Dialectical behavioral therapy: What it is, for whom and how to use it

Dialectical behavior therapy (DBT) is a form of psychotherapy focused on changing negative behavior patterns. Developed in the late 1980s by Marsha M. Linehan, it was originally designed for individuals with borderline personality disorder. DBT helps develop skills to better manage stress, regulate emotions, and improve interpersonal relationships.

DBT combines cognitive-behavioral therapy techniques with concepts from Zen Buddhism. It involves a combination of individual therapy and group sessions. DBT trains four essential skills: mindfulness, emotion regulation, interpersonal effectiveness, and distress tolerance.

The effectiveness of DBT is widely supported in reducing self-destructive behaviors and improving mental health. It is actively used in rehabilitation centers, helping individuals cope with addiction and underlying emotional issues. DBT provides a safe environment to learn and practice new, healthy behavior patterns.

What is DBT in therapy?

DBT stands for dialectical behavior therapy and is a form of psychotherapy that combines cognitive and behavioral strategies. It is specifically designed for individuals who experience intense emotions. DBT aims to help individuals accept and regulate their feelings while developing healthy coping mechanisms.

The benefits of DBT include the ability to better manage negative or difficult emotions and reduce self-destructive behaviors. It is effective in treating and managing a wide range of mental health issues, including chronic suicidality, borderline personality disorder, and problems related to drug or alcohol abuse and eating disorders.

DBT typically includes a combination of individual therapy, group therapy, phone coaching, and therapist consultation. It is used for patients who struggle with emotion regulation and distress tolerance.

Techniques include mindfulness, interpersonal effectiveness, emotion regulation, and distress tolerance. DBT trains skills to manage extreme emotions and helps individuals learn healthy behaviors. It is also effective as group therapy.

How does DBT therapy work?

Lynch and Cheavens (2008) stated in the Journal of Clinical Psychology that DBT effectively treats comorbid personality disorders by addressing cognitive-behavioral rigidity and emotional restriction.

DBT combines cognitive behavioral therapy with mindfulness. It teaches patients skills to manage negative emotions and behaviors. The therapy helps individuals cope with stress and improve relationships. DBT is unique due to its dialectical component, integrating opposing perspectives to find balance.

DBT consists of four stages.

1. Phase one: Guides patients out of a self-destructive state of distress that may lead to parasuicidal behaviors. This phase may also involve eliminating dangerous or counterproductive behaviors or circumstances, such as substance abuse and homelessness.
2. Phase two: Focuses on improving patients’ motivation to make changes in their lives and helps them apply their skills and abilities in real-life situations.
3. Phase three: Aims to teach patients how to lead a fulfilling and meaningful life by effectively developing and using their skills and abilities.
4. Phase four: Helps patients maintain their skills and abilities, prevent relapse, and continue improving their lives.

DBT typically lasts a year but may vary depending on individual needs.

What is DBT used for?

DBT is used to treat borderline personality disorder and has been adapted for other mental health conditions. It helps patients cope with stress, extreme mood swings, and impulsive actions.

It teaches problem-solving skills, improves relationships, and builds self-confidence. The therapy provides support in managing distress and regulating interpersonal relationships.

What techniques are used in dialectical behavior therapy?

Dialectical behavior therapy utilizes various conversational techniques to achieve results. Active listening is essential, where attention is given to what is being said, and feelings are validated without necessarily agreeing. Reflective speaking allows individuals to gain insight into their emotions by mirroring their experiences and problems.

Clients develop healthy coping mechanisms and behaviors in a safe, supportive environment. Therapists assist in identifying solutions and practicing behaviors that promote acceptance and emotion regulation.

What skills does DBT teach?

According to Neacsiu, Rizvi, & Linehan (2010), dialectical behavior therapy increases skill use in individuals with borderline personality disorder. This leads to a reduction in suicidal behavior, depression, and improved anger management.

DBT trains skills to manage emotions, tolerate stress, and communicate more effectively. It focuses on four main areas:

• Mindfulness, to be aware of the present moment.
• Distress tolerance, to endure difficult situations without reacting impulsively.
• Emotion regulation, to reduce negative emotions and increase positive ones.
• Interpersonal effectiveness, to improve skilled interactions in relationships.

Does DBT work as group therapy?

Yes, DBT works as group therapy. It also teaches skills in a group setting where therapists conduct weekly sessions focused on practical application. These sessions help with emotional regulation and interpersonal effectiveness.

Groups provide individuals with a space to practice skills with peers. DBT sessions function like a class, where trainers teach skills. Participants sit together, share experiences, and receive homework assignments.

What is the effectiveness of DBT?

DBT is effective in treating a wide range of mental health issues. It is particularly helpful for borderline personality disorder, addiction problems, suicidal adolescents, eating disorders, incarcerated individuals, depressed older adults, and ADHD.

Robins, C. & Chapman, A. (2004) wrote in the Journal of Personality Disorders that DBT is effective for various populations. This therapy has been shown to reduce behaviors that lead to hospitalization and improve social interactions, decreasing the likelihood of therapy dropout.

The structured nature of DBT, including homework, is a key factor in the process and requires significant effort from individuals who must be willing and committed to making changes.

When is DBT not suitable?

DBT is not suitable when trauma processing is needed without a stable foundation. Individuals with severe intellectual disabilities often find DBT too complex. Uncontrolled behavior makes formal therapy difficult, and DBT requires commitment.

Clients recovering from traumatic experiences may sometimes need a more structured approach, where DBT could be overwhelming. People unwilling to work within the set boundaries may be less suited for DBT.

How is DBT used in rehab centers to treat addiction?

DBT is used in rehab centers to treat addiction by addressing the underlying emotional and behavioral issues that contribute to substance abuse. The therapy encourages patients to commit to abstinence and strengthens motivation.

DBT helps individuals assess and recover from the events that lead to substance misuse. It reduces physical discomfort during withdrawal and promotes behavioral change.

According to research by Dimeff and Linehan (2008), published in Addiction Science & Clinical Practice, dialectical behavior therapy is effective in promoting abstinence and reducing relapse rates.

Is DBT an evidence-based treatment?

Yes, DBT is an evidence-based treatment. It has been extensively researched and proven effective for individuals with mental health disorders. Randomized controlled trials have demonstrated DBT’s effectiveness, making it a valuable treatment option.

Is DBT an intervention?

An intervention is a targeted action designed to address a problem, often in the context of medical or psychological care. Dialectical behavior therapy is considered an intervention.

Does dialectical behavior therapy work for eating disorders?

Eating disorders are complex conditions characterized by abnormal eating habits that negatively impact health. They include anorexia nervosa, bulimia nervosa, and binge eating disorder, with obsessions over food, body weight, and shape playing a central role.

Dialectical behavior therapy has been found to be effective in treating eating disorders, particularly bulimia and binge eating disorder. While DBT is useful as a standalone therapy, it is often combined with other treatments to enhance effectiveness.