Admittedly, Dialectical Behavior Therapy (DBT) features an unusual name that does not intuitively convey what it might entail, who it might help, or how it is conducted. Often called DBT, because it is simply easier to say, this therapy approach was initially developed by Marsha Linehan to address Borderline Personality Disorder. Since its development, DBT has been found useful for many other conditions too.
At its core, DBT aims to help clients develop skills that they can use to manage difficult emotions, tolerate distress, strengthen mindfulness skills, and improve their relationships. It is helpful for clients struggling with symptoms of depression, anxiety, eating disorder, and many other conditions. Learn more about DBT to determine whether it might be a helpful approach for you.
Premise of Dialectical Behavior Therapy
DBT was developed on the foundations of Cognitive Behavior Therapy (CBT). CBT was developed by Aaron Beck, to address anxiety and depression, although it has many other applications as well. CBT focuses on identifying and correcting dysfunctional thoughts and through that improving emotions and behaviors. At its core, DBT also aims to improve thoughts, emotions, and behaviors, yet it has a very different flavor and different components.
DBT takes its name from and is influenced by a philosophical perspective rooted in Eastern/Buddhist practices. As such, it focuses on dialectics, or the balancing of opposites. The idea is that people often need to hold two different, perhaps even opposite, perspectives simultaneously. Being able to successfully do this, allows people to think clearly and act decisively.
Recall that DBT was initially developed to treat Borderline Personality Disorder. Thus, the premise for it was based on Linehan’s observation that individuals with the condition often struggle with intense emotions based on extreme viewpoints. Such thoughts and feelings lead to relationship and work difficulties, which often just deepen extreme thinking and emotional dysregulation.
DBT is intended to teach people a new outlook, encouraging slowing down, thinking things through from multiple perspectives, and seeing the gray-zones in situations. DBT skills teach how to do a chain analysis of behaviors to set oneself free from dysfunctional patterns and to have more choices in how they behave. This can allow individuals to develop balance in their thinking, emotions, and life in general.
Format of Dialectical Behavior Therapy
As noted, when DBT was initially developed, it was designed for use to treat Borderline Personality Disorder. Marsha Linehan had observed that existing treatments did not seem to adequately help this population and yet, she firmly believed that they could be helped. Dr. Linehan suffered greatly from her own BPD and she described her path and struggles and how she developed DBT in her book Building A Life Worth Living: A Memoir. She developed DBT as a holistic treatment to help individuals with BPD symptoms learn the skills necessary to improve their lives.
DBT involves a combination of individual therapy and skill class in group settings. This allowed individuals to learn and practice their skills in the company of others, who had similar struggles. A trained therapist would lead the group, teaching a new skill each week and assisting the clients as they practiced those skills. In subsequent sessions, previously taught skills would be reviewed. Clients in DBT also participate in individual therapy sessions, usually on a weekly basis. This allows the individual to talk one-on-one with their therapist about the skills they are learning, how to apply those skills to their daily life, and how to manage any challenges that they may face.
DBT therapists also make themselves available to their clients outside of scheduled session times for skill coaching, in order to provide skill support as needed (almost like tech support when you face a computer problem). This support could occur via phone or text.
While the full DBT model involves the combination of individual sessions and group sessions, some clients may benefit from receiving DBT in individual or group settings alone. This depends on each client and what makes the most sense for their treatment.
Content of Dialectical Behavior Therapy
DBT is considered largely a psychoeducational approach because it involves teaching clients information and skills that they can use to improve their psychological functioning. DBT teaches skills, which are organized into four modules. Each module focuses on a different skill set that addresses a particular set of symptoms.
Mindfulness
The first module of DBT is Mindfulness. This module focuses on improving an individual’s ability to live in the present moment and accept life’s circumstances. Skill groups usually start with a mindfulness module. Mindfulness skills begin with an exploration of the logical mind, emotional mind, and wise mind. With time and practice, clients spend more time in ‘wise mind,’ and learn how to access that state to make better decisions.
Additional mindfulness module lessons cover many other skills such as observing their internal states and the outside world, being able to describe what is happening without judgment, being able to fully participate in activities with one’s whole body and mind, and generally being able to focus one’s mind on the present moment.
During the mindfulness module, DBT therapists teach clients skills that they can use to practice being more mindful in their daily life. Individuals will have all these different skills, from which they can always choose whichever seems to fit best for them. The goal is to give clients the tools they need to make the most effective choices at any given time.
Distress Tolerance
The second module of DBT is Distress Tolerance. This module focuses on increasing a person’s ability to manage or simply tolerate negative and even painful emotions. Often, people feel inclined to deal with negative emotions by avoiding them and then they do not learn how to manage them well. As a result, people may handle intense emotions in negative and unhelpful ways that create more problems.
Lessons in the Distress Tolerance module of DBT include learning how to: distract from difficult emotions when appropriate, self-soothe, and improve the moment. A key lesson focuses on ‘radical acceptance’ which involves learning that some situations cannot be changed, and instead only one’s reaction can be changed. Accepting a situation allows a person to more calmly attend to their emotions.
Emotion Regulation
The third module of DBT is emotion regulation. This module focuses on helping the person develop strategies to manage their emotions and even change (improve) their emotions. Dysregulated emotions are a problem in many different psychological conditions. By learning how to better regulate one’s emotions, a person will be more capable of managing anxious and depressive reactions.
The first lesson in this module involves understanding what emotions are and how they occur. Then, clients are taught how to reduce their emotional vulnerability. This entails learning to practice self-care, so they will be most capable of managing whatever life throws at them. Finally, clients are taught how to reduce emotional suffering by sometimes letting go and sometimes acting the opposite of what they feel.
Interpersonal Effectiveness
The fourth module of DBT is interpersonal effectiveness. This module focuses on developing techniques for better communication so that interpersonal functioning can be improved. Lessons here involve learning how to be assertive but not aggressive, how to balance self-respect with respect for others, how to compromise without compromising oneself, and how to communicate during difficult discussions.
Throughout the modules, a lot of information is taught and there are many lessons to be learned. Some people may fear this will ultimately be boring and difficult to engage with. However, the information is all very practical, and it is interspersed with opportunities to practice the skills being taught. Most clients enjoy the skills group after they overcome the fear of joining a group and give it a try.
It is key to note that DBT, like other forms of therapy, provides the most benefits when clients practice what they learn, outside of the sessions. To assist with this, in DBT, clients are asked to complete ‘homework.’ Now, this is not like homework in school, which may have been dry or boring. This usually just requires practicing newly learned skills and reflecting on how this worked in your daily life.
Not only is this homework fairly simple, it is also helpful. Everything you learn in DBT will go to waste unless you start using those lessons in your daily life. By committing to practicing new skills outside of session, you will start bringing those lessons into daily life and strengthen your abilities to use the skills you are learning in therapy.
Benefits of Dialectical Behavior Therapy
Dialectical Behavior Therapy is an effective and evidence-based approach supported by many research studies. It has quickly grown in popularity as psychiatrists and therapists apply the approach to various conditions, with favorable results. As noted, it has been used for common problems such as anxiety and depression, as well as more severe problems such as eating disorders, borderline personality disorder, and trauma recovery.
In addition to being a well-supported approach to therapy, clients enjoy this approach because it gives practical and tangible tools to use for quick relief. This approach can also be helpful in a broader course of treatment. For example, a client aiming to address trauma might benefit from first participating in DBT, so they can best manage their emotions during subsequent trauma therapy.
If you seek out DBT, be sure to work with someone who has DBT training.
Final Recommendations
If DBT sounds like an approach to therapy you would like to try, then you can look for a provider that offers this approach. You can search online for providers in your area. All therapists and clinicians at Mind Body Seven are trained in DBT.
To learn more about the way that DBT is used to treat Borderline Personality Disorder and Depression, and the way it can be adapted for use with adolescents, check out the additional articles in this blog series.
Mind Body Seven clinicians offer treatment in Brooklyn and via teletherapy for adolescents and adults. If have not worked with us and want to get started please contact us here, so we can set you up with the clinicians that best suit your individual needs. If you are an existing patient get in touch with us here to set up your next appointment.
