Dialectical Behavior Therapy

What is DBT?

Dialectical Behavior Therapy (DBT) is a treatment for individuals who have difficulty managing their emotions and behaviors. This may mean that they feel emotions more intensely than other people, making them difficult to tolerate. As a result, individuals might attempt to cope with painful emotions by engaging in harmful behaviors such as self-injury, substance abuse, or unhealthy eating. A renowned treatment for managing emotions and behavior, DBT helps people experience and regulate their emotions without necessarily acting on them. As an evidence-based treatment, it has been shown through research to be an effective approach in treating numerous difficulties.

Dialectics are a key element of DBT. A dialectic is the idea that two seemingly opposing ideas can both be true. DBT balances the dialectic of acceptance and change— two things that at face value seem to be the opposites, though when practiced together, can enable individuals to improve their lives. Therapists work to help individuals and families learn to tolerate distress, validate emotions and accept things as they are, while also working to help change patterns of thoughts and behaviors which may contribute to challenges such as depression, self-harm, and suicidal thinking. These concepts are an integral part of each component in a comprehensive DBT program, and emphasized throughout treatment.

History of DBT

DBT was developed as an alternative treatment for challenges that were not successfully addressed by cognitive behavioral therapy (CBT) alone. DBT draws heavily from such behavioral treatments in combination with eastern philosophies to treat the more complex concerns of self-harm and emotion dysregulation. DBT shares a similar goal in helping people understand the connections between their thoughts, feelings, and behaviors, and how changing adverse patterns of thought and behavior can improve how they feel. The method was initially developed by Dr. Marsha Linehan to treat adults with borderline personality disorder. It has also been adapted to treat adolescents and pre-teen children with severe trouble managing their emotions.


What Challenges Does DBT Address?

The overarching goal of DBT is to help individuals and families build lives worth living.  Those struggling with depression, significant family conflict, or difficulties regulating emotions may at times feel that their life is not worth living as it is, especially if these problems have been persistent. DBT aims to address five main “problem areas” to help participants identify short-term and long-term goals to build a life they want to live. 

  1. Confusion of the Self: Being unaware of one’s own emotions, not understanding thoughts and urges, or being unsure of why one feels or acts in certain ways. This may manifest as feeling stuck in the past or worrying about the future, both of which are patterns of thought that make it difficult to focus on and be present in the moment. Individuals may also feel confusion about what their personal goals and values are.
  2. Emotion Dysregulation: Dysregulation occurs when one feels emotions intensely and has little control over managing them and/or resulting behavior. This can look like fast and intense mood changes, or a long-lasting negative emotional state such as depression.
  3. Impulsivity: This can be acting on an emotion or urge without evaluating the possible outcomes or consequences. Impulsive actions can include substance use, self-harm, impulsive eating, and verbal or physical outbursts fueled by anger. These behaviors may be engaged in to avoid or escape painful emotional experiences. 
  4. Interpersonal Problems: This pertains to one’s relationships with other people, including peers. Interpersonal challenges may result in difficulty maintaining healthy relationships, lots of conflict in relationships, and potential loneliness due to the way relationships have been adversely affected. Maintaining self-respect in the face of peer pressure, as well as voicing one’s own needs and saying no to others are also challenges individuals may face.
  5. Family Challenges: While conflicts between family members may be the norm, significant conflict can be an area of concern. Challenges commonly faced include difficulty understanding each other’s emotions, actions, or point of view. Individuals and families may also be “polarized,” or think and act in extreme ways.

How DBT Can Help

DBT offers a set of skills for each “problem area” to help individuals and families cope with these challenges. DBT skills teach how to address adverse patterns of thoughts and behaviors by replacing them with more skillful ways of thinking and acting and how to tolerate difficult emotions. These specific skills include mindfulness, emotion regulation, distress tolerance, interpersonal effectiveness, and walking the middle path.

The most effective approach to DBT is a comprehensive one that consists of four main components: skills training (typically in a group format), individual therapy, phone coaching, and family and parent sessions. Each of these offers a unique type of support to individuals and their families, creating a well-rounded approach.