Dialectical behavioral therapy, or DBT for short, is a form of talk therapy originally developed in the 1980s by Dr. Marsha Linehan to help people at high risk for suicide. Although it is rooted in behaviorism, it pushed toward the strategy of temporarily tolerating distressing experiences rather than changing them. DBT also drew from contemplative practices from the West and East. These features came together to form some of the key components of DBT.
Target populations
Primarily, DBT is used for individuals with borderline personality disorder (BPD); however, it is also effective for treating other mental health conditions. Literature shows that DBT helps with depression, anxiety, PTSD, eating disorders, self-harm behavior, and substance use. DBT can easily be adapted to other populations due to its modular and hierarchical structure, and can be scaled to address simpler or more complex clinical presentations.1
Goals of DBT treatment
DBT emphasizes validation and acceptance of one’s own emotions, thoughts, and behaviors. This helps individuals feel understood. At the same time, they are encouraged to work toward changing unhealthy patterns of feeling, thinking, and behaving and to work toward balance.
Structure of DBT treatment
DBT can take form as individual therapy, skills training groups, and telephone coaching. Individual therapy provides the opportunity for a client to work one-on-one with a therapist to identify and work on goals specific to their condition. Skills training groups are group sessions where participants learn different practical skills based on the four core skill modules of DBT. Telephone coaching involves brief, on-call coaching over the telephone to help individuals work through real-time problems in their daily lives.
The four core skills of DBT
Mindfulness
Mindfulness cultivates awareness of being in tune with the present moment. The goal is to focus on the emotions and thoughts during the “here and now”, and to accept them without judgment, so that they can pass. Mindfulness practices included breathing exercises and body scans.
Distress tolerance
Distress tolerance focuses on enduring emotionally difficult situations and crises without resorting to harmful behaviors. It relies on the concept of radical acceptance and promotes healthy coping strategies through skills like TIPP, STOP, and self-soothing.
Emotional regulation
The emotional regulation skill helps individuals identify and manage their emotions effectively without judgment and to be able to respond to situations with less impulsivity. Mastering self-regulation is the key to being able to decrease emotional vulnerability and increase positive emotional experiences.
Interpersonal effectiveness
Interpersonal effectiveness is about improving communication with others through boundary setting, assertiveness, and managing conflict effectively. Some goals may include saying no without feeling guilty, asking for what you need or want appropriately, and maintaining or improving the quality of relationships. DEAR MAN and FAST are examples of skills within the interpersonal effectiveness module.
References
- Linehan, M. M. & Wilks, C. R. (2015). The course and evolution of dialectical behavior therapy. The American Journal of Psychotherapy, 69(2), 91-239. ↩︎