolled temperament style. This means that they experience strong emotions, and tend to be emotion driven. If they feel it, they tend to do it. For example, if they don’t feel like getting out of bed, they might not do so. If they feel like buying something, they do it. If they feel like someone doesn’t like them, they act accordingly.

Dialectical Behavior Therapy Techniques

Dialectical Behavioral Therapy has the following treatment components:

Group Therapy: The client learns behavioral skills in a group setting.  They learn skills in four different categories: Mindfulness, Distress Tolerance, Emotion Regulation, and Interpersonal Effectiveness. The group is more like a class. It starts with a mindfulness practice, then homework is reviewed, and a new skill is taught. Homework is assigned and then the group ends. Completing the homework and practicing the skills is critical for the therapy to work.

Individual Therapy: In individual therapy, you identify the client’s life worth living goal, and the obstacles that are blocking the client from reaching that goal. You identify triggers in the client’s life that precipitate maladaptive coping and identify more adaptive skills. You’ll assist the client in learning what drives their behavior and to manage intense emotions in effective ways.

Phone Coaching: Clients call for phone coaching between sessions to receive assistance in using skills to cope effectively with a difficult situation they are currently in. Phone coaching, in addition to homework, helps the client generalize the skills to their everyday life.

In addition, therapists participate in a team consultation meeting that focuses on the therapist learning from other therapists and continually improving their skills.

What’s Taught in the Skills Classes or Groups?

In DBT Skills Group you’ll learn skills in four different categories. The categories are Mindfulness,
Interpersonal Effectiveness, Distress Tolerance, and Emotion. Regulation.

Mindfulness in DBT is not meditation. It’s about learning how to keep your mind in the here and now. When your mind jumps to the future, it’s often about worry. When it goes into the past, it’s often about sadness, longing, regret or perhaps resentment. You’ll experience less stress and be able
to make more effective choices when you are mindful. You can practice mindfulness anywhere at any time; for example, in the shower, on the bus, driving to work, or when talking with your family. Mindfulness helps you focus on the present or “live in the moment.” This helps you pay attention to
what is happening inside you (your thoughts, feelings, sensations, and impulses) as well as using your senses to tune in to what’s happening around you (what you see, hear, smell, and touch) in nonjudgmental ways.

Mindfulness skills help you slow your reaction time, calm yourself, and focus on using healthy coping skills when you are in the midst of emotional pain. The strategy can also help you avoid engaging in self-destructive or harmful behaviors that interfere with you having the life you want to live.

Distress tolerance skills help you get through a difficult situation when you can’t change it. Of course, it’s important to solve problems when you can, but you can’t always do that. Sometimes you must tolerate a situation for a period of time, and distress tolerance skills help you do that without making the situation worse. In our world today, we all need distress tolerance skills.

The Interpersonal Effectiveness skills focus on your ability to have lasting, healthy relationships and to be effective in your relationships. Sometimes you need to be more assertive than other times, and the skills you need in a business interaction will be different from the skills you use with friends. Interpersonal Effectiveness skills will help you ask for what you want, say “no” when you need to and live according to your values. You’ll learn when to ask and how strongly to ask for what you want as well as how to express concern about someone else’s behavior, in a way that keeps the relationship strong. Plus, you’ll learn how to set your priorities in interpersonal interactions.

Emotion regulation skills increase your ability to manage your intense emotions effectively. The skills you learn will help you to identify, name, and change your emotions. Emotion regulation is about learning to manage your emotions in the long term and ease the suffering you experience. Instead of your strong emotions controlling you, you’ll learn to control/manage your emotions.

What Dialectical Behavioral Therapy Can Help With

Research has shown that DBT can be effective with:

  • Attention-deficit/hyperactivity disorder (ADHD)
  • Bipolar disorder
  • Borderline personality disorder (BPD)
  • Binge Eating Disorder
  • Bulimia
  •  Cluster B Personality Disorders
  • Emotion Dysregulation (transdiagnostic)
  • Suicidal and Self-harming adolescents
  • Pre-adolescent children with severe behavioral and emotional dysregulation
  • Complex PTSD
  • Severe Depression for undercontrolled personality type