Dialectical behavior therapy
Dialectical Behavior Therapy (DBT) is an evidence-based psychotherapy treatment. Created in the late 1970s by Dr. Marsha Linehan, (yay women!) DBT was originally researched and studied for women struggling with chronic suicidality. Dr. Linehan combined traditional cognitive-behavioral techniques alongside mindfulness and acceptance principles to create DBT.
What’s a dialectic?
A dialectic is a philosophical concept where we recognize that opposing ideas can all be true. In DBT, dialectics involve the acceptance of two seemingly contradictory truths: acceptance and change. This approach encourages individuals to accept themselves and their experiences while also recognizing the need for change and growth. By embracing dialectics, individuals can navigate complex emotions, relationships, and life challenges more effectively.
The Four Modules
At its core, DBT operates on the belief that people are doing their best at all times, while also wanting and needing to improve and change. It emphasizes balancing acceptance and change through the use of skills. There are 4 modules of DBT skills: Mindfulness, Distress Tolerance, Emotion Regulation, and Interpersonal Effectiveness. Half of the skills are acceptance skills (mindfulness and distress tolerance) and the other half are change skills (emotion regulation and interpersonal effectiveness).
Mindfulness: DBT places a strong emphasis on mindfulness practices, which involve being present in the moment without judgment. Mindfulness techniques help individuals observe and experience their thoughts, emotions, and sensations without becoming overwhelmed by them.
Emotion Regulation: A core component of DBT is learning to identify, understand, and regulate emotions effectively. Clients learn skills to manage intense emotions and reduce emotional vulnerability.
Interpersonal Effectiveness: DBT teaches strategies for improving communication and building healthier relationships. Clients learn how to assert their needs, set boundaries, and navigate interpersonal conflicts skillfully.
Distress Tolerance: Life inevitably brings moments of intense distress and discomfort. DBT equips individuals with skills to tolerate and cope with distress without resorting to harmful behaviors.
Components of DBT
Many providers, myself included, provide DBT-informed treatment. For me, this means that I have extensive training in DBT and currently provide just individual therapy. I have prior experience providing comprehensive DBT. Comprehensive DBT treatment involves all 4 components that were originally researched. Here's a breakdown of each component:
Individual Therapy: Clients meet one-on-one with a therapist regularly to work on specific goals and address personal challenges. The therapist provides support, guidance, and validation while helping the client apply DBT skills to their life.
Group Skills Training: DBT skills groups focus on teaching clients practical skills in mindfulness, emotion regulation, interpersonal effectiveness, and distress tolerance. These groups provide a supportive environment for learning and practicing new skills alongside peers.
Phone Coaching: Clients have access to their therapist for brief phone consultations outside of scheduled sessions, particularly during moments of crisis or intense distress. Phone coaching offers real-time support and helps clients apply DBT skills in challenging situations.
Consultation Teams: Therapists who provide DBT undergo regular consultation and supervision to ensure fidelity to the treatment model and to address any challenges they encounter. These teams help therapists maintain their own well-being and effectiveness in delivering DBT.
Who Benefits from DBT?
DBT was initially developed to treat individuals with borderline personality disorder (BPD), a diagnosis characterized by intense emotions, unstable relationships, and impulsive behaviors. However, research has shown DBT to be effective for a wide range of mental health issues, including depression, anxiety disorders, substance abuse, eating disorders, and post-traumatic stress disorder (PTSD). I utilize DBT a lot with almost all my clients, particularly those struggling with ineffective behaviors such as self-harm, disordered eating, and suicidial thoughts/attempts.
A Life Worth Living
The ultimate goal of DBT is to build a life that’s worth living. When clients begin, life often feels miserable and is full of unbearable pain. For many, they’ve gone through numerous types of treatment before coming across DBT. DBT is a treatment full of skills and support to help you reduce suffering, improve relationships, and build a life that’s worth living. If you feel that DBT-informed therapy could be a good fit for you, let’s talk about your goals and the behaviors you’re struggling with.
