What is Dialectical Behavior Therapy? 

Learn more about dialectical behavior therapy and how it’s used to treat mental health issues.

What is DBT?

Dialectical behavior therapy (DBT) is an effective, science-backed therapy that helps people, many of whom experience significant mental health challenges, build an ideal life.

DBT techniques can be helpful even if you have never had an official mental health diagnosis. It’s a common treatment for those experiencing issues with health, quality of life, or relationships due to mental health issues.

Some common issues that DBT therapy can help with include:

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A Further Look at DBT

What Does Dialectical Mean? 

Marsha Linehan, who created many models like dialectical behavioral therapy (DBT), defines dialectical as the synthesis of opposites. These opposites could be two ideas, contradictory opinions, or an analogy containing contradicting imagery.1
A basic example of dialectical thinking is “I love you and I hate you.” The idea is based on both these statements being true simultaneously. The core of dialectics uses AND not BUT in these statements.

History of DBT

The goal of DBT from the beginning has been to create a “life worth living.” The treatment manual’s first complete draft concentrated primarily on alleviating suicidal actions; yet, funding for the project required that treatment outcome research identify a mental disorder diagnosis. As a result, the first clinical trials were designed to treat chronically suicidal individuals who qualified for borderline personality disorder (BPD), a group known to be at risk for suicide.2
Dialectical behavior therapy is based on behaviorism, and at the time DBT was created, behavioral therapies were primarily concerned with changing unpleasant events rather than tolerating them. This necessitated a change in traditional behavioral treatment.2
DBT was originally founded in the late 1970s by Marsha Linehan, a suicide researcher at the time. She didn’t originally know anything about borderline personality disorder, but she found out later. As a result, DBT is well known for helping with a borderline personality disorder.3

How Does DBT Work?

DBT’s roots lie in dialectics, a theory that balances opposing ideas. The therapist works with the individual to discover methods to maintain two seemingly contradictory viewpoints at once, promoting balance and avoiding black-and-white thinking. DBT promotes a both-and rather than an either-or mentality in service of this balance. Change and acceptance are at the heart of DBT’s dialectic.

Biosocial Model in DBT

The biosocial model comes into play when talking about dialectical behavior therapy. The basic points of Dr. Linehan’s presentation are that DBT’s biosocial model is the idea of how symptoms arise and are sustained and that it’s a no-blame theory.4
  • Emotional sensitivity plus an invalidating atmosphere equals widespread emotion dysregulation, according to the equation for the biosocial model
  • Empathy is inborn
  • A person does not fit into an invalidating environment
  • An invalidating environment does not have to be abusive
  • Transactions characterize the biosocial model

What is the Difference Between CBT and DBT?

CBT and DBT have more in common than people may realize. Cognitive behavioral therapy is a type of therapy that incorporates several characteristics shared by various other types. Dialectical behavior therapy is one example, the exact type depending on the therapist’s heretic of practice.

Even though DBT is a type of CBT, it has been tailored towards helping people acknowledge the pain and discomfort they feel and still stay safe and “ok” at the moment. People can also become empowered and choose to take healthy actions. The course teaches patients how to identify the triggers that put them in a negative state and then offer a healthy coping mechanism or response to regain a positive state.

Dialectical Behavior Therapy

Focus

The main difference between cognitive behavioral therapy and dialectical behavior therapy is in the matter of emphasis. CBT focuses mainly on thought patterns and their redirection; DBT focuses more on balance and the relationship between acceptance versus change. Both cognitive behavioral therapy and dialectical behavior therapy aim to ultimately help the client change their thought patterns.5

Time Frame

Another difference is the time frame. Cognitive behavioral therapy is often completed quickly, and the therapist and client focus on concrete problems. As a result, clients can feel like they’re getting somewhere with a set goal in mind, and CBT is finished when the client meets their goal. Dialectical behavior therapy usually involves sessions that last more than just one session. These sessions help the therapist and client work on the bigger picture.5

Therapy Setting

Cognitive behavioral therapy often takes place in a one-on-one setting. For this treatment to work, the client and therapist have to work together—you can’t do it just by reading about it. Dialectical behavior therapy can also be used in both one-on-one and group settings.5

Understanding CBT

Benefits of DBT

Evidence-based research has confirmed that DBT is more effective than treatment as usual in reducing suicide attempts, self-injury, and anger and improving overall functioning among people with borderline personality disorder.
Some of the most common benefits of DBT include:
  • Less risk of suicidal or self-harming behavior
  • Better quality of life
  • Increased self-respect
  • Fewer symptoms of depression, anxiety, and trauma
  • Improves relationships

Effectiveness of DBT

The effectiveness of DBT shouldn’t be understated. Although the strongest evidence exists for DBT as a treatment for people with borderline personality disorder, DBT is effective for a wide variety of mental health conditions.
Some of the psychiatric disorders that DBT can help treat include:
  • Borderline personality disorder
  • PTSD
  • Major depression
  • ADHD
  • Bipolar Disorder
  • Cluster B personality disorders
  • Binge eating
  • Bulimia nervosa

Dialectical Behavior Therapy Techniques

DBT is broken down into stages, skills, and functions.
Dialectical Behavior Therapy Techniques Stats

Five Functions 

DBT treatment follows five functions to be comprehensive:6
  • The motivation of individuals: Motivation is derived from a deep knowledge of clients’ objectives, the identification of pertinent strengths, resources, and roadblocks, and the collaboration on the means employed to achieve goals.6

  • The teaching of skills: Skills training is an essential function of DBT.6

  • Generalizing skills to environments: Functional deficits, ineffective behaviors that are self-defeating and self-destructive, and the means to be more physically and psychologically healthy and productive are all addressed by skills training.6

  • Improving skills of the therapists: Clients must be able to handle a variety of challenges, people, and environments. Therapists must be driven to work with clients, especially those with challenging behaviors.6

  • Structuring the treatment environment: The treatment structure, as well as precise rules, expectations, and activities of therapy that have been mutually agreed upon by customers and therapists, is referred to as structure.6

DBT Treatment Stages

DBT isn’t just one basic concept. Instead, it’s made of stages and skills to help each person’s individual needs.

Stage 1

The client is unhappy, and their behavior is out of control: they might be attempting to commit suicide, self-harming, using drugs and alcohol, or engaging in other types of self-destructive behaviors. When clients first begin DBT therapy, they frequently describe it as being in “hell.” The aim of Stage 1 is for the person to transition from being out of control to having behavioral control.7

Stage 2

They’re going through life with their head in the sand. They may appear to be functioning well but are actually caught in a cycle of quiet desperation, suffering despite having behavioral control over it. Their emotional experience is limited. The goal of Stage 2 is for the client to transition from one of quiet desperation to one of full emotional expression.7

Stage 3

The goal is for the client to learn to live, develop self-respect, and find contentment and pleasure. The purpose is for the client to lead a normal existence of happiness and misery.

Stage 4

Stage 4 is required for all patients, unlike the previous three stages. Stage 4 is when patients learn to find deeper meaning in their spiritual life. Some people need spiritual fulfillment to achieve their life objectives. Patients develop a sense of belongingness while being a part of a greater whole and acquire the ability to enjoy happiness and freedom during Stage 4.

Behavioral Components of DBT Skills

Behavioral Components of DBT Skills
The DBT techniques include four behavioral skill modules: two acceptance-oriented skills (mindfulness and distress tolerance) and two change-oriented skills (emotion management and interpersonal effectiveness).7

Core Mindfulness 

You can use mindfulness to help you live a more present life. Eastern meditation techniques are adapted for Mindful Breathing. You learn how to concentrate on one thing at a time instead of focusing on yourself or others.7

Distress Tolerance 

Instead of getting caught in thought patterns that don’t aid you to process a problem (for example, thinking, “this isn’t fair!”), distress tolerance teaches acceptance. Acceptance may help you solve difficulties and boost your spirits when things you can’t change are accepted.

This lesson also teaches you healthy, in-the-moment alternatives to impulsive or self-harming behavior. Distraction and self-soothing methods, such as doing a deep breathing exercise, going for a walk, or listening to your favorite music, are included.7

Emotion Regulation 

Emotion regulation skills teach you how to describe your feelings without passing judgment. You learn how emotions impact your behavior and what barriers prevent you from doing so. You also learn to avoid circumstances that typically evoke strong emotions while pursuing events that enhance happy feelings.7

Interpersonal Effectiveness 

In this lesson, you’ll learn how to have healthy relationships while also taking care of yourself. Interpersonal effectiveness entails dealing with difficulties, listening attentively, and clearly expressing your requirements.7

What Can DBT Help With? 

DBT has been shown to help numerous mental conditions and psychiatric disorders, including:
DBT Treatment Stats

PTSD  

DBT can help reduce the symptoms of PTSD. Mindfulness is a DBT technique that enables you to ground yourself in the present moment. Emotion regulation and distress tolerance DBT skills can assist you in coping with distressing thoughts.

Disruptive Behaviors 

DBT for teenagers is common for those suffering from disruptive behaviors. It can help teenagers with anger, drug use, coping skill, and depression. Some methods will incorporate the parent into the treatment for better results.8

Mood Swings 

Emotion regulation, the third component of dialectical behavior therapy (DBT), teaches clients how to control unpleasant and overpowering emotions while also increasing positive experiences. The three objectives of this module are as follows: Recognize one’s feelings.8

Suicidal Behaviors 

DBT views suicidal behavior as an individual’s attempt to resolve an issue that feels unsolvable, according to the DBT website. Therefore, DBT focuses on assisting clients in better understanding the elements that contribute to their suicidal and self-injurious behaviors and identifying and utilizing more adaptive problem-solving techniques.9

Depression 

DBT is beneficial in the treatment of common symptoms of depression. Given that DBT was originally designed to help people regulate their emotions, it’s no surprise that it effectively treats depressive disorders.10

Anxiety 

DBT treatment focuses on learning emotional and cognitive skills (acquisition) and applying them to your life (generalization). DBT is designed to treat unpleasant or distressing feelings, as well as your capacity for emotional regulation, that is, your ability to regulate emotions when you have them, how you experience and express them.11

Anger Issues 

Dialectical behavior therapy is a highly effective anger-reduction technique that has been shown to help individuals who have been diagnosed with severe mental illness. Emotional management, distress tolerance, interpersonal effectiveness, core mindfulness, and self-management abilities are components of this treatment.

Eating Disorders 

The dialectical behavior therapy (DBT) treatment successfully treats binge eating disorder (BED). This study tests the usefulness of group DBT for obese “emotional eaters” who want to lose weight and maintain their weight.12

An Example DBT Session

How to Start Dialectical Behavior Therapy

Now that you know how DBT can help you and what steps are involved, it’s time to take action by finding an online DBT program or searching for DBT therapy near you.

What to Look for in a Dialectical Behavior Therapist

DBT recognizes that treatment, including group skills training, must pay as much attention to the behavior and experience of clinicians working with clients as it does to those of the clients.

As a result of this, the treatment of providers is an essential component of any DBT program, and therapists should practice the skills themselves. They must have a fundamental knowledge of behavior therapy techniques and DBT treatment plans. Look for a mental health professional with specialized training and experience in DBT certified by the Linehan Board of Certification, a non-profit organization that sets standards for practitioners. It’s also crucial to find someone you trust to work with and help you throughout the process.

What to Expect with DBT

It’s always best to know what to expect when attending DBT sessions. Whether online DBT or in person, the structure is the same.
    • Pre-treatment involves sitting down with the therapist and seeing if you can work together. The therapist will go over the process during the first couple of sessions. The typical agreement for treatment is one year.
    • Weekly individual therapy and weekly group sessions will have individual and group components. The personal session will focus on behaviors and can include assessments and homework. Group sessions focus more on building skills to assist in treatment.

    • Between session contact means that because you don’t have a scheduled meeting doesn’t mean you can’t be in touch with your therapist. You could receive calls, texts, and emails to help you avoid therapy-interfering behaviors.

How Long Does DBT Take?

While there is no set period for dialectical behavior therapy, most patients will complete a six-month or one-year duration of sessions. However, the term may change based on what disorder is being treated, if any other issues are discovered, and how severe the illness is. Each of the modules is covered for six weeks each.
The sessions will take up a few hours a week with the possibility of homework throughout the treatment.

Resources

  1. https://linehaninstitute.org/dbt/
  2. https://psychotherapy.psychiatryonline.org/doi/full/10.1176/appi.psychotherapy.2015.69.2.97
  3. https://psychotherapyacademy.org/dbt/history-of-dialectical-behavioral-therapy-a-very-brief-introduction/#:~:text=DBT%20was%20developed%20in%20the,personal%20experience%20with%20mental%20illness.
  4. https://psychotherapyacademy.org/dbt/biosocial-model-in-dbt-how-symptoms-arise-and-are-maintained/
  5. https://www.goodtherapy.org/blog/Compare_Contrast_CBT_DBT
  6. https://onlinelibrary.wiley.com/doi/10.1002/9781118957882.ch9
  7. https://depts.washington.edu/uwbrtc/about-us/dialectical-behavior-therapy/
  8. https://www.goodtherapy.org/blog/managing-emotions-through-dialectical-behavior-therapy-0924124
  9. https://behavioraltech.org/wp-content/uploads/2018/09/How-DBT-Helps-High-Risk-for-Suicide.pdf
  10. http://jmums.mazums.ac.ir/files/site1/user_files_0d0bf0/bahareh13703-A-10-4883-46-9ee3a54.pdf
  11. https://www.anxiety.org/dbt-dialectical-behavior-therapy-compared-to-cbt
  12. https://pubmed.ncbi.nlm.nih.gov/26160619/