Have you ever felt overwhelmed by intense emotions or found it hard to maintain a healthy relationship? Or perhaps you know someone who has attempted suicide and fear they might do it again?
If you’ve been looking for mental health treatments for such symptoms, DBT (Dialectical Behavior Therapy) is likely one term that has come up frequently.
But what is DBT, how does it work, and who benefits the most from this type of therapy? We’ll answer these questions and more, so keep reading.
What Is Dialectical Behavior Therapy?
Dialectical behavior therapy is a type of talk therapy used to help people process intense emotions.
It was created in the late 80s by Marsha Linehan, a mental illness expert, psychologist, and author of the book “Building a Life Worth Living.” Linehan, a psychiatric patient herself in her youth, originally developed it to treat extremely suicidal patients.
DBT has since expanded to manage symptoms of emotion dysregulation in borderline personality disorder and other complex mental disorders.
It borrows certain concepts from cognitive behavior therapy (CBT) but focuses more on emotions and social skills. Specifically, it teaches you how to:
- Handle stress without losing your cool
- Get along better with others, especially in relationships
- Manage extreme emotions and damaging behaviors
- Be more aware of the present moment
More importantly, DBT follows the idea that two seemingly opposing things can be true at the same time. This here is thinking in dialectics.
For instance, you can accept yourself as you are right now and still want to change. Notice how the word “and” connects these two opposite thoughts instead of “but”?
That’s because DBT gives these statements equal value. This “both/and” thinking is a big part of what makes DBT unique.
Core DBT Skills Modules
Below are the building blocks of DBT:
1. Mindfulness
Mindfulness is being aware of what’s happening in the present, without getting caught up in worries about the future or regrets about the past.
Below are some exercises to build your mindfulness skills:
- Acceptance without judging
- Observing
- Relaxation (mind-body connection)
- Emotion labeling
- Mental noting
- Meditative breathing
- Though defusion (distancing from unproductive thoughts)
2. Distress Tolerance
In this module, you’ll learn radical acceptance as an intervention. It means accepting things as they are in the moment, without trying to fight or resist them. In other words, you acknowledge a difficult situation and let go of the struggle.
Another useful DBT skill you’ll develop is validation. In psychiatry, this means accepting a person’s thoughts, feelings, or reactions as valid and understandable. You get why someone thinks or feels that way, even if you don’t agree with them.
3. Emotion Regulation
Emotions are natural responses to experiences. As such, DBT trains you to manage them in healthier ways, not eliminate them.
These strategies can help:
- Self-care
- Journaling
- Checking facts
- Talking with friends
- Taking a break
4. Interpersonal Effectiveness
This module involves improving your communication and social skills so you can have more positive relationships.
To achieve interpersonal effectiveness, you’ll add these essential skills to your DBT inventory:
- Assertiveness: Expressing thoughts, feelings, and needs directly but respectfully
- Active Listening: Fully engaging with others during conversations
- Negotiation: Finding compromises and solutions during conflicts
- Boundary Setting: Learning to say “no” and establishing clear personal boundaries
Components of DBT
A comprehensive DBT program includes:
- Individual Therapy: You’ll meet one-on-one with a therapist, usually once a week, to set goals and track your progress.
- Group Therapy/Training: You learn DBT skills with others in a class. The group leader teaches skills in the four core areas and assigns homework for you to practice.
- Phone Coaching: DBT treatment offers phone support between sessions. If you’re struggling to use a skill in a tough moment, you can call your therapist for quick guidance.
- Consultation Team: DBT therapists meet regularly to support each other and make sure they’re providing the best care possible. It helps keep your therapist sharp and motivated.
If a facility or therapist doesn’t offer all four services, they’re not providing the full DBT package. These modified versions are pretty common, and they may even be cheaper in some cases.
However, it’s unclear if getting just two or three components is as effective as the full program. So, it’s something to consider when looking for a DBT provider.
What Can DBT Help With?
DBT helps with the following mental health conditions:
- Borderline personality disorder (BPD)
- Anxiety
- Depression
- Eating disorders, like bulimia and binge eating disorder (BED)
- Post-traumatic stress disorder (PTSD)
- Self-harm and suicidal behaviors
- Substance use disorders (SUD)
- Intellectual and developmental disabilities
How Does DBT Work?
You start with an assessment to see if DBT is a good fit for you. If it is, you’ll commit to a full course of treatment, usually lasting about 6 months to a year.
During your individual sessions, you and your DBT therapist track your progress using diary cards, which are basically daily logs of your emotions, behaviors, and skill use.
The group skills training follows a set curriculum. You’ll go through each module, learn new skills each week, and practice them as assignments. The group setting lets you learn from others and practice interpersonal skills in real time.
Throughout the process, you’re encouraged to apply the skills you’re learning in real life. Your therapist teaches you how to use these skills in your specific situations.
DBT is pretty structured, but it’s also flexible. The idea is to keep you engaged and motivated while teaching you skills that can change your life.
It takes time and major work to get good at these skills. However, many people find that with consistent effort, DBT makes a tremendous difference in how they handle life’s challenges.
What to Expect in DBT Sessions
During therapy sessions, your therapist will try to strike a balance between self-acceptance and motivation to change. They might suggest different ways to handle a situation.
Some of these might focus on accepting things as they are, like learning to tolerate stress. Others might be about making changes, such as solving a problem, changing your behavior, or rethinking a situation.
It’s not unusual that you and your therapist will disagree on something. When this happens, instead of trying to prove who’s “right,” your therapist will try to find a middle ground.
They believe both of you have part of the answer, and by working together, you can find a better solution. If something isn’t working, an experienced clinician will try a different approach.
DBT sessions are designed to keep things moving. Your therapist might switch up their style to keep you engaged. Sometimes they might be energetic and lively, and other times calm and methodical. They might validate your feelings one moment and challenge your thinking the next.
How Long Does DBT Take to Show Results?
Research suggests that DBT can reduce self-injury, suicidal thoughts, trips to the ER, and hospital admissions. It also eases depressive symptoms, compliance, impulsivity, and mood swings.
DBT treatment is long-term, often lasting six months to a year or longer, depending on your needs. That said, improvements can start to become noticeable at certain stages.
You may see initial changes in how you deal with stress in the first few months. As you continue therapy, you should have more stable moods and fewer symptoms of self-destructive behaviors.
Over time, DBT can lead to profound behavioral changes that improve your quality of life. Again, the key to long-lasting results is consistency.
Final Thoughts
DBT (dialectical behavior therapy) is an evidence-based form of psychotherapy for the treatment of borderline personality disorder, suicidal ideation, and many other mental disorders.
There’s no shame or blame in DBT. What it offers are skills not to make you less of a burden, but to live a happy, meaningful life.
