Dialectical Behavior Therapy

What is dialectical behavior therapy (DBT)? Who is it for?

DBT was developed by Marsha Linehan as treatment for individuals with Borderline Personality Disorder (BPD). It was designed to help improve care and reduce suffering for people experiencing severe and chronic difficulties in multiple areas of life, such as:

• Emotional regulation:

  • High emotion sensitivity

  • Overwhelming, frequent, and intense shifts in emotions

  • Slow return to emotional baseline

• Impulsive behavior:

  • Self-harm and suicidal behavior

  • Binge eating, spending sprees

  • Substance abuse

  • Risky behavior

• Cognitive dysregulation:

  • Dissociation and derealization

  • Feelings of paranoia under stress

• Interpersonal relationships:

  • Instability in relationships

  • Fears of abandonment

  • Significant distrust of others

• Identity disturbance:

  • Unstable or absent sense of self

  • Intense feelings of emptiness

What exactly is involved in DBT?

Since the first published treatment manual [1], DBT has been extensively research and adapted for a wide range of problems and populations [e.g., 2, 3, 4]. The two formats with the most research support are Comprehensive DBT and DBT Skills Training.

Comprehensive DBT

This approach is considered a frontline treatment for individuals with BPD or who are experiencing complex, multi-problem, and high risk concerns. It has four components:

• Individual DBT Therapy: Clients meet with an individual therapist weekly. Sessions are structured and goal-focused. The therapist works with the client to apply DBT skills and strategies to resolve high priority problems and build a “life worth living.”

• Group DBT Skills Training: Clients learn DBT skills while participating in at least 6-12 months of group therapy. Skills from all four modules are covered, including mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness.

• Phone Coaching: Clients are able to access their therapist for brief (~5-10m) coaching calls between sessions for support applying DBT skills to address problems in real-time.

• DBT Team Consultation: Therapists participate in weekly consultation meetings with other therapists providing DBT. These sessions help therapists to improve their skills and show up effectively for their clients.

As clients progress through comprehensive DBT, other therapies may be integrated. For example, clients may work to address underlying problems, such as the impact of trauma and traumatic invalidation or anxiety and OCD using research-backed protocols.

DBT is designed to be time-limited and research suggests benefits can occur within 6-12 months. Intensive DBT programs can provide more intensive care over a shorter period of time. These include residential, partial hospitalization (PHP) and intensive outpatient programs (IOP).

DBT Skills Training

This approach involves only the DBT Skills Training component described above. This is often done in a group setting, but may be offered one-on-one. Clients often complete the standard 6-month DBT curriculum, which includes skills to:

• Mindfulness: Reduce suffering, increase joy, and improve control of your mind.

• Distress Tolerance: Learn how to survive crises and accept painful realities.

• Emotion Regulation: Understand emotions, decrease suffering, and increase wellbeing.

• Interpersonal Effectiveness: Get what you need, set boundaries, and strengthen relationships.

As a standalone treatment, DBT Skills Training has been shown to have benefits for a wide range of presenting problems (e.g., anxiety, depression, eating disorders, substance use; [4]).