What is DBT, and How Does it Work?

Dialectical Behavioral Therapy, also known as DBT, was pioneered by Dr. Marsha Linehan and combines cognitive-behavioral techniques with mindfulness practices, offering a comprehensive toolkit for those who are navigating complex emotions and interpersonal challenges.[2] DBT therapy blends flexibility with evidence-based principles to guide individuals toward profound personal growth and emotional well-being.

Evidence-based care is important to a well-rounded, effective treatment plan, as it integrates proven methodologies into your care—enhancing intervention effectiveness and promoting positive outcomes for individuals seeking support.[1] By grounding interventions in research, evidence-based care ensures they are tailored to meet your unique needs, increasing the likelihood of positive changes.

What is Dialectical Behavioral Therapy?

DBT therapy is a type of cognitive-behavioral therapy (CBT) that was originally developed to treat borderline personality disorder (BPD).[3] Since it’s origins, it has been adapted for the treatment of various other mental health conditions, including mood disorders, substance use disorders, eating disorders, and post-traumatic stress disorder (PTSD).[4]

DBT is based on the dialectical philosophy, which emphasizes the combination of opposites. In the context of therapy, this means it helps you to find a balance between acceptance and change. The primary discussion in DBT is between acceptance and change, where clients learn to accept themselves and their current circumstances while also working towards change and personal growth.[5]

Dialectical Behavioral Therapy typically involves both individual therapy sessions and group skills training sessions. DBT therapy is a structured, goal-oriented, and evidence-based therapy approach that aims to help individuals build a life worth living by improving their emotional regulation and interpersonal relationships.

How is DBT Related to Cognitive Behavioral Therapy (CBT)?

DBT is a specialized form of cognitive-behavioral therapy designed to address complex emotional and behavioral challenges. While it shares roots with CBT in its focus on thought patterns and actions, DBT therapy expands upon this framework by integrating mindfulness practices and strategies for emotional regulation.

In essence, dialectical behavior therapy offers a structured yet flexible approach to therapy, emphasizing collaboration between therapist and client to set achievable goals and develop practical coping skills. These DBT skills often include mindfulness techniques for present-moment awareness, distress tolerance strategies to manage intense emotions, and interpersonal skills to navigate relationships more effectively.

While CBT tends to target cognitive restructuring, DBT broadens its scope to address emotional dysregulation and interpersonal difficulties, making it particularly beneficial for individuals struggling with complex and challenging mental health symptoms.[6]

Related: What Does CBT Mean and What is it Used For?

What Mental Health Conditions Can Be Helped by DBT Treatment?

DBT treatment has been adapted and found effective in treating a range of other mental health conditions, including:[7]

• Borderline Personality Disorder (BPD): DBT is considered one of the most effective treatments for BPD, helping individuals manage intense emotions, improve relationships, and reduce self-destructive behaviors.
• Mood Disorders: DBT is effective in treating mood disorders such as depression and bipolar disorder, particularly in managing emotional dysregulation and reducing suicidal behaviors.
• Anxiety Disorders: DBT skills, particularly mindfulness and distress tolerance, can help manage symptoms of anxiety disorders such as generalized anxiety disorder (GAD), social anxiety disorder, and panic disorder.
• Post Traumatic Stress Disorder (PTSD): DBT techniques, particularly those related to distress tolerance and emotion regulation, can be beneficial for individuals with PTSD in managing symptoms such as flashbacks, hypervigilance, and emotional numbing.
• Substance Use Disorders: DBT treatment can be used as part of comprehensive treatment for substance use disorders, helping individuals manage cravings, cope with triggers, and develop alternative coping strategies.
• Eating Disorders: DBT has been adapted for the treatment of eating disorders such as bulimia nervosa, binge eating disorder, and anorexia nervosa, focusing on emotion regulation, distress tolerance, and interpersonal effectiveness.
• Self-Harming Behaviors: DBT is effective in reducing self-harming behaviors such as cutting, suicidal ideation, and suicide attempts, particularly in individuals with BPD.
• Impulse Control Disorders: DBT skills, particularly those related to impulse control and building tolerance to distress, can be helpful for individuals with impulse control disorders such as intermittent explosive disorder and kleptomania.

How Can DBT Help With Borderline Personality Disorder?

Dialectical behavior therapy (DBT) can offer several supports for those struggling with BPD, addressing its unique challenges through its structured and comprehensive approach. DBT therapists help individuals manage the intense emotions characteristic of BPD, teaching practical skills to regulate emotions, tolerate distress, and navigate interpersonal relationships more effectively.

By providing tools for coping with distress without resorting to harmful behaviors, DBT focuses on reducing self-destructive actions and suicidal ideation commonly associated with BPD. Moreover, DBT assists individuals in developing a more stable sense of self, fostering self-awareness and self-acceptance as they work towards building a fulfilling and meaningful life.[8]

What Are the Core Components of DBT?

DBT incorporates several core components that work together to help individuals develop skills for better managing their emotions:[9]

1. Mindfulness: Mindfulness skills form the foundation of this evidence-based therapy and a DBT therapist teaches individuals to become more aware of their thoughts, feelings, and sensations in the present moment without judgment. Mindfulness practices help cultivate self-awareness, reduce reactivity, and promote emotional regulation.
2. Distress Tolerance Skills: DBT includes techniques for tolerating distressing emotions and situations without resorting to harmful behaviors. Healthy coping skills help individuals cope with crises, distress, manage intense emotions, and prevent impulsive actions.
3. Emotion Regulation: Building your emotional regulation skills focus on helping individuals identify, understand, and effectively manage their emotions. This component teaches strategies for reducing emotional vulnerability, increasing emotional awareness, and changing emotional responses.
4. Interpersonal Skills: Interpersonal effectiveness skills teach individuals how to navigate relationships more effectively, set boundaries, communicate assertively, and resolve conflicts. This component helps improve communication, build healthy relationships, and enhance social functioning.

What is Skills Training in DBT?

Skills training in DBT is a structured component of treatment in which individuals learn practical techniques to manage their emotions, cope with distress, and improve their interpersonal relationships. Typically conducted in group therapy settings led by a trained therapist, skills training covers the four main areas listed above: mindfulness, tolerating distress, emotion regulation, and interpersonal effectiveness.

Participants learn about each skill, discuss its relevance to their lives, and engage in activities and exercises to then practice DBT skills. Through consistent practice and application of these skills, individuals develop greater emotional resilience, enhance their ability to navigate challenging situations, and build more fulfilling relationships.

Has DBT Been Proven Effective?

Numerous studies have been conducted to evaluate the effectiveness of DBT, indicating that it is highly effective in reducing suicidal behavior and non-suicidal self-harming behavior among individuals with BPD. Moreover, DBT has been shown to significantly decrease hospitalizations and emergency room visits for individuals undergoing treatment. DBT interventions have demonstrated a positive impact on reducing symptoms of depression and anxiety as well.[10]

Studies on DBT for disorders such as bulimia and substance use disorders suggest that DBT interventions can effectively reduce core symptoms, such as binge/purge episodes in bulimia and substance use frequency in substance use disorders. DBT has also demonstrated effectiveness in reducing self-harming behavior, suicide attempts, and inpatient treatment days across various populations.[11]

How is DBT Incorporated Into Treatment?

DBT is a versatile therapeutic approach that can be effectively incorporated into treatment for various conditions and across different levels of care. Whether addressing mood disorders, personality disorders, substance use disorders, or other mental health conditions, DBT offers a flexible framework that can be tailored to meet the specific needs of individuals.

Outpatient Programs

In outpatient settings, DBT is often delivered by a licensed mental health professional through individual therapy sessions, group skills training, phone coaching, and consultation team meetings. These components work together to provide individuals with a comprehensive toolkit for managing their emotions, improving interpersonal effectiveness, and building resilience.

In intensive outpatient programs (IOPs) or partial hospitalization programs (PHPs), DBT may be utilized as a primary treatment modality or integrated with other therapeutic approaches. This intensive level of care allows individuals to receive more structured support while still benefiting from the flexibility and evidence-based principles of DBT.

Residential Programs

In residential treatment centers or inpatient settings, DBT can be incorporated into the overall treatment plan to address acute symptoms and provide individuals with the skills they need to navigate challenging situations. Additionally, DBT principles can be integrated into the therapeutic milieu to promote a supportive and validating environment for individuals in these settings.

Regardless of the level of care, DBT emphasizes the importance of collaboration between the individual and their treatment team, as well as ongoing practice of skills outside of therapy sessions. This collaborative and skills-focused approach makes DBT adaptable to various treatment settings and conducive to long-term recovery and emotional well-being.

Find Effective Care with Clear Behavioral Health

At Clear Behavioral Health, we’re committed to providing you with the highest standard of evidence-based care. Our team of experienced mental health professionals and therapists specialize in Dialectical Behavioral Therapy (DBT), a proven approach that empowers individuals to manage their emotions, navigate challenges, and build a life worth living.

Whether you’re seeking support for Borderline Personality Disorder (BPD), mood disorders, or difficulties with emotion regulation, we’re here to help. Contact us today to learn more about our residential mental health treatment for severe mental illnesses, outpatient mental health programs, and virtual iop serving all of California. We also offer substance use programs such as detox and residential treatment and dual diagnosis outpatient programs for individuals struggling with addiction. Take the first step towards greater well-being and schedule a consultation with us today. With Clear Behavioral Health, you can find the support and guidance you need to thrive.

References:

1. Evidence-Based Treatment – Mental Health. (n.d.). Www.mentalhealth.va.gov. https://www.mentalhealth.va.gov/get-help/treatment/ebt.asp on April 15, 2024
2. Chapman, A. L. (2006). Dialectical behavior therapy: Current indications and unique elements. Psychiatry (Edgmont), 3(9), 62–68. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2963469/ on April 15, 2024
3. Cleveland Clinic. (2022). Dialectical Behavior Therapy (DBT). Cleveland Clinic. https://my.clevelandclinic.org/health/treatments/22838-dialectical-behavior-therapy-dbt on April 15, 2024
4. Cleveland Clinic. (2022). Dialectical Behavior Therapy (DBT). Cleveland Clinic. https://my.clevelandclinic.org/health/treatments/22838-dialectical-behavior-therapy-dbt on April 15, 2024
5. Chapman, A. L. (2006). Dialectical behavior therapy: Current indications and unique elements. Psychiatry (Edgmont), 3(9), 62–68. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2963469/ on April 15, 2024
6. Cognitive Behavioral Therapy (CBT) vs. Dialectical Behavior Therapy (DBT). (2024). Paloaltou.edu. https://concept.paloaltou.edu/resources/business-of-practice-blog/cbt-dbt on April 15, 2024
7. Corliss, J. (2024, January 22). Dialectical behavior therapy: What is it and who can it help? Harvard Health. https://www.health.harvard.edu/blog/dialectical-behavior-therapy-what-is-it-and-who-can-it-help-202401223009 on April 15, 2024
8. May, J. M., Richardi, T. M., & Barth, K. S. (2016). Dialectical behavior therapy as treatment for borderline personality disorder. Mental Health Clinician, 6(2), 62–67. https://doi.org/10.9740/mhc.2016.03.62 on April 15, 2024
9. Treating Borderline Personality Disorder | NAMI: National Alliance on Mental Illness. (2017). Nami.org. https://www.nami.org/Blogs/NAMI-Blog/June-2017/Treating-Borderline-Personality-Disorder on April 15, 2024
10. Association for Behavioral and Cognitive Therapies. (2021, March 6). Dialectical Behavior Therapy | Fact Sheet. ABCT – Association for Behavioral and Cognitive Therapies. https://www.abct.org/fact-sheets/dialectical-behavior-therapy/ on April 15, 2024
11. Stiglmayr, C., Stecher-Mohr, J., Wagner, T., Meiβner, J., Spretz, D., Steffens, C., Roepke, S., Fydrich, T., Salbach-Andrae, H., Schulze, J., & Renneberg, B. (2014). Effectiveness of dialectic behavioral therapy in routine outpatient care: the Berlin Borderline Study. Borderline Personality Disorder and Emotion Dysregulation, 1(1), 20. https://doi.org/10.1186/2051-6673-1-20 on April 15, 2024