Dialectical Behavior Therapy For Anxiety

With numerous therapeutic approaches available, there are many options to choose from when it comes to improving the symptoms of anxiety. One of these treatments, dialectical behavior therapy (DBT), focuses on assisting individuals to learn how to regulate their emotions and recognize when they feel overwhelmed or triggered. While CBT may be more effective for the overall symptoms of anxiety, DBT can be effective for specific symptoms, like executive dysfunction and emotional dysregulation. Learning more about the origin and function of DBT may be beneficial to determine whether this treatment is right for you. 

What is dialectical behavior therapy?

Dialectical behavior therapy (DBT) is a form of cognitive-behavioral therapy developed by Marsha Linehan in the 1980s. It was originally designed to treat individuals with borderline personality disorder. Since then, it has proven effective in treating a variety of other mental health conditions, including anxiety disorders. 

One of the goals of DBT is to cultivate mindfulness and related skills that may help individuals with coping and healing.

DBT is a skills-based therapy that centers on four key principles:

• Core mindfulness skills: One of the biggest components of DBT is mindfulness, which involves focusing on the present and slowing down one’s thought patterns. These skills can help someone avoid being overwhelmed by intense emotions, which may manifest in negative or destructive behaviors. 
• Interpersonal effectiveness skills: This element of DBT involves learning an individual's needs in a relationship and finding healthy ways to get those needs met. Interpersonal effectiveness skills may focus on self-respect, active listening, repairing relationships, and techniques for interacting with difficult individuals. 
• Distress tolerance skills: In order to get through difficult situations or cope with stressful environments, DBT therapy may involve learning skills that allow someone to make decisions during times of distress. These can involve crisis survival and reality acceptance skills. 
• Emotion regulation skills: Emotion regulation skills are meant to help someone identify and accept their feelings regardless of intensity. This skill set can also help people understand how to acknowledge their emotions without negatively acting on them. 

With its emphasis on developing new habits and creating an environment of acceptance and understanding, DBT can help individuals learn effective approaches for managing anxiety symptoms over the long term.

Why dialectical behavior therapy is used for anxiety 

DBT has been found to be particularly effective in helping people who experience the intense emotions and impulsive behaviors often associated with anxiety. One key element of DBT is the concept of radical acceptance. This concept refers to a deep level of acceptance of the individual’s current situation as it is, without trying to change it. Radical acceptance may be constructive for individuals with anxiety as it may allow them to better control their environment, thoughts, or feelings.

In many cases, the role of radical acceptance in DBT is to help individuals learn how to tolerate and manage anxiety and discomfort. By accepting their current reality, individuals may be able to let go of any resistance to what is happening and instead focus on what they can control. Radical acceptance may serve as a powerful tool in managing anxiety since it allows individuals to focus on their own internal experiences rather than uncontrollable external stressors.

The benefits of dialectical behavior therapy 

While studies have shown that CBT may be more effective at reducing anxiety symptoms, DBT may produce more significant improvements in emotional regulation and mindfulness. One of the key benefits of DBT is that it can provide practical skills that may be useful in managing emotions and coping with distress. Further research has shown that DBT may effectively reduce anxiety severity in adults who met the criteria for anxiety disorders compared to an activities-based support group (ASG). 

Anxiety-focused DBT often aims to provide individuals with a greater understanding of the underlying causes of their anxiety. Individuals may be encouraged to evaluate the root causes of their behaviors and work towards personal development and mindfulness.

Understanding the functions of a specific treatment type can shed light on its potential benefits. According to the DBT-Linehan Board of Certification, the main functions of DBT include: 

• To improve and maintain a client’s motivation to change and be engaged with treatment
• To enhance the motivation of therapists to deliver effective treatment
• To ensure generalization of change occurring through treatment
• To enhance an individual’s capability by increasing skillful behavior
• To assist the individual in restructuring or changing his or her environment such that it supports and maintains progress and advancement towards goals

What to expect from dialectical behavior therapy 

DBT sessions for anxiety and borderline personality disorder may involve a combination of individual therapy, group therapy, coaching, and homework assignments. 

Individual therapy may focus on addressing concerns unique to the individual, identifying unhealthy or destructive behaviors, teaching new skills, and tracking progress. Therapists may work with individuals to identify triggers for anxiety, challenge negative thought patterns, and develop strategies for calming an overactive mind.

Group therapy sessions might involve learning and practicing DBT skills alongside others with anxiety or borderline personality disorder. These sessions may provide valuable peer support and can allow individuals to practice their new skills in a safe and supportive environment. 

Coaching could involve regular check-ins with a DBT therapist or counselor in person, via phone, or online. These check-ins may allow individuals to discuss any current challenges or successes they have experienced and receive guidance from their therapist.

DBT may also involve homework assignments, which can include mindfulness exercises and journaling. These assignments may help individuals integrate DBT skills and techniques into their daily lives and reinforce what was learned in therapy and coaching sessions.

DBT may serve as a comprehensive and holistic approach to managing anxiety. With the help of a trained therapist, individuals may learn strategies for reducing anxiety, improving emotional and cognitive skills, and building interpersonal skills. 

Who can benefit from DBT?

Dialectical behavior therapy (DBT) is a specialized form of cognitive-behavioral therapy that can be used to assist those with a number of mental health conditions and challenges. DBT can be adapted for a variety of mental health concerns and may provide a healthy avenue for healing and growth for individuals experiencing the following conditions:

• Anxiety disorders 
• Mood disorders 
• Post traumatic stress disorder (PTSD) 
• Eating disorders 
• Substance use disorder
• Borderline personality disorder (BPD)

If you are experiencing trauma, support is available. Please see our Get Help Now page for more resources.

If you are struggling with substance use, contact the SAMHSA National Helpline at (800) 662-4357 to receive support and resources. Support is available 24/7.

Online dialectical behavior therapy 

For some individuals, the symptoms of anxiety may make it difficult to participate in in-person sessions or group therapy appointments. These individuals may feel anxious about the idea of talking to a stranger about their problems, for example. In these circumstances, online therapy may offer a practical solution that enables more convenient options for professional treatment. With online therapy, individuals can receive dialectical behavior therapy treatment from the comfort of their own homes. This may allow a more inviting entrance to therapy and facilitate improved participation from the individual. 

In a study that explored the effectiveness of DBT approaches for treating individuals with mental health struggles in an online setting, researchers found that group DBT sessions held online were viable alternatives to online CBT. While the methods may vary depending on who facilitates the therapy, the overall approach may be just as effective as it would in person.