DBT For Mental Health: Understanding Dialectical Behavior Therapy For Depression

Developed in the 1970s by the American psychologist Marsha Linehan, dialectical behavior therapy (DBT) builds on several concepts associated with cognitive-behavioral therapy (CBT). However, DBT was designed for individuals who experience emotions intensely, often used to treat those living with borderline personality disorder (BPD).

In some cases, this treatment may help address symptoms of depression. DBT’s emphasis on skills training and managing painful emotions can contribute to mitigating and treating the prolonged low moods of depressive disorders. If you are looking at therapeutic modalities for depression, it may be beneficial to look into DBT. 

What is depression, and how does it affect mental health?

Depression is a term to refer to all depressive disorders in the DSM-5 but is often used to refer to major depressive disorder (MDD), the most common. This mental illness is characterized by a sense of persistent sadness or hopelessness lasting over two weeks. 

Depression is more complex than “feeling down.” It is marked by various physical and emotional symptoms that can significantly impact a person’s functioning. Below are some of the physical and behavioral symptoms of this condition: 

• Exhaustion and general lethargy, including slower speech and movements
• Isolation from others and increased time spent alone
• Substance use
• Dramatic changes in one’s sleep schedule, including insomnia or hypersomnia 
• Significant shifts in eating habits
• Agitation and restlessness
• Worsened personal hygiene 
• Pain or achiness with no clear physical or medical cause
• Withdrawal from work, school, or other responsibilities
• Difficulty concentrating, remembering events, or making decisions 
• Self-harm or self-destructive behaviors

The following are emotional symptoms of depression that individuals may experience: 

• Persistent feelings of sadness
• Hopelessness 
• Apathy or a feeling of being “empty” 
• Irritability, including outbursts of disproportionate anger 
• A decreased self-esteem, including a heightened sense of self-blame 
• Sensitivity to criticism 
• A loss of interest in previously enjoyed activities 
• Deteriorating relationships with friends, family members, or partners 
• Feeling guilty or worthless
• A bleak outlook toward the future 
• Frequent thoughts of death or suicide

What is dialectical behavior therapy (DBT)?

Dialectical behavior therapy (DBT) shares some of the goals and treatment methods included in cognitive-behavioral therapy but focuses more on developing new coping skills for intense emotions. DBT can involve training in four key modules that can significantly impact overall well-being. These modules are as follows: 

• Mindfulness
• Emotional regulation
• Interpersonal effectiveness 
• Distress tolerance

Mindfulness

The mindfulness module of DBT discusses mindfulness, the practice of grounding yourself in the present moment, not thinking about the future or the past, and recognizing what is currently occurring within your body and in your environment. Mindfulness skills can be developed through techniques like breathing exercises, meditation, or journaling. Mindfulness is not about changing one’s reality but understanding it for what it is without judgment. 

Emotional regulation

Developing a mindfulness mindset can enhance one’s ability to learn the second DBT skill, emotion regulation. Emotion regulation involves recognizing and understanding your emotions, including sources of intense or distressing emotions. Some emotions are primary emotions, which result from your initial reaction to a thought or situation, and some are secondary emotions, which are a reaction to your initial reaction.  

A common example of this relationship between primary and secondary emotions is feeling angry, followed by a sense of guilt for feeling angry. Practicing emotion regulation can mean acknowledging that your emotions exist and are valid while understanding they don’t necessarily control your thoughts or impact your behaviors. 

You can have agency over yourself, regardless of your emotional experiences. The act of understanding two opposing realities at once (dialectics) is what makes dialectical behavior therapy unique among other modalities. 

Interpersonal effectiveness

Interpersonal effectiveness continues to build on the DBT skills of mindfulness and emotion regulation. Interpersonal effectiveness focuses less on knowledge and awareness and more on behavior in interactions and relationships. Interpersonal effectiveness involves healthy communication skills, including understanding your own needs and the needs of other people and knowing when you need to say no. This kind of assertive communication and boundary-setting can help an individual develop self-respect. 

Distress tolerance

The final component of DBT, distress tolerance, involves developing skills for coping with distress. When faced with an intense or stressful situation, a natural reaction is a fear response, often resulting in avoidance or minimization. Such techniques may not address the source of distress. Hence, distress tolerance teaches a person how to exist in a stressful situation and recognize aspects of the situation they can change, as well as those that may be beyond their control. Skills in this category may include changing your environment and learning to accept situations outside of your control. 

What are the benefits of DBT or dialectical behavior therapy for depression?

Depression can involve distressing symptoms, and people with the condition may sometimes be tempted to avoid acknowledging or addressing their emotional state. The four key skills of DBT can help people with depression better understand what is occurring with their feelings and behaviors, cultivate a mindset of acceptance and grace, and learn to shift maladaptive behavior patterns that may be worsening symptoms. 

Interpersonal effectiveness may address relationship concerns that could contribute to one’s depression or relationships that may have been impacted by depression. Distress tolerance may also be valuable, helping people learn healthy coping skills and behaviors to address unhappiness and other intense emotions. A licensed therapist can be a key support system in developing these DBT skills. 

How to find mental health support for depression

Depression can feel overwhelming, and those experiencing the condition may find it difficult to seek treatment. If you are experiencing low energy levels, physical pain, or other depression symptoms that make it hard to leave the house, online therapy may offer an accessible way to receive support. Through an online therapy service like BetterHelp, you can match and meet with a licensed therapist from home, lessening the fees of therapy and reducing accessibility barriers.  

Online dialectical behavior therapy for depression

Dialectical behavior therapy can be an effective treatment method when provided in person or through an online platform. One scoping review of 11 studies examined the effectiveness of online DBT for a range of concerns, including depression. It found that outcomes for patients enrolled in online DBT were comparable to those receiving traditional face-to-face DBT. If depression symptoms make it complicated to access in-person therapy, or if you have a busy schedule and prefer to access therapy on your ideal timeline, online therapy may be helpful.