Dialectical Behavior Therapy (DBT)

Dialectical Behavioral Therapy, or DBT, is a form of cognitive-behavioral therapy originally developed to treat borderline personality disorder (BPD). Those with BPD struggle to regulate their emotions, which can lead to unhealthy and impulsive behaviors. Thus, DBT was created to help individuals develop new coping skills to better manage emotions, thoughts, and behaviors more effectively. DBT is broken down into four sections or modules of skill building, including:

1. Mindfulness – tools/skills to increase present moment awareness, without judgment
2. Emotion Regulation – tools/skills for understanding and reducing vulnerability to difficult emotions and for changing unwanted emotions
3. Distress Tolerance – tools/skills to aid in moving through times of crisis/distress without making them worse; focus on acceptance
4. Interpersonal Effectiveness – relationship maintenance, increasing self-respect in relationships, and getting interpersonal objectives met

DBT places an emphasis on finding a balance between acceptance and change. This means helping clients accept their current situation and struggle, while simultaneously working to improve it.

Traditionally, dialectical behavioral therapy includes several components. It is most typically carried out in:

• Individual therapy (1 hour/week) – within the individual therapy sessions, a therapist will work with a client to help identify negative thoughts/behavioral patterns and educate them on new, healthier ways of coping, which can help them manage emotions more effectively and improve their relationships.
• Skills training groups (2 hours/week) – typically run like a class, these teaching groups cover all four modules of DBT and frequently incorporate homework assignments for clients to complete in between groups. There are many different kinds of homework assignments and/or activities for DBT clinicians to provide their clients in between sessions. Some of the most popular include:
  • Meditation
  • Naming and tracking emotions
  • Visualizing a safe place
  • Tuning into the 5 senses
• Team consultation (1-1.5 hours/week) – unlike the other components which are intended for the client(s), DBT team consultation is for the therapists themselves. Often referred to as “therapy for the therapist,” team consultation involves a group of DBT providers who work together to conceptualize clients, evaluate the therapeutic relationship, and discuss treatment application.

Telephone coaching (as needed) – telephone coaching is a mode of treatment where the primary DBT therapist is available to the client(s) between sessions. The primary focus of phone coaching is to assist clients in applying the skills to daily life.

While incorporating all components may prove most effective for individuals, it is still possible to successfully learn and apply DBT skills through only one modality; DBT is most popularly practiced in a one-on-one setting with a trained therapist and client.

Although it may be most effective to work with a therapist, it is possible to practice DBT on your own. There are numerous self-help resources available for those interested in learning about and incorporating DBT principles into their lives.

DBT is considered very effective for some individuals with anxiety disorders. Research has demonstrated the value of DBT in reducing anxiety symptoms like ruminations, worry, and fear. Through the mindfulness module of DBT, those with anxiety can learn to embrace the present moment, become more aware of anxiety “warning signs” and incorporate tools such as meditation to help calm the mind. DBT’s distress tolerance can help individuals identify healthy distractions, and thus, “ride the wave” of the anxiety. Emotion regulation skills taught in DBT assist in replacing destructive ways of coping with healthier, more productive approaches. The interpersonal effectiveness module helps enhance communication skills, which in turn, can enhance personal relationships, which are often a source of anxiety.

Dialectical behavioral therapy has been proven effective in treating a variety of mental health conditions, including anxiety disorders, such as panic disorder. Research has shown the effectiveness of DBT in reducing the frequency and intensity of panic attacks.

Using the skills taught in DBT, those who suffer from panic attacks often find they better manage the intense emotions and the physical sensations that accompany panic attacks. Additionally, through addressing the negative thoughts that contribute to the development of panic, clients can learn to challenge and reframe them, thus reducing the likelihood of future panic attacks.

While DBT is extremely effective in treating panic attacks, it may not be the best fit for everyone. It is always advisable to discuss treatment options with a mental health professional to determine the best course of treatment for one’s individualized needs.

Although DBT was originally developed for the treatment of borderline personality disorder, it has since been found to be hugely effective in treating an array of other mental health conditions, including:

• Depression
• Post-Traumatic Stress Disorder (PTSD)
• Substance Use Disorders
• Eating Disorders
• Bipolar Disorder
• Attention-Deficit/Hyperactivity Disorder (ADHD)

DBT is applicable in the treatment of so many mental health conditions because it is highly adaptable. This means DBT treatment can be adjusted to meet the needs of specific populations and/or settings.

Although effective for many mental health struggles and conditions, it should not be assumed that dialectical behavioral therapy is appropriate for everyone. For example, individuals with severe psychotic disorders or certain cognitive impairments may not benefit from DBT. Also, for DBT to be successful, there needs to be a certain amount of client motivation. Thus, this modality of therapy may not be a good fit for those who unwilling to engage in the therapeutic process.

There are many qualified and effective DBT therapists yet identifying a DBT therapist who is a “right fit” for you can be challenging. To simplify the process, try the following:

1. Get a referral – reach out to family, friends, or other healthcare providers regarding referrals/recommendations for DBT therapists in your areas.
2. Check your insurance provider – if you have health insurance, contact your policy provider as they may have a list of DBT therapists who accept your insurance.
3. Check professional organizations – look for DBT therapists through professional organizations like the International Society for the Improvement and Teaching of DBT or the Behavior Therapy and Psychotherapy Division (Division 29) of the American Psychological Association.

When looking for qualified DBT therapists, there are some things to consider. It can be helpful to schedule an initial consultation with more than one therapist. That way you can be sure you feel comfortable and have an opportunity to ask questions. Also, make sure to check the credentials and experience of any potential DBT therapist. They should have received formal training in DBT and have a history of working with individuals with similar conditions. Lastly, be sure to consider location, accessibility, and availability of the therapist. Convenient location and flexible appointment times can make a world of difference when starting therapy.