Dialectical Behavioral Therapy
First developed for treating borderline personality disorder in the 1970s, dialectical behavioral therapy (DBT) focuses on changing behaviors and thought patterns. It remains one of the most common forms of psychotherapy used to date. DBT is a cognitive behavioral therapy that focuses on making positive behavioral changes.
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What Is Dialectical Behavioral Therapy?
DBT is an evidence-based therapy where patients build new skills to cope with intense emotions better.
DBT is frequently used to treat borderline personality disorder but can also benefit individuals with substance use disorders and eating disorders.
DBT helps patients address core issues such as:
- Suicidal ideation
- Self-destructive behaviors
- Emotional dysregulation
- Low self-esteem
DBT treatment typically consists of weekly 1-hour individual therapy sessions, a weekly group skills training session (approximately 1.5–2.5 hours), and a DBT therapist consultation team meeting.
DBT Core Principles
Dialectical behavior therapy evolved from American psychologist Dr. Marsha Linehan in the 1970s. Her core principles help DBT patients cope with day-to-day life.
DBT emphasizes improvement in these four core principles or modules:
- Mindfulness: Patients develop mindfulness skills that involve being fully present instead of worrying about the past or future.
- Interpersonal effectiveness: Patients learn how to ask for what they need while balancing self-respect with respect for others; patients also improve relationships by learning how to communicate better during conflict.
- Distress tolerance: Patients learn distress tolerance skills to self-soothe and avoid self-destructive behaviors (i.e., impulsivity, self-harm) when things feel out of control—also known as “radical acceptance.”
- Emotion regulation: Patients develop emotion regulation skills that help them understand their emotions first to eventually learn to control their reactions to intense emotions.
How DBT Differs from Other Types of Therapy
Although DBT originates from cognitive behavioral therapy, some key differences set DBT and other therapies apart.
For example, cognitive-behavioral treatment centers on the idea that thoughts and behaviors influence feelings. However, DBT works by helping people change their behavior patterns instead of trying to think or talk through issues.
Another significant component is DBT skills training; patients meet in a group therapy setting and learn coping skills from DBT therapists alongside their peers.
DBT also has a distinct edge on patients with borderline personality disorder and some substance use disorders.
How Dialectical Behavioral Therapy Works
Depending on the patient’s needs, complete DBT treatment could involve a mixture of one-on-one therapy, group sessions, skills training, and phone coaching.
Patients may also complete “diary cards,” a form of self-monitoring where the patient will track current emotions, skills, and behaviors.
Common DBT Techniques
Because DBT emphasizes changing behavior, DBT therapy sessions may be more frequent than other cognitive-behavioral therapies.
DBT treatment typically requires several hours a week, and DBT therapists may use various techniques.
Standard techniques used in DBT include:
- One-on-One Therapy: Like typical “talk therapy,” one-on-one sessions give the therapist time to help the patient build personal skills and navigate specific challenges.
- Skills Training: Similar to group therapy, a patient group meets once a week for 2 to 3 hours, where they learn about and practice one of the four DBT skills by talking through the scenario with each other.
- In-the-Moment Coaching: By using phone calls and other environmental coaching methods to provide in-the-moment support, patients can practice their DBT skills for effectively coping with difficult situations that arise in everyday life.
What Can DBT Help Treat?
Despite being initially created to treat people with suicidal behavior and borderline personality disorder, research has shown that DBT can help with other conditions.
DBT relieves patients with multiple mental illnesses or treatment-resistant patients with complex co-morbidities.
Eating disorders like bulimia or binge eating disorder have seen improvements from DBT and generally lower rates of self-harm and suicide attempts.
DBT and Addiction Treatment
Because of high rates of substance abuse among borderline personality disorder (BPD), many patients with substance use disorders have also found relief thanks to DBT.
According to research from Lahey Health Systems, 64% of BPD patients also had substance use disorder.
DBT has helped many patients suffering from substance abuse reduce their urges to use and shorten relapses. As mental illness can often cause or worsen substance abuse, DBT may also address those core mental health conditions in addicts.
DBT and Mental Illness
Other than borderline personality disorder, patients struggling with various disorders have succeeded with DBT.
- Eating disorders like bulimia or binge eating disorder
- Depression
- Post-traumatic stress disorder (PTSD)
- Bipolar disorder
- Dissociative Disorder
A small study showed DBT to be helpful for older adults with treatment-resistant depression, while another indicated DBT helped a group of women with binge eating disorder.
Other Issues DBT Can Address
Adolescents and adults at risk of suicide and self-injury have benefited from DBT, which addresses the profoundly intense emotions that cause self-harming behaviors.
Many DBT patients find they can better cope with day-to-day issues and succeed in other forms of treatment they may be using. DBT has helped many people avoid going inpatient or spending extended time in hospitalization.
Locate Dialectical Behavioral Therapy Providers in Your Area
DBT can provide life-changing strategies and skills to cope with substance use disorder or other mental illnesses.
If you or a loved one could benefit from DBT for substance abuse, check out SAMHSA’s online treatment locator at https://findtreatment.gov or call (800) 662-4357 to find a treatment center that fits your needs.
FAQs About Dialectical Behavioral Therapy
What does dialectical behavioral therapy do?
Dialectical behavior therapy (DBT) is a modified type of cognitive behavioral therapy (CBT) that teaches people how to develop healthy ways to cope with stress, regulate intense emotions, and improve relationships with others.
What are the four skills of DBT?
- Distress tolerance: Learning to feel intense emotions like anger without reacting impulsively or using self-injury or substance abuse to cope.
- Emotion regulation: Recognizing, labeling, and adjusting emotions without judgment.
- Mindfulness: Living in the present and becoming more aware of yourself and others.
- Interpersonal effectiveness: Navigating conflict and interacting confidently with firm, healthy boundaries.
What is the difference between CBT and DBT?
CBT focuses on identifying and shifting problematic thought patterns into something more productive. DBT, on the other hand, emphasizes changing behavior that results from those same problematic thought patterns.
This focus on behavioral change makes DBT effective for patients who experience intensive, sometimes explosive emotions or reactions. However, for some patients, CBT is often not enough for some patients to combat those emotions. DBT also provides skill-building exercises that CBT typically does not.
Is DBT better than other therapies?
While DBT isn’t better overall, DBT can be the better choice for patients struggling with borderline personality disorder, substance abuse disorder, eating disorders, PTSD, and other treatment-resistant forms of depression and mood disorders.
