What is Dialectical Behavior Therapy (DBT)?

Dialectical behavioral therapy is an intensive psychotherapy approach that teaches emotional regulation and distress tolerance.

What is Dialectical Behavior Therapy?

Dialectical behavior therapy (DBT) is a form of psychotherapy that is based on cognitive behavior therapy and uses the practices of mindfulness, distress tolerance, and emotional regulation to help individuals who struggle with intense emotions.

Dialectical behavioral therapy was originally developed to be used with dialectical behavior disorders such as borderline personality disorder. The theory of dialectical psychology is based on the idea of combining two opposites by focusing on helping individuals accept their lives and behaviors while also helping them learn to make changes.

How Does DBT Compare to Cognitive Behavioral Therapy (CBT)?

Though dialectical behavior therapy is a form of cognitive behavioral therapy, and both are aimed at teaching coping skills and altering negative thought patterns and behaviors, there are several differences between the two approaches.

Cognitive behavioral therapy is more focused on challenging and changing negative thought patterns, whereas dialectical behavioral therapy has more of a focus on balance and the relationship between acceptance and change. The focus of DBT is less on the changing of negative thoughts and more on identifying and accepting those thoughts without judgment and learning to develop coping strategies when experiencing negative thoughts. Dialectical behavior therapy is often used to help treat individuals that experience intense emotions, chronic self-harming behavior, suicidal thoughts, or have difficulty regulating emotions.

How Does DBT Therapy Work?

Dialectical behavioral therapy works by focusing on moving individuals away from black-or-white or all-or-nothing thinking and towards being able to hold two opposite perspectives simultaneously. In many types of disorders, individuals tend to only think in terms of black or white, which can create extreme conflict within themselves and among relationships.

The goal of DBT is to use dialectical behavioral skills to learn healthy mechanisms for coping. This can be done by focusing on building an individual’s identity that is more focused on support and positive thinking as opposed to negative self-talk. To do this, the dialectical behavior therapist works collaboratively with the individual to develop skills that promote identifying thoughts and being non-judgmental.

What Skills Does DBT Help Develop?

There are four skills that are the focus of dialectical behavioral therapy. These include:

• Mindfulness: Mindfulness is the practice of being fully present in the moment. DBT mindfulness skills involve being able to accept negative thoughts and emotions without judgment.
• Distress Tolerance: This is the ability to manage difficult emotions without becoming overwhelmed. Some DBT exercises for distress tolerance include using distraction or self-soothing techniques.
• Interpersonal Effectiveness: Interpersonal effectiveness skill training helps individuals learn how to be more assertive, express their needs, and learn to set boundaries while keeping healthy relationships.
• Emotional Regulation: Emotional regulation involves being able to identify intense emotions and ways to navigate those emotions in a positive way. An example of these skills includes the opposite action technique, in which the individual identifies the emotion they are experiencing and instead of acting on that emotion as they normally would, they perform the opposite action. For example, if you are feeling sad and usually isolate, the opposite action would be to engage with family or friends.

What Techniques Does DBT Use?

Dialectical behavior therapy treatment occurs at several different levels. These dialectical therapy techniques include:

• One-on-One Therapy: During one-on-one therapy, the therapist assists the individual in learning to adapt the DBT coping skills learned during group sessions to their personal life.
• Skills Training: The focus of skills training is to teach DBT coping skills, typically done in a group setting.
• Phone Coaching: A dialectical behavior therapy program provides phone coaching in addition to individual and group sessions. Phone coaching is used between sessions for the individual to call the therapist for guidance on how to cope with a difficult situation.

Types of Dialectical Behavioral Therapy

Dialectical behavior therapy treatment focuses on two different types of treatment that happen concurrently in order for individuals to get the most out of treatment. These include:

• Individual Treatment: Individual sessions typically occur once a week with a trained dialectical behavior therapist. This is a time for the individual to discuss issues and to process thoughts and feelings. During one-on-one therapy, the therapist helps reinforce the dialectical behavior therapy skills.
• Skills Group Treatment: Skills training occurs during group sessions, about once a week for between one to two hours per session. During this time, the DBT group activities focus on education and skills training.
• Family Skills Training: Though not standard in all types of dialectical behavior treatment, some of these types of intensive outpatient programs may include family skills training as well, which focuses on helping to teach families and loved ones about the behavioral patterns of the individual in treatment, how to remain non-judgemental, and learn effective communication.⁴

What Conditions Can DBT Help Treat?

Though initially developed for borderline personality disorder, dialectical behavior therapy has been found to be effective for multiple other disorders and conditions. There are DBT skills for depression, anxiety, bipolar disorder, trauma, substance use, and many others.

Some of the conditions that have been shown to be effective with adapted dialectical behavior therapy will be detailed below.

Attention-Deficit/Hyperactivity Disorder (ADHD)

Using dialectical behavior therapy techniques to treat ADHD has been proven effective in helping individuals use mindfulness to stay in the present moment and regulate the intense emotions often associated with hyperactivity.

Bipolar Disorder

Adapted dialectical behavior therapy can be used for individuals with bipolar disorder by teaching emotion regulation skills and distress tolerance to provide DBT skills for depression and mania.

Borderline Personality Disorder (BPD)

As the initial dialectical behavior disorder treated by DBT, there is ample support for the use of dialectical behavior therapy skills in addressing the emotional dysregulation, poor distress tolerance, and interpersonal issues often associated with BPD.

Eating Disorders

Dialectical behavior therapy for eating disorders has been shown to be effective by helping individuals learn more mindful eating, identify emotions, and how to manage stressors around eating.

Obsessive-Compulsive Disorder (OCD)

Dialectical behavior therapy interventions such as mindfulness and distress tolerance can be helpful in treating OCD by teaching individuals to accept thoughts and feelings while also teaching the skills to tolerate their feelings of distress.

Post-Traumatic Stress Disorder (PTSD)

There has been research that has shown the effectiveness of dialectical behavior therapy for trauma. This is done by focusing on emotional regulation and distress tolerance.⁶

Generalized Anxiety Disorder (GAD)

DBT therapy is helpful for anxiety, especially for those with comorbidities or elevated emotional regulation.

Substance Use Disorder

Dialectical behavior therapy training for substance abuse may be focused on mindfulness skills of acceptance and distress tolerance to help cope with risks or causes.

Benefits of Dialectical Behavioral Therapy

DBT is an evidence-based treatment that assists individuals to improve their quality of life. The dialectical behavior therapy benefits include:

• Less frequent and less severe suicidal behavior by teaching skills to accept these thoughts and feelings without judgment, along with providing healthier coping skills.
• Shorter hospitalizations occur with intensive dialectical behavior therapy, as individuals have learned how to tolerate their distress more appropriately.
• Less anger is also a benefit, as DBT exercises focus on skills that help to regulate emotions, so intense emotions are less likely to occur.
• Less likely to drop out of treatment with more engagement and positive results.
• Improved social functioning, as teaching interpersonal skills provides individuals with effective means of communication.

Dialectical Behavioral Therapy Treatment Target

There are four main target areas in dialectical theory. The effectiveness of DBT has been shown to help improve life-threatening behaviors, therapy-interfering behaviors, quality of life behaviors, and increase the acquisition of skills.

Life-threatening behaviors include any behaviors that pose an imminent risk, such as suicidal ideation and self-harm. These are the behaviors that take priority in sessions and need to be addressed immediately for safety. It is important to ask about potential life-threatening behaviors or thoughts at the start of each session.

Other Targets of Treatment

The next target to be addressed is any therapy-interfering behavior. These behaviors include missing appointments, chronically showing up late, not paying attention, not engaging during DBT group activities, or misusing contact between sessions. These behaviors can often lead to early termination and are therefore important to address.

Once life-threatening behaviors and therapy-interfering behaviors have been addressed, the treatment target can focus on quality of life behaviors. These include any behaviors that may interfere with an individual’s quality of life, including drug abuse, legal problems, financial problems, not taking prescribed medication, unemployment, and relationship issues. Any issues that impair an individual’s quality of life should be treatment targets.

Finally, the fourth target in treatment is the acquisition of skills. Once the behaviors that are imminent or may interfere with the treatment are addressed, the individual and therapist can focus on acquiring and implementing DBT skills.

Get Dialectical Behavioral Therapy At Alta Centers

If you or someone you know is interested in DBT treatment, therapy at Alta Centers can help. Alta Centers uses evidence-based approaches and trained, skilled professionals to provide the best possible treatment. For more information, contact us today.