Dialectical Behavior Therapy (DBT) is a comprehensive cognitive-behavioral treatment that emphasizes the psychosocial aspects of therapy. Marsha M. Linehan developed it in the late 1980s to help treat borderline personality disorder (BPD), and it has since been adapted for other complex and severe mental disorders.
DBT combines standard cognitive-behavioral techniques for emotion regulation and reality testing with concepts of distress tolerance, acceptance, and mindful awareness derived from Buddhist meditation. The term “dialectical” refers to synthesizing opposite concepts, such as acceptance and change, to help patients find a balance between the two.
What are the Six Main Points of Dialectical Behavior Therapy?
Dialectical Behavior Therapy (DBT) is particularly effective for those with borderline personality disorder, but it’s also used to treat a range of other conditions. Here are the six main points of DBT:
#1. Core Mindfulness
DBT emphasizes mindfulness, encouraging individuals to actively engage in the present moment and maintain a non-judgmental awareness of their internal experiences and external environment. Individuals can effectively acknowledge and tolerate their intense emotions by cultivating this awareness without feeling overwhelmed or resorting to self-judgment.
#2. Distress Tolerance
This aspect of DBT helps individuals accept and tolerate distress without resorting to self-destructive behaviors. It includes coping strategies like distraction, self-soothing, and improving the moment. It includes techniques for surviving crises without making them worse.
#3. Emotion Regulation
DBT teaches skills to help individuals understand and manage their emotions to reduce impulsivity and improve emotional stability. It helps individuals identify emotions, increase positive emotional events, increase mindfulness of current emotions, and take the opposite action.
#4. Interpersonal Effectiveness
This component focuses on increasing relationship satisfaction. Skills taught include effective communication strategies and how to set boundaries. It focuses on improving relationships through assertive communication and maintaining self-respect in social interactions.
#5. Walking the Middle Path
This skill involves learning to see things from others’ perspectives, understanding and accepting different opinions, and finding a balance between acceptance and change. It involves understanding that two opposing views can both have validity and finding an effective approach to problem-solving.
#6. Validation
DBT teaches that validation is crucial for building relationships and helping individuals accept their thoughts, feelings, and behaviors as understandable. DBT stresses the importance of validating one’s emotions and experiences and those of others to build trust, empathy, and understanding.
These points work together to create a robust framework for individuals to develop skills that promote emotional and cognitive regulation and lead a more fulfilling life.
How Does DBT Differ From other Types of Therapy?
One of the primary differences between DBT and other therapies, including CBT, is its explicit focus on acceptance and mindfulness strategies. DBT incorporates techniques that help individuals accept their current experiences while working towards change.
In contrast, other psychotherapies primarily target the identification and modification of negative thought patterns and behaviors. CBT is typically a more structured, short-term treatment, often lasting between 10 to 20 sessions, whereas DBT can be a longer commitment, sometimes extending to a year or more of therapy.
Another distinctive feature of DBT is its use of out-of-session contact, such as phone coaching, to provide real-time support and reinforce the application of DBT skills in daily life. This aspect of DBT underscores its practical orientation towards skill-building and generalization to real-world situations.
What are the Main Components of DBT Treatment?
The main components of DBT are:
Individual Therapy
This one-on-one therapy between a patient and a trained therapist focuses on enhancing patient motivation, applying DBT skills to specific challenges, and addressing obstacles that arise during treatment.
Skills Training Group
In a classroom-like setting, patients learn and practice skills alongside others. Skills are divided into four key areas:
- Mindfulness,
- Interpersonal Effectiveness,
- Emotion Regulation, and
- Distress Tolerance.
Phone Coaching
To provide in-the-moment support, patients can contact their therapist between sessions to receive guidance on how to deal with difficult situations as they occur.
Therapist Consultation Team
DBT therapists participate in regular consultation meetings to support one another, discuss patient care, and ensure adherence to the treatment model.
How is A Typical DBT Session Structured?
A typical DBT session is meticulously structured to ensure that the therapeutic goals are met efficiently and effectively. It includes;
| Pre-Treatment Phase | Before the therapy sessions begin, there is a pre-treatment phase where the therapist and the client agree to work together. This phase sets the stage for the upcoming sessions and involves creating a treatment agreement, usually lasting about one year for adults. |
| Individual Therapy Sessions | Individual therapy sessions typically occur once a week and last for approximately one hour. These sessions are crucial for ensuring the client applies the DBT skills in their daily life. |
| Group Skills Training | In addition to individual therapy, clients attend weekly group sessions where they learn and practice DBT skills together. These educational sessions support the development of skills learned in individual therapy. |
| Intersession Contact | DBT also includes intersession contact, which allows clients to reach out to their therapists between sessions for coaching on using DBT skills in real-life situations, especially during crises. |
| Peer Consultation Team Meetings | Therapists also participate in peer consultation team meetings, which support them and ensure they adhere to the DBT treatment model. |
What are the Four Modules of DBT Skills Training?
DBT skills training is a crucial component of this therapy, structured around four core modules. Each module targets specific areas of skill development that contribute to the overall goal of achieving a balanced and mindful approach to life’s challenges.
#1. Core Mindfulness Skills
Mindfulness is the foundational module in DBT and permeates all other skills taught within the therapy. Individuals learn to observe, describe, and participate in their thoughts, sensations, emotions, and external environment without judgment through mindfulness. This skill helps in reducing reactivity to emotional stimuli and promotes a more reflective and less impulsive response to life events.
#2. Distress Tolerance Skills
Life inevitably involves encountering stressful situations and distressing emotions. The distress tolerance module equips individuals with skills to withstand and survive these crises without resorting to self-destructive behaviors. It emphasizes accepting reality as it is, not as we want it to be, and finding ways to endure and tolerate the moment without exacerbating the pain.
#3. Emotion Regulation Skills
The emotion regulation module focuses on understanding and managing intense emotions that can interfere with a person’s quality of life. The skills in this module help individuals change unwanted emotions and develop tools to prevent extreme emotional states.
#4. Interpersonal Effectiveness Skills
The interpersonal effectiveness module addresses this by teaching skills that help individuals assertively interact with others, maintain self-respect, and strengthen relationships. These skills are invaluable for navigating conflict, expressing needs and boundaries, and building a supportive social environment.
How can DBT Skills be Applied in Daily Life?
Here’s how you can integrate DBT skills into your routine:
- Practice being fully present in the moment. That could involve paying close attention to your senses, such as the taste of your food or the feeling of water during a shower, to ground yourself in the now.
- Learn to tolerate and survive difficult situations without making them worse. Techniques include distraction (focusing on something else), self-soothing (engaging in comforting activities), and improving the moment (finding positives in a tough situation).
- Work on discovering your feelings, understanding their triggers, and taking appropriate action to modulate their intensity. It might involve deep-breathing exercises when feeling anxious or journaling to process feelings.
- Enhance your communication skills by being assertive, maintaining self-respect, and strengthening relationships. It could mean practicing saying no without feeling guilty or asking for what you need clearly and respectfully.
- If you’re feeling down and have the urge to isolate, choose instead to reach out to a friend or engage in a social activity.
What Conditions Does DBT Effectively Treat?
Dialectical Behavior Therapy (DBT) effectively treats various conditions, particularly those associated with difficulties in regulating emotions. Here is a list of conditions that DBT has been found to treat effectively:
1- Borderline Personality Disorder (BPD): DBT was originally developed for the treatment of BPD and is considered one of the most effective treatments for this condition.
2- Self-Harm: DBT helps individuals gain skills to manage distress without resorting to self-harmful behaviors.
3- Suicidal Behavior: It provides individuals with tools to cope with suicidal thoughts and reduce the risk of suicide attempts.
4- Post-Traumatic Stress Disorder (PTSD): DBT can be adapted to address PTSD, helping individuals process trauma and develop healthy coping mechanisms.
5- Substance Use Disorders: The therapy is used to treat various substance use disorders by addressing the underlying emotional and behavioral issues.
6- Eating Disorders: Specifically, DBT is effective in treating binge eating disorder and bulimia, focusing on regulating emotions and developing mindful eating practices.
7- Depression: DBT assists in managing intense emotions and reducing depressive symptoms.
8- Anxiety: It helps individuals understand and control their anxiety triggers and responses.
How is DBT Adapted for Adolescents?
Dialectical Behavior Therapy (DBT) has been successfully adapted for adolescents facing emotional and behavioral challenges. This adaptation, known as DBT for Adolescents (DBT-A), introduces modifications to accommodate the developmental stage of adolescents, their environments, and the dynamics within their families.
Family therapy sessions are integrated into the treatment to support adolescents in navigating family conflicts and to educate family members about the treatment process. It helps create a supportive home environment conducive to the adolescent’s recovery.
Another significant component is the multifamily group skills training. DBT-A also offers between-session telephone coaching, providing adolescents and their families real-time support to reinforce new skills in challenging situations.
How is DBT Used for Substance Abuse Treatment?
Dialectical Behavior Therapy (DBT) has been found effective in treating substance use disorders (SUDs). The core of DBT is its focus on mindfulness, which helps individuals become more aware of their thoughts, and this awareness is critical for managing cravings and avoiding impulsive behaviors related to substance use.
Treatment includes individual therapy, group skills training, phone coaching, and therapist consultation. The therapy aims to help individuals build a life that they experience as worth living without relying on substances. Research has shown that DBT can be effective in reducing substance abuse, as well as improving mental health outcomes for individuals with dual diagnoses.
By learning to accept uncomfortable feelings and developing healthier coping mechanisms, individuals can work towards reducing their reliance on substances as a means of emotional regulation.
How can Someone Find a DBT Therapist?
Initially, one can seek referrals from trusted healthcare providers, friends, or family members who might have recommendations. Additionally, online directories and resources provided by professional associations can be valuable. For instance, Psychology Today offers a platform where one can search for therapists with specific expertise in DBT.
It’s important to ensure that the therapist is a licensed mental health professional with training and experience in DBT. Certification from a recognized credentialing organization, such as the designation CDBT (Certified DBT Therapist), indicates a therapist’s qualifications.
Consider therapists who treat the specific concerns you’re facing, whether it’s a borderline personality disorder, depression, anxiety, or other conditions, DBT is known to help with. Lastly, it’s crucial to verify the therapist’s credentials and to feel comfortable with their approach to therapy.
What Should One Expect When Starting DBT?
A typical DBT program includes individual therapy, group skills training, phone coaching, and therapist consultation. The therapy focuses on teaching skills in four key areas:
- Mindfulness,
- Distress Tolerance,
- Emotion regulation, and
- Interpersonal effectiveness
A detailed assessment is usually required before starting DBT, and progress is often tracked through regular sessions. Patients may also receive medication as part of their treatment plan if necessary. Commitment to the therapy process and readiness to actively participate in homework assignments are paramount for the success of DBT.
How Does DBT Help with Emotional Regulation?
Dialectical Behavior Therapy (DBT) provides a set of practical skills that encourage individuals to be present at the moment and observe their feelings without judgment. Skills like ‘Opposite Action’ and ‘PLEASE’ are central to DBT, aiding in changing unwanted emotions by acting opposite to the current emotion or taking care of one’s physical health to reduce vulnerability to negative emotions.
Additionally, DBT teaches ‘Check the Facts’ to challenge and change unhelpful thoughts that often intensify emotional distress. By integrating these skills, DBT aims to decrease the frequency of overwhelming emotions, reduce vulnerability to emotional triggers, and increase positive emotional events.
What is the Typical Duration of a DBT Program?
Dialectical Behavior Therapy (DBT) programs typically have a structured duration, which can vary depending on the specific needs and progress of the individual.
Generally, a full course of DBT takes around 6 months to complete, with patients spending approximately 6 weeks on each of the four main modules: mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness.
However, some treatment protocols analyze the effectiveness of shorter and longer durations, ranging from 6 months to a full year. The flexibility in program length allows for adjustments based on individual treatment goals and response to therapy.
Is DBT Covered by Insurance?
Coverage for Dialectical Behavior Therapy (DBT) by insurance varies depending on the specific health insurance plan and provider. When carried out by a registered, certified mental health clinician, most health insurance companies must provide partial or full coverage for mental health treatments, including DBT.
However, the extent of coverage and the out-of-pocket costs can differ based on the type of health insurance coverage you have. It’s important to check with your insurance provider to understand the details of your coverage. If you’re considering DBT, contacting your insurance company directly or reviewing your policy’s coverage details online is a good first step to determine if your plan covers this therapy.
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Conclusion
DBT’s emphasis on the dialectical process, balancing acceptance and change, provides a compassionate framework that respects the individual’s experiences while promoting growth and transformation. As mental health professionals continue to seek effective interventions for complex psychological conditions, DBT offers a well-rounded and evidence-based approach.
By equipping individuals with the skills to manage their emotions, navigate relationships, and cope with distress, DBT not only alleviates suffering but also enhances overall quality of life.
Integrative Researcher in the field of Psychology, Spirituality and Religion, Professor of Integral Psychology and Spiritual Counseling, Bilingual Psychotherapist.