Dialectical behavioral therapy (DBT) is a derivative of cognitive-behavioral therapy (CBT). CBT is centered on identifying and changing negative thinking patterns and instead encouraging positive behavioral changes.
The term ‘dialectical’ is deduced from the idea that bringing together two opposites concepts in therapy, acceptance, and change, brings about greater results than either one alone.
What Can DBT Help With?
This approach to therapy can help people successfully improve their emotional and mental coping skills and develop effective ways to manage and express intense emotions in a healthy way.
Originally DBT was used to treat symptoms of borderline personality disorder, but it has been adapted to treat other mental health conditions, including:
- Major depressive disorder
- Anxiety disorders (PTSD, GAD, OCD, Panic attack disorder)
- Eating disorders (such as anorexia nervosa, bulimia nervosa, compulsive overeating, and binge eating disorder)
- Bipolar disorder
- Self-destructive/harming behaviors or suicidal ideations
- Substance use disorders
- Extreme emotional/mood distortion
How Does DBT Work? Techniques And Modules
DBT has evolved to become an extensively used, evidence-based psychotherapeutic approach to treat several mental health conditions. DBT is often used in various settings such as:
- Individual therapy with a trained professional where a patient’s learned behavioral skills during the course of their therapy sessions are adapted to their personal life challenges.
- Group therapy where patients are taught behavioral skills in group settings.
- Phone coaching wherein patients can call the DBT therapist outside sessions to receive guidance on coping with a distressing situation they might currently be in.
As mentioned above, DBT is based on cognitive behavior therapy, wherein you identify goals that are important to you and overcome the obstacles that prevent you from achieving those goals. You learn skills and techniques to change unhelpful thoughts, emotions, and behaviors.
The same applies to DBT, which is a highly structured treatment that teaches critical skills with the help of these four modules:
1. Core Mindfulness
This skill is considered the foundation of DBT; a patient will not be taught any other skillsets within their sessions until they fully learn how to be a mindful person.
Mindfulness helps you focus on the present and live in the moment. This helps you pay attention to your somatic reactions (your thoughts, feelings, as well as impulses) while also using your bodily senses to tune in to what’s happening all around you (what you see, hear, smell, and touch or any other sensations) in a non-judgmental approach.
An individual will eventually learn to accept all situations, no matter how intense or overwhelming their emotions may become. The strategy can also help you remain calm and avoid engaging in impulsive behavior and automatic negative thought patterns.
2. Distress Tolerance
Within the sessions of distress tolerance, an individual will develop the ability of acceptance and change. An elemental factor of learning acceptance is first to grasp the concept of radical acceptance.
Radical acceptance will allow you to embrace the idea that you will face both positive as well as negative situations in life. You will then learn how to view situations without being judgmental and learn how to accept whatever the outcome may be, thus preventing self-harming or impulsive behaviour.
This skill set heavily incorporates the first skill mentioned, mindfulness. You will further discover four primary techniques within this class that will help you handle any situation or crisis:
- Distracting yourself
- Thinking of the pros and cons of the situation
- Improving the stressful situation
3. Interpersonal Effectiveness
Interpersonal effectiveness will encourage you to become more assertive in relationships (for instance, expressing your actual needs and ability to say “no”) while still maintaining a positive and healthy relationship. You will learn to listen and communicate more efficiently, deal with challenging people or situations while respecting yourself and others.
4. Emotional Regulation
Emotion regulation lets you navigate and comprehend powerful feelings efficiently. The skills you learn here will help you identify, name, and alter your emotions.
When you are able to identify and cope with intense negative emotions (such as anger, frustration, or guilt), it reduces your emotional vulnerability and helps you have more positive emotional responses and experiences.
Sample Exercise: Opposite Action
Understand how you’re feeling and do the opposite. For example, if you feel depressed and want to withdraw from family or friends, make plans to go out and see your loved ones.
Stages And Goals In DBT
DBT therapy is designed to systematically and comprehensively treat issues depending on the severity. Since DBT therapy was initially intended for people with borderline behavioural and emotional problems, treatment progresses in stages. This ensures all concerns are gradually addressed. DBT adheres to the following four stages:
Stage 1: The goal of this stage is stabilization. Individuals in therapy may be dealing with serious issues like addiction, self-harm, or suicidal thoughts. They often report feeling like they are stuck at an all-time low point in their lives. Therapy is typically cantered on safety and crisis intervention aiming to help people achieve control over distressing emotions/behaviours.
Stage 2: The goal of this stage is for individuals in treatment to fully experience and comprehend their emotions instead of silencing or burying them. Here, behaviours become more stable, but mental health issues may still be present. Deep emotional pain is brought to the surface, and traumatic experiences are safely explored.
Stage 3: This stage focuses on enhancing the quality of life through realistic goal-setting and progress maintenance. The goal of this stage is to promote happiness, contentment, and stability.
Stage 4: In this stage, therapists support their patients in advancing their lives to a better phase. People may improve on learned skills or work toward emotion and spiritual fulfilment. This stage aims to help people achieve and maintain an ongoing capacity for happiness and well-being.
Things To Consider
You cannot expect instant results as progress with DBT is gradual and requires a significant commitment of time and self-improvement.
In addition to regular therapy sessions, patients are also required to do homework to work on skills outside of their therapy sessions.
DBT therapy may also be extremely challenging and emotionally triggering for some people as they begin to explore their traumatic experiences and emotional pain.
The Bottom Line
We understand that the first step is always the hardest, but we encourage you to get in contact with a specialist if you feel you or your loved one may benefit from CBT treatment and get the help needed.
The competence of DBT is evaluated for borderline personality disorder by Bohus, Martin, et al. in “Effectiveness of inpatient dialectical behavioral therapy for borderline personality disorder: a controlled trial.” Behaviour research and therapy (2004).
DBT, an effective approach for parasuicide, is well explained in “Dialectical behavioral therapy: A cognitive-behavioral approach to parasuicide.” Journal of Personality disorders (1987) by Linehan and Marsha M.