Dialectical Behavior Therapy (DBT): What Is It & How It Works
Last Updated: November 20, 2023
Dialectical behavioral therapy, or DBT, is an evidence-based and comprehensive psychotherapy approach integrating acceptance and mindfulness with elements of traditional cognitive behavioral therapy. Dialectical behavioral therapy is a variation of cognitive behavioral therapy. The process helps people as they’re dealing with challenging emotions. It can also reduce relationship struggles and interpersonal conflicts.
What Is Dialectical Behavioral Therapy?
Dialectical behavioral therapy is psychotherapy that’s evidence-based and helps with the regulation of emotions. Other goals of DBT are to help participants stay in the moment, manage their relationships more effectively, and tolerate distressing moments in life.
DBT provides structure and can help build or improve coping mechanisms to deter problematic behaviors. DBT focuses on emotion, with an underlying assumption that acceptance and change can come together, even though they’re opposites.
Most often, DBT is used as a treatment for chronic suicidal behaviors and borderline personality disorder. It can also be helpful to treat other mental health and mood disorders, like anxiety and eating disorders. The treatment usually lasts for a minimum of six months.
Origins and History of DBT
Marsha Linehan developed DBT in the early 1990s. A psychology researcher at the University of Washington, Linehan created the therapy approach as she was working with patients with borderline personality disorder who were chronically suicidal. Linehan built the concept of DBT based on research and evidence-based strategies for cognitive behavioral therapy that specifically addressed suicidal behaviors.
Linehan’s patients were taught how to react in varying situations while learning the need for acceptance of experiences and emotions. The acceptance theme incorporated into this therapeutic approach then needed to be balanced with interventions to promote change. That led to a behavioral treatment program that went in-depth to treat patients with borderline personality disorder comprehensively.
What’s the Difference Between DBT and CBT?
Cognitive behavioral therapy (CBT) focuses on helping a person change their maladaptive and irrational thinking patterns. These thought patterns have a negative effect on behaviors and feelings. DBT modifies CBT by combining mindfulness and acceptance with cognitive behavioral strategies.
Consider some additional differences between the two below:
- CBT is used for treating depression, anxiety, and eating disorders. It’s also helpful as part of addiction treatment, and it can help treat impairments related to social skills.
- DBT is most often used for suicidal behavior and borderline personality disorder.
- DBT is used with adults and adolescents only, while CBT can be for children and teens.
- CBT usually takes place on a weekly basis in an individual setting, but DBT integrates modalities like individual therapy, phone coaching, and skills groups.
- Another difference is that DBT is considered a long-term treatment while CBT is short-term.
DBT Treatment Modalities
Treatment modalities include:
- Individual therapy focuses on the identification and understanding of maladaptive thoughts, feelings, and patterns of behavior. Individual therapy sessions can be used to develop new skills for regulating emotions and thoughts. The focus of individual DBT sessions is on motivation, engaging in treatment, learning appropriate behaviors, and reducing behaviors interfering with treatment.
- Group skills training usually takes place weekly. Areas that may be emphasized are distress tolerance, mindfulness, and interpersonal skills. Group therapy will also focus on helping participants apply these skills in their daily lives.
- Phone coaching can take place between sessions or during a client crisis. Phone coaching can be used to help someone cope with symptoms or emotions.This modality can also be helpful during times when emotions are heightened or when suicidal thinking is taking place.
- DBT consultation teams are a group of providers who attend weekly meetings to strengthen their skills. These are a way to reduce burnout in DBT providers working with high-risk clients who have intense emotions.
How DBT Works
In DBT, a client is taught acceptance of thoughts, experiences, and feelings, free of judgment. Someone in this type of therapy learns how to focus on a single thing at a time while they’re aware of their thoughts and senses. Skills development emphasizes the identification, verbalization, and understanding of emotions at the same time as they’re observing, experiencing, and describing them.
Distress tolerance skills help clients accept and deal with stress without impulsivity to prevent the long-term worsening of the situation. Emotional regulation skills help with managing responses. Interpersonal skills in DBT are meant to help clients learn communication skills and navigate conflict when it inevitably occurs in relationships.
DBT modules help people learn skills to interact with their environment in healthier ways. Then, in weekly group sessions, clients review how to apply them.
The four DBT modules are:
- Mindfulness is where clients are taught to focus on the current moment while regulating their attention. In this module of DBT, you’re encouraged to observe, participate, and describe what’s happening at the moment without judgment.
- DBT teaches distress tolerance so that the client can cope with difficult situations without making them worse. Techniques that might be taught as part of this module are self-soothing, distraction, weighing pros and cons, and improving the moment in productive ways.
- Interpersonal effectiveness educates participants about how to have healthy relationships, handle conflicts, and utilize assertive communication.
- DBT teaches emotional regulation skills to help participants identify and work through their negative emotions by enhancing positive emotions and using distress tolerance strategies.
What to Expect During a DBT Session
Treatment using DBT is made up of individual and group sessions. Skills are taught and then practiced. Individual sessions are led by a therapist who helps clients keep up their sense of motivation, manage obstacles that might arise during treatment, and apply skills in everyday life.
Group therapy sessions educate participants on DBT skills so they can then practice them in a supportive group environment. Group sessions typically last for two hours, during which time members are asked to share experiences and support one another. Homework is often assigned to be done between sessions.
Benefits of Dialectical Behavioral Therapy
DBT was initially designed as a treatment approach for women with chronic suicidality and borderline personality disorder; it’s now more widely used to help people with mental health disorders and conditions associated with emotional dysregulation. Depression, addiction, and eating disorders can all be treated with DBT. The skills training and treatment modalities of DBT allow it to be tailored to a variety of mental health conditions.
Goals of DBT
The primary goals of DBT can depend on the person and what’s being treated. Still, generally, it is about learning how to cope in healthy ways and reduce maladaptive behaviors and responses. Mindfulness is taught to help combat feelings of emptiness and disconnection; interpersonal skills help with loneliness, and emotional regulation helps with distress tolerance to reduce the risk of impulsive or destructive behaviors. Participating in this type of psychotherapy can also improve self-confidence, self-esteem, motivation, and overall quality of life.
Effectiveness of DBT
DBT is a practical treatment approach for:
- Self-harming behavior
- Anger management
- Emotional dysregulation
- Borderline personality disorder
There is a significant body of research that looks at the effectiveness of DBT, which is viewed as one of the leading treatments for borderline personality disorder in addition to what’s listed above.
DBT in Addiction and Mental Health Treatment
The conditions that DBT can help include:
- DBT for Addiction: This therapeutic approach can be modified to help individuals who are struggling with addiction. There are concepts and interventions utilized that promote abstinence and lower the risk of relapse. DBT can be used to reduce urges and cravings, resist triggers, reduce substance use, and minimize physical discomfort. DBT for addiction is built on the concept that harm reduction and abstinence are both essential and can co-exist in recovery.
- DBT for Borderline Personality Disorder: Dialectical behavior therapy was created initially to treat borderline personality disorder, and as such, it teaches skills for emotional regulation, reducing distressing emotional pain, and improving reactivity. DBT can also strengthen distress tolerance and mindfulness in people with BPD.
- DBT for Anxiety: Mindfulness skills taught in DBT help anxiety disorders so that clients can live in the moment. DBT is helpful for anxiety because it helps people identify and change how they feel and create more positive emotional experiences. A DBT client can learn how to deal with worries about the past or future by focusing on the present.
- DBT for Depression: Symptoms of depression can be addressed through empowerment to create positive emotional experiences. There are tools taught during DBT that can be used during depressive periods.
- DBT for Eating Disorders: Skills that help eating disorders in DBT include learning how to regulate emotions that cause harmful behaviors. The symptoms of eating disorders are viewed in DBT as a coping mechanism for negative emotions. By participating in DBT, you can learn how to effectively manage your negative emotions without turning to harmful food-related behaviors.
- DBT for Bipolar Disorder: Someone with bipolar disorder could benefit from DBT skills for distress tolerance and emotional management.
Finding Dialectical Behavioral Therapy in Kansas City
There are various ways to find a therapist who uses DBT. For example, the Substance Abuse and Mental Health Services Administration (SAMHSA) has a tool online you can use to find treatment. You can search for inpatient or outpatient facilities offering DBT. Another option is contacting your insurance company to see if they can connect you with DBT providers in your area.
At The Recovery Village Kansas City, we offer dialectical behavioral therapy. We provide DBT as part of our addiction treatment programs and also as an integration into our mental health services that don’t include addiction treatment. We are in-network with most major insurance providers, and we can quickly help you verify your coverage or take the next steps. Reach out to one of our recovery advocates today.
Chapman, Alexander L. Ph.D. “Dialectical Behavior Therapy.” NIH National Library of Medicine, September 2006. Accessed November 7, 2023.
Linehan, Marsha M. PhD. And Wilks, Chelsey R. M.S. “The Course and Evolution of Dialectical Behavior Therapy.” The American Journal of Psychotherapy, April 30, 2018. Accessed November 7, 2023.
Cohen, Jeff, PsyD. And Sloan, Colleen, A. PhD. “What is dialectical behavior therapy (DBT)?” Anxiety & Depression Association of America, May 3, 2022. Accessed November 7, 2023.
May, Jennifer M, MD. Et al. “Dialectical behavior therapy as treatment for borderline personality disorder.” NIH National Library of Medicine, March 2016. Accessed November 7, 2023.
Lenz, A. Stephen; Taylor, Rebecca; Fleming, Molly; Serman, Nina. “Effectiveness of Dialectical Behavior Therapy for Treating Eating Disorders.” Journal of Counseling & Development, January 2014. Accessed November 16, 2023.