What Is Dialectical Behavioral Therapy (DBT)?
Developed in the treatment of borderline personality disorder (BPD), DBT helps clients accept and control intense emotions and the reactions that may result by allowing them to increase self-compassion and practice research-backed coping skills.
The word "dialectic" refers to analytical reasoning in pursuing knowledge and truth in conflict. Through interpersonal effectiveness skills, individuals can develop important skills that allow them to see the facts of a situation before reacting to a conflict with another individual.
DBT was developed by Dr. Marsha Linehan, Ph.D., a psychologist who developed the therapy modality due to her diagnosis of BPD. Since its development, DBT has become a widely used modality by many of those involved in mental health fields, including individual therapists, counselors, clinicians, and psychologists, for numerous mental health diagnoses and challenges. You do not need to have a mental illness to use DBT.
Studies, including one from 2006, have shown DBT's effectiveness since its development in the 90s. The criteria outlined by Dr. Linehan for effective DBT practice include the following:
- Enhancing your capability to increase skilled behavior
- Improving and maintaining your motivation to induce a state of change
- Ensuring the generalization of change through treatment
- Enhancing the motivation of therapists to deliver the best treatment
- Assisting you in changing or restructuring your environment to support and maintain progress towards goals, with or without medication
The Key Elements Of Dialectical Behavioral Therapy
Four critical elements of dialectical behavior therapy are often used to help clients assess their needs, manage painful emotions, and decrease relationship conflicts. The elements covered in DBT programs include:
- Interpersonal Effectiveness: Skills focused on healthy communication, relationships, and self-respect to build and maintain advantageous connections
- Emotional Control: Strategies focused on helping clients control, change, and understand their intense emotions
- Distress Tolerance: Skills focused on increasing the acceptance and tolerance of unwanted or painful emotions instead of trying to escape or ignore them
- Mindfulness: Skills related to being present at the moment and accepting emotions and facts without judgment using a wise mind
DBT involves a workbook that clients can use to learn the skills from the above four modules. Often, therapists actively partake in roleplay and activities to help clients learn these modules.
Who Can Benefit From DBT?
Although DBT was developed to treat BPD, anyone can benefit from its teachings. As DBT occurs in a class format, it is a structured form of therapy that involves various skills and worksheets. Anyone looking for a structured form of therapy with lesson plans and interactive activities may enjoy this form of treatment. DBT can also benefit the following:
- Substance use disorders
- Bipolar disorder
- Depressive disorders
- Eating disorders
- Post-traumatic stress disorder
- Anxiety disorders
- Attention deficit hyperactivity disorder (ADHD)
- Behavioral concerns
- Relationship conflicts
- Antisocial personality disorder (ASPD)
- Narcissistic personality disorder (NPD)
- Histrionic personality disorder (HPD)
- Executive functioning difficulties
- School challenges in children and teens
If you are experiencing issues with substance use, contact the SAMHSA National Helpline at (800) 662-4357 to receive support and resources.
How DBT Teaches Acceptance
One of the primary themes in DBT is the concept of radical acceptance, which is also a skill and worksheet from the distress tolerance section of the workbook. Rather than teaching you to avoid or eliminate challenges, DBT helps you cope with challenges by showcasing that life can be worth living and that you can still make changes while feeling immense emotional pain. The radical acceptance skill teaches clients how to accept situations that cannot be changed, even when they are challenging to accept. It may be used in the loss of a relationship, during an inevitable transition, or when you believe a situation is out of your hands.
According to Dr. Linehan, learning the skills to manage these feelings can change your life dramatically, making it possible for you to enjoy your relationships that have formerly been defined by conflict. DBT is more than a way to change your behaviors; it is a tool that helps an individual learn skills to use their emotions and feelings in a more productive way that serves them.
How Does DBT Work?
DBT is a form of cognitive-behavioral therapy that teaches clients to accept themselves as they are without judgment while learning skills that have been studied to work. DBT involves four modules with various skills and worksheets throughout. When you first get to your sessions, you may start at the beginning of the DBT workbook and work your way through learning and practicing each skill. Your therapist may participate in the practice, modeling how these skills can be used.
In addition, DBT can be practiced in an individual or group environment. People can partake in DBT independently, with a partner, with their family, or in a group of strangers. In a group environment, everyone in the group starts the treatment together in the first module, often focused on mindfulness. After going through all four modules, those who have successfully completed the modules may graduate from therapy and have a ceremony. In some cases, this might look like a quick ceremony with treats and music or a session where other group participants offer handmade gifts and goodbyes at the end.
Graduating DBT doesn't necessarily mean you no longer would benefit from using the skills. Instead, it means your therapist likely believes you've learned the skills sufficiently and can practice them independently. You might still supplement these skills with talk therapy sessions.
How Can I Find A DBT Therapist?
Many therapists are trained in DBT. If you're looking for official DBT therapists, classes, or groups, look for a therapist that has graduated courses in teaching DBT and isn't only offering it as a side service to CBT or another treatment. To get the full benefit from DBT, you may want to search for a specialist. You may be able to find a therapist by asking your primary care physician for a referral. If you have a personal therapist already and would like to participate in a DBT group, ask them where you might be able to find one in your city that could be a good fit for you. You may also ask them to refer you to an online directory that lists local DBT groups.
Many therapists accept insurance, but if you do not have insurance or can't find a provider that offers coverage, group DBT sessions may be more affordable than individual therapy, as there are more slots offered for the session time, allowing therapists to cut down on session costs or distribute the cost of their services between multiple clients.
Linehan Board of Certification
The Linehan Board of Certification is one of several organizations that provides a public online tool to help potential clients identify providers trained in and offering DBT therapy supported by evidence-based research. Those listed with the Linehan Board of Certification are vetted and proven to have the requisite skills and knowledge to deliver DBT and adhere to the model Dr. Linehan and her colleagues created.
An online mental health tool like BetterHelp can provide a flexible and convenient way to receive DBT. Although you may be responsible for downloading or purchasing the DBT workbook, your therapist can provide free worksheets and offer the same structure and lessons as an in-person therapist. Many therapists working on online platforms practice DBT and other forms of cognitive-behavioral therapy.
Additionally, studies have found that internet-based DBT was as effective as in-person therapy for those that completed the program. Attendance in the online group was also higher than in in-person groups, showcasing the accessibility of online formats. When you use an online platform, you can match with a DBT therapist and choose to meet over the phone, via video chat, or through a live chat session with a licensed therapist from any location with an internet connection.
BetterHelp Therapist Reviews
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"I am a 42-year-old female, successful entrepreneur in a loving marriage, and have a bright and healthy 4-year-old boy. I shouldn't have anything to complain about. I am generally happy, motivated, and have ample self-confidence. So why in the world would I need therapy? Because I need help with constructive ideas to control my negative attitude. I'm generally not a negative person but I'm very self-aware that I have vast mood swings of anger and pessimism and I get that from my dad. I chose Douglas because he counsels using cognitive behavioral therapy and anger management - which is the kind of therapy I need. Douglas comes up with clear solutions and I appreciate that. I didn't want a therapist to tell me to talk about my day and how does that makes me feel and that it's normal to have these feelings. I know it is normal to feel angry sometimes, but I wanted to understand how to recognize it and address it. So if you need a constructive conversation with fast results for everyday annoyances and (especially effective child-rearing advice!) I think Douglas is your therapist."
Whether you're experiencing symptoms of a personality disorder, feel you have sensitive emotions or are looking to improve your relationships, DBT may benefit you. Those experiencing fear of abandonment, chaotic relationships, identity issues, mood challenges, impulsive behavior, sleep challenges, self-harming, suicidal thoughts, substance use, anger concerns, or another challenge may also benefit from the skills within the modules. Take the first step by contacting a mental health professional to get started.
If you are experiencing suicidal thoughts or urges, call the National Suicide Prevention Lifeline at 988 to talk to someone over SMS. They are available 24/7 to offer support.
Frequently Asked Questions (FAQs)
Below are several frequently asked questions on the topic of DBT.
What Is DBT Used To Treat?
Dialectical behavior therapy (DBT) is often used in treating borderline personality disorder. Clients with this diagnosis may struggle with emotional control, which can be critical to living a healthy, happy life. Individual psychotherapy with an effective consultation team can create positive changes by helping clients understand the reasoning behind these emotional responses and feel in control of their behavioral reactions.
What Are The Six Main Points Of Dialectical Behavior Therapy?
The six unique elements of dialectical behavior therapy include the following:
- Acceptance and change
- Skill sets
DBT skills training focuses on four modules: distress tolerance, emotional control, interpersonal effectiveness, and mindfulness.
How Are DBT and CBT Different?
Cognitive-behavioral therapy is centered around challenging unwanted and unhelpful thought patterns to change behaviors. Dialectical behavior therapy helps clients manage emotional control and reduce potentially destructive behaviors. It involves mindfulness and a structured skill-learning environment with worksheets and homework. CBT can be structured but may not always be. Both treatment options can be effective.
Can You Learn DBT On Your Own?
You can purchase the DBT skills workbook to learn about DBT independently. However, DBT therapy with a professional is unique in that it offers structured support, lessons, and interactive activities with a professional. In DBT groups, you can meet new friends, relate to the experiences of others, and feel less alone in your experiences. Although anyone may benefit from practicing DBT skills, DBT therapy offers a comprehensive way to learn and use them, with personalized support and treatment planning.
What Are The Pros And Cons Of DBT?
The advantages of DBT may include decreasing the risk of self-destructive behaviors, decreasing behaviors that interfere with quality of life, and learning and mastering behavior skills. The disadvantages may include significant time commitment with attendance and homework. In addition, the therapy modality may not be the most effective for everyone.
Is DBT Effective For Trauma?
DBT can be effective in treating PTSD and past adverse experiences. However, the focus of the therapy may not be on talking about trauma or expressing your past. Instead, DBT focuses on learning skills and staying in the present moment.
Is CBT Or DBT Better For Trauma?
DBT may be more effective for trauma than CBT due to its approach to addressing intense emotions, which may be common in those with a trauma history. In addition, many individuals diagnosed with personality disorders have a history of trauma, and DBT is effective in treating personality disorders.
What is DBT therapy best for?
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