What is Dialectical Behavioral Therapy (DBT)
Dialectical Behavioral Therapy (DBT) is a potent combination of cognitive and behavioral therapies originally created for chronically suicidal individuals and those affected by borderline personality disorder (BPD).
The goal of DBT is to transform negative thinking patterns and destructive behaviors into positive outcomes using a variety of problem solving and acceptance-based techniques within a framework of dialectical methods. By freeing individuals from their negative thought processes and helping them to establish mindfulness practices and emotional regulation, they will be better prepared to manage any challenging hardships that lay ahead.
Along with being the gold standard for treating borderline personality disorder, DBT has proven to be highly successful in treating a variety of other mental disorders including eating disorders , post-traumatic stress disorder , substance abuse disorders , and depression .
Designed to address the complexities of these often-debilitating disorders that are challenging to treat, DBT uses a combination of group, individual therapy, and coaching to help clients better regulate their emotions, manage their behaviors, and improve overall functioning.
Origins of DBT
Developed in the early 1970s by Dr. Marsha Linehan, Professor of Psychology at the University of Washington, DBT impressed therapists with its ability to help clients overcome emotional dysregulation and suicidal thoughts and regain control of their life and experience a more meaningful existence. Throughout the process of DBT, unwanted thoughts and behaviors are replaced by a positive mental framework that empowers individuals to make healthier decisions in their everyday lives.
How DBT Works
DBT incorporates a combination of group and individual therapy sessions that seek to teach individuals valuable self-management skills.
Different than other psychotherapies that utilize a more singular approach to treatment, a standard DBT program consists of a combination of highly effective components that consist of the following:
1 – DBT Individual Therapy
With DBT individual therapy, clients meet one-on-one with a therapist to address the unique challenges faced in their everyday lives. Individual meetings occur one or more times per week throughout the entirety of the therapeutic process.
2 – DBT Skills Training
DBT skills training allows clients to connect with others who are experiencing similar difficulties in life. DBT skills training is performed in a group setting, and the therapist teaches a variety of skills and assigns homework for each member to carry out on their own. The homework calls upon the clients to practice using their newly learned skills on a regular basis.
DBT skills training classes meet one or more times per week. In a standard outpatient DBT program, it takes about 6 months to complete the entire skills curriculum. The same curriculum is commonly repeated for another 6 months to create a full 1-year program. In a DBT intensive outpatient program or a residential DBT program, the skills are taught in a more accelerated manner by increasing the number of skills groups taught per week.
Within the group skills training component there are 4 specific modules – each module is crucial to the overall effectiveness of treatment. Skills learned in each module enable the client to redefine their identity and lead a more productive life. The four DBT modules are as follows:
Emotional Regulation Because many clients experience fluctuations of extreme emotional states , helping to regulate clients’ emotions during stressful times is a primary goal. Emotional regulation helps the client to better understand, adapt, and alter their emotions to improve their mindset. A structured approach includes being able to identify emotions, reduce vulnerability to reactive behaviors, and identify obstacles to changing emotions.
Distress Tolerance Here, clients learn to reframe their thoughts, implement self-soothing techniques, and better understand the present moment to better cope with uncomfortable events and occurrences that cause anxiety and stress.
Mindfulness The practice of being fully aware and present in the moment, which is achieved through a variety of techniques. Clients are encouraged to keep a diary and reflect on the challenges and triumphs of their daily efforts along the way.
Interpersonal Effectiveness Helping clients learn how to speak up for what they want is the goal of this approach. Interpersonal effectiveness provides the tools for helping clients to ask effectively for what they need and also helps them to say no in a way that minimizes conflict and keeps relationships healthy.
3 – DBT Phone Coaching
Because added therapeutic assistance may be needed between sessions, clients are encouraged to call their therapists during times when in-the-moment support might be necessary for stressful situations that occur in clients’ everyday lives. Here, therapists coach clients over the phone on how to use the DBT skills they’ve learned in group and individual therapy settings.
4 – DBT Therapist Consultation Team
Due to the severity and complexity of the issues encountered by those who provide DBT, a consultation team is considered essential for DBT providers. To offer optimal care to the client, individual therapists, skills training group leaders, case managers, and others who are part of the treatment team meet on a weekly basis to compare notes, share knowledge, and motivate one another as they move forward with DBT treatment plans. Along with helping maintain a high level of motivation and competence among support team members, these weekly consultations also prove vital to preventing provider burnout.
How Effective is DBT?
Over the past decade, extensive research has been done to validate the effectiveness of DBT for various psychological issues and disorders. These findings have consistently demonstrated that DBT is highly successful in lessening suicidal behavior, non-suicidal self-injury, psychiatric hospitalization, treatment dropout, substance use, binge eating, anger, anxiety, and depression. DBT works to make notable improvements in overall social functioning.
Several studies have demonstrated the positive impact of DBT in reducing the adverse consequences Borderline Personality Disorder, posttraumatic stress disorder (PTSD), self-harm, and suicidality .
- A controlled trial conducted in an institutional setting used DBT to treat female participants exhibiting deliberate self-harm (DSH) behaviors. After receiving a full, one-year DBT treatment program, the participants showed a significant reduction in DSH during the course of therapy as well as at the 6-month follow-up. In addition, participants demonstrated a reduction in dissociative experiences, an increase in survival and coping beliefs, improvement in depressive symptoms, reduced suicidal ideation, and decreased impulsivity.
- A recently conducted randomized clinical trial set to evaluate whether DBT would be effective for drug-dependent women with Borderline Personality Disorder found subjects assigned DBT showed considerably greater reductions in drug abuse than those receiving treatment as usual (TAU). Findings also showed that individuals within the DBT group demonstrated significantly greater gains in global and social adjustment at follow-up than did those assigned to TAU.
- Another study led by Linehan suggests DBT may be effective in reducing suicide attempts . Findings demonstrated that those who received DBT were 50% less likely to attempt suicide, had less psychiatric hospitalizations, and were more likely to continue treatment compared to those who received therapy from professionals considered to be experts in the treatment of suicide.