Dialectical Behavioral Therapy (DBT) is a cognitive behavioral psychotherapy originally developed in the 1980s to treat individuals diagnosed with Borderline Personality Disorder (BPD) who were chronically suicidal. Today, it is still recognized as the top therapeutic modality for this population, and is also widely used to treat a number of other issues, including drug and alcohol addiction and substance abuse.
What is DBT?
The premise of DBT is to integrate the opposite strategies of acceptance and change. For example, a DBT therapist would accept that a client is an alcoholic while also acknowledging that in order to reach their goals of sobriety or a healthier life, they need to change.
All skills taught in DBT are based on this main principle of balancing acceptance and change. Four skill modules are taught:
- Distress Tolerance
- Emotion Regulation
- Interpersonal Tolerance
The first two modules help develop develop acceptance skills, while the second two modules emphasize skills for change.
DBT has been proven a particularly effective treatment for clients who have difficulty regulating their emotions. This is because it teaches clients how to tolerate painful situations, how to ask for what they want, and how to regulate their own emotions. This can be particularly helpful for those recovering from substance abuse issues.
What does DBT treat?
- Borderline personality disorder (BPD) and other mental health personality disorders
- Drug and alcohol addiction
- Substance abuse or dependence
- Behavioral addictions like gambling addiction sex addiction, and eating disorders like anorexia and bulimia
- Non-suicidal self-injury (cutting and other forms of self-mutilation)
- Mental health illnesses like schizophrenia, bipolar disorder, and PTSD
How does DBT work?
DBT was invented by a psychologist Marsha M. Linehan, who was treating a number of women diagnosed with Borderline Personality Disorder (BPD). She was using cognitive behavioral therapy (CBT), the popular therapy at that time, but ran into problems with her clients as she tried to apply CBT.
Her clients consistently felt invalidated by CBT's constant focus on change and became angry and withdrawn. Many dropped out of treatment. The severity of her client's problems made CBT an ineffective treatment modality, so Linehan made significant changes to the model, thus creating DBT.
DBT is comprised of four elements: skills group, individual treatment, DBT phone coaching, and consultation team.
The four sets of behavioral skills taught in DBT are:
- Mindfulness: being present and aware in each moment
- Distress Tolerance: how to tolerate pain in difficult situations, without changing the situation itself
- Interpersonal Effectiveness: how to ask for what you want, and how to say no while maintaining relationships and self-respect
- Emotion Regulation: how to regulate or change your own emotional state when you want to
DBT is an proven, effective method of treatment that can help individuals get out of the cycle of addiction or other issues they're experiencing to a place where they can experience their life as one worth living. Where there was once incompleteness, they might experience joy.
What is a session like?
Sessions involve four main components: skills training, individual treatment, DBT phone coaching, and consultation team.
Skills training in DBT is protocol-based, meaning it has a set structure and does not go by the individual needs of each client. Skills training groups teach clients behavioral skills. Groups meet weekly for a 2.5 hour class in which group leaders teach skills, then assign homework so clients can practice the learned skills. The set program lasts for 24 weeks, and is usually repeated to create a full one-year program.
Individual therapy also takes place once a week while the client is in treatment. Individual therapy helps clients apply the skills they're learn to specific challenges in their lives, thereby increasing their motivation and keeping them focused.
Phone coaching provides clients with coaching on how to apply the skills they learn in everyday life. The focus is primarily on how to effectively cope with difficult situations. Clients can call their individual therapist between sessions and get coaching when they need assistance.
An additional component in DBT is for DBT therapists themselves. A DBT therapist consultation team helps therapists stay motivated and competent so they are able to give the best treatment possible to clients. Teams meet weekly and are made up of both the individual therapist and group leaders who treat that particular client.
What are the advantages of DBT?
The stages of DBT treatment often take a client from a state of "hell", where they are miserable and out of control, to a state in which their behaviors are in control but they continue to suffer. The next challenge is to live a full life, meaning one in which the client can experience both happy and unhappy experiences. The final stage is that of connecting a client to a deeper meaning. The goal of that stage is to encourage and facilitate a spiritual experience by which the client finds spiritual fulfillment and/or connection to a greater whole.
The structure and skill sets taught in DBT help keep a client from getting caught in any rigid thoughts, feelings, or behaviors, even in stressful situations (when triggers occur). When emotions are heightened, having a sense of how to maintain one's internal sense of balance is critical to not engaging in unhealthy behaviors like substance abuse.
DBT has the potential to carry someone from a life they themselves report isn't worth living into a space in which life can experienced as both happy and unhappy (balance). It helps clients regulate their own emotions and build skills to enhance their interactions with both themselves and others. This, in turn, leaves them well equipped to establish and maintain sobriety, as well as to have the capacity to feel motivated, uplifted, and satisfied as human beings.