What is Dialectical Behavioral Therapy (DBT)?

​DBT is an empirically-supported treatment developed by Dr. Marsha Linehan that has been proven successful in improving the lives of people with a variety of struggles, such as: anxiety, depression, bipolar disorder, eating disorders, suicidal ideations, self-harming behaviors, anger management and PTSD.  The main modality of DBT treatment is for clients to join a DBT skills training group while also seeing a DBT trained individual therapist who is a member of a DBT consultation group.  The combination of the group and individual work has proven to be most effective in re-training the brain and learning new coping mechanisms.

DBT helps clients reduce behaviors that leads to distress and disruption and increase helpful behaviors, resulting in a calmer, more fulfilled life.

It includes 4 modules of skills, taught in a psychoeducational skills training group, and reinforced in individual therapy sessions and/or coaching calls:

• Mindfulness skills - Teach awareness of thoughts and feelings and implement the concept that urges, cravings, ideas, and feelings do not always require immediate action.  The focus is on the here and now, the present moment. 

• Interpersonal effectiveness skills- These skills allow the client to resolve conflicts, attend to relationships, get objectives met, and maintain one’s self-respect.  

• Emotion regulation skills- All emotions serve a purpose. These skills assist the client in describing and identifying emotions and emotional triggers, determining what role/function emotions serve, and how to reduce emotional vulnerability and intensity.

• Distress tolerance skills- These skills assist with tolerating painful events and emotions. Skills suggest involvement in different activities or behaviors in order to distract the client from emotional activation at the moment of crisis, until the intensity decreases.

Is DBT right for me?​

If the intensity of your emotions sometimes makes it hard to act and speak in ways that line up with your values, DBT can be incredibly helpful.

 DBT skills help you:

• Regulate emotions (help you deal when things get really overwhelming)

• Be in the moment (not try to escape the moment with overthinking, overworking, or excessive substances)

• Handle tough conversations (say what you mean in a way you won’t regret later)

Though DBT was originally developed as a treatment for borderline personality disorder, it has since been shown to be effective in treating clients with a variety of struggles. As many DBT clients say, “I wish everyone could learn DBT.” This is because ANYONE and EVERYONE can benefit from the skills practiced. Because the skills training portion of DBT treatment is not therapy, even coaching clients without diagnosable mental health conditions can participate in and benefit from DBT skills groups.

Different Kinds of DBT

There is a wide spectrum of DBT offerings. Finding out which type of DBT is right for you is key. If you are interested in DBT, the general guide below can help you find the right fit. When a therapist or coach says they offer DBT, be sure to ask exactly what that looks like. This will ensure you or your loved one gets treatment that meets your personal needs.

• Traditional or Adherent DBT – This is the original DBT. It was created for individuals living with borderline personality disorder. Fully adherent or traditional DBT (meaning adhering closely or exactly to the original manual created by Dr. Linehan) usually consists of one 50-minute individual therapy session per week in addition to one hour-and-a-half skills training group per week. It also includes phone-based coaching with a therapist outside of scheduled sessions when needed. The individual therapist must be part of a DBT consultation team in order for treatment to be considered adherent.
  
  Traditional DBT is best when an individual is really struggling to find stability in big aspects of life like work and relationships. There may be some level of crisis fairly regularly. In this mode of DBT, clinicians and clients work together to create highly targeted plans to address specific behaviors (for example: self-harming or binge eating) that are interrupting their lives.
  
  All forms of DBT come with some level of practice outside of sessions. Adherent DBT has very specific homework and can require a substantial time and energy commitment to be effective.

• Radically Open DBT – If the original DBT was created for people who get stuck in “emotion mind,” radically open DBT (RO-DBT) was created to help those who get stuck in “reason mind.” This form of DBT is set up similarly to traditional DBT. However, it differs in its goals and skills taught.

RO-DBT is for individuals who have trouble expressing emotions, who are likely to attempt to control whatever aspects of their lives they can, and who struggle to be open. Whereas traditional DBT helps individuals who feel and express emotions very intensely, RO-DBT helps those who avoid feeling or expressing their emotions at all.

• Non-Adherent DBT – There are a variety of ways to incorporate DBT into other types of therapy and coaching. It can range from using DBT skills as-needed with individual clients to having a DBT skills group that’s a little less structured than adherent DBT, or that doesn’t require participants to have individual DBT as well.

 As stated above, almost anyone can benefit from DBT skills. If you’re not in a crisis or at high risk of harming yourself, therapy or coaching that includes some DBT skills may be right for you.

Whatever form of DBT you seek, ask the therapist or coach about their DBT training and experience and how they use DBT in sessions. It’s also important to share a bit about yourself and what you want help with. An ethical provider will let you know if they’re not be the best fit and will help you find someone who is.