Dialectical Behavior Therapy is a non-medication, 12-session psychological treatment program that’s designed for people who are leading emotionally painful lives and feel like life itself is crushing them. A dialectical approach focuses on developing the ability to identify and look at different viewpoints, challenge your assumptions, and balance between your changing outlook and accepting situations as they are to create new perceptions and perspectives to help you move forward and lead a happier life.
Many people in our therapy program have been diagnosed with borderline personality disorder and have tried countless other treatments without relief.
DBT has been demonstrated to be effective in helping people work through problems including:
- Overwhelming emotions
- Impulsive behavior
- Self injury
- Suicidal thoughts
- Substance use
- Eating disorders
- Trauma
- Challenging relationships that are filled with conflict or arguments
Overview
What is dialectical behavior therapy (DBT)?
Dialectical behavior therapy (DBT) is a type of talk therapy (psychotherapy). It’s based on cognitive behavioral therapy (CBT), but it’s specially adapted for people who experience emotions very intensely.
Cognitive behavioral therapy (CBT) is a type of talk therapy that helps people understand how thoughts affect emotions and behaviors.
“Dialectical” means combining opposite ideas. DBT focuses on helping people accept the reality of their lives and their behaviors, as well as helping them learn to change their lives, including their unhelpful behaviors.
Dialectical behavior therapy was developed in the 1970s by Marsha Linehan, an American psychologist.
What is dialectical behavior therapy (DBT) used for?
Dialectical behavior therapy (DBT) is especially effective for people who have difficulty managing and regulating their emotions.
DBT has proven to be effective for treating and managing a wide range of mental health conditions, including:
- Borderline personality disorder (BPD).
- Self-harm.
- Suicidal behavior.
- Post-traumatic stress disorder (PTSD).
- Substance use disorder.
- Eating disorders, specifically binge eating disorder and bulimia.
- Depression.
- Anxiety.
It’s important to note that the reason DBT has proved effective for treating these conditions is that each of these conditions is thought to be associated with issues that result from unhealthy or problematic efforts to control intense, negative emotions. Rather than depending on efforts that cause problems for the person, DBT helps people learn healthier ways to cope.
How do I find a DBT therapist?
A therapist can be a psychiatrist (a medical doctor who can prescribe medications), psychiatric nurse, psychologist, social worker or family therapist.
Finding the right therapist is often a time-consuming task, and DBT therapy isn’t any different. Try not to become discouraged. Talk to people you trust to give you a referral for a therapist who uses dialectical behavior therapy, whether it’s your primary healthcare provider or a friend or family member.
You can also search for therapists online through local and state psychological associations.
Be sure that any therapist you’re interested in seeing is a state-certified and licensed mental health professional and that they treat your area of concern (for example, eating disorders, borderline personality disorder, self-harm, etc.).
Most therapists’ websites list the conditions and problems they treat. If you have questions, call or email the therapist’s office before you choose.
It may be helpful to ask a potential DBT therapist the following questions:
- What is the nature of your training in DBT?
- Do you provide comprehensive DBT or a modification? If not comprehensive DBT, why not?
- Do you belong to a DBT consultation team?
- What’s your policy on phone calls and emails during the week?
- How much time will you initially ask me to commit to for the entire therapy process?
Procedure Details
How does dialectical behavior therapy (DBT) work?
The main goal of therapists who use dialectical behavior therapy (DBT) is to strike a balance between validation (acceptance) of who you are and your challenges and the benefits of change. Your therapist will help you learn new skills to improve emotion regulation.
The structure of dialectical behavior therapy can vary some from therapist to therapist, but, in general, DBT involves these four types of sessions:
- DBT pre-assessment.
- Individual therapy.
- Skills training in groups.
- Telephone crisis coaching.
DBT pre-assessment
Your therapist may offer an assessment before starting DBT. They’ll determine how suitable DBT is for you by asking you questions and explaining how DBT works. If you decide that DBT is the right therapy for you, they’ll ask you to commit to the treatment and the length of treatment.
Individual DBT therapy
Individual DBT therapy involves weekly sessions with your therapist. Each session lasts about 40 minutes to 60 minutes.
Individual DBT therapy sessions have the following goals:
- To help keep you safe by reducing suicidal and self-harming behaviors, if applicable.
- To limit behaviors that get in the way of productive therapy.
- To help you reach your goals and improve your quality of life by addressing what’s blocking your progress, such as mental health conditions or relationship issues.
- To help you learn new skills to replace unhelpful behaviors.
Your therapist will likely ask you to keep a diary to track your emotions and actions and to look for patterns of behavior. You’ll bring this diary with you to your sessions so you and your therapist can decide what to work on for each session.
DBT skills training in groups
In these sessions, your therapist will teach you skills in a group setting. This isn’t to be confused with group therapy, in which you discuss your problems with others. Think of it more like a teaching and learning session in a classroom setting.
DBT skills aim to help enhance your capabilities in day-to-day life. The four skills your therapist will teach include:
- Mindfulness: This is the practice of being fully aware and focused in the present instead of worrying about the past or future.
- Distress tolerance: This involves understanding and managing your emotions in difficult or stressful situations without responding with harmful behaviors.
- Interpersonal effectiveness: This means understanding how to ask for what you want and need and setting boundaries while maintaining respect for yourself and others.
- Emotion regulation: This means understanding, being more aware of and having more control over your emotions.
Telephone crisis coaching
DBT often involves telephone crisis coaching to support you in your daily life. This means you can call your therapist at certain times for support between sessions.
Examples of when you may need to call your therapist include:
- When you need help with an immediate crisis, such as wanting to self-harm.
- When you’re trying to use the DBT skills you learned but want some advice on how to do it.
However, your therapist will set clear boundaries about when you can call them, such as during an agreed-upon range of time during the day.
Crisis coaching functions on an as-needed basis. The calls are usually brief, and they shouldn’t replace the work of individual or group sessions.
Risks / Benefits
What are the benefits and risks of dialectical behavior therapy (DBT)?
Dialectical behavior therapy (DBT) has been proven to help people with their mental health conditions in several studies. For people with borderline personality disorder, in particular, DBT results in:
- Less self-harm behavior and anger.
- Fewer days of inpatient hospitalization.
- Less drug and alcohol misuse.
- Improved depressive symptoms.
However, DBT isn’t for everyone, and it can be very difficult. DBT is more likely to work for you if you:
- Are committed to making positive changes.
- Are ready to fully commit to therapy and do homework assignments.
- Are ready to focus mostly on your present and future, rather than your past.
- Feel able to do some sessions in a group with others.
Recovery and Outlook
How long will I need dialectical behavior therapy?
Dialectical behavior therapy (DBT) usually takes at least six months to a year. However, each person is unique, and mental health conditions are complex. You shouldn’t expect to be completely free of symptoms or no longer have problematic behaviors after one year of DBT.
Many therapists believe that the treatment for borderline personality disorder, in particular, can often take several years.
Try not to get discouraged by how long it may take to be able to better manage your emotions and have a better quality of life. The important thing is that you’re seeking help. Any progress is good progress.
When to Call the Doctor
When should I see my healthcare provider or therapist while doing DBT?
It’s important to go to all of your scheduled individual DBT therapy sessions and group skill training sessions.
If you’re experiencing a crisis, such as feeling suicidal, and can call your therapist, do so.
If your therapist is unavailable, call the National Suicide Prevention Lifeline at 1.800.273.8255. Someone will be available to talk with you 24 hours a day, seven days a week. You can also call 911 or go to the nearest emergency room.
A note from Cleveland Clinic
Dialectical behavior therapy (DBT) is an effective treatment to help people who experience very intense, negative emotions. Although it may be difficult and time-consuming to find the right DBT therapist for you, it’s important to keep trying. The sooner you can start therapy — and stay committed to it — the sooner you’ll have an improved quality of life.
What are the Benefits of Dialectical Behaviour Therapy (DBT)?
Dialectical Behaviour Therapy (DBT) is a variation of Cognitive Behaviour Therapy (CBT).
Developed in the 1980s to treat borderline personality disorder, it’s now a viable therapy for many conditions. In this post, we’ll be exploring what DBT involves and what it can be used for — as well as the key benefits.
What is Dialectical Behaviour Therapy (DBT)?
DBT evolved from Cognitive Behaviour Therapy (CBT), and like CBT, it is a form of talking therapy designed to help us manage a variety of mental health conditions and challenges.
DBT was first created to help people with borderline personality disorder and has a greater emphasis on managing extreme emotions and relationships.
The Oxford English Dictionary defines ‘dialectical’ as the following: Concerned with or acting through opposing forces.
This is an accurate way of describing how DBT works. It simultaneously aims to develop acceptance as well as promoting behavioural changes. These two seemingly opposing forces work together to aid recovery.
How Does DBT Work?
There are four key aspects of DBT — often known as the four modules or skills. Two of these relate to acceptance, and two relate to behavioural change:
1. Mindfulness
Mindfulness is usually the first way a DBT therapist will help promote acceptance. This involves observing your thoughts, emotions and actions, without judgement.
2. Distress Tolerance
Behaviour change isn’t always possible immediately — especially in times of crisis. Distress tolerance is the second acceptance skill developed in DBT. It helps us cope with emotional pain and challenging situations, accepting them for what they are and letting go of what we think they ‘should’ be.
3. Emotional Regulation
Emotional regulation helps us work with intense emotions, developing strategies to regulate them. To start with, this involves learning how to identify emotions for what they are (e.g. anger, sadness, anxiety). Over time, the therapist will help you learn techniques to:
• Reduce your susceptibility to extreme emotions,
• Experience more positive emotions,
• Cope better when intense emotions do arise.
4. Interpersonal Effectiveness
The final way DBT works is by improving the way you communicate in relationships with others. This can help you be more assertive, communicate your needs clearly and set boundaries to protect your mental health.
What can DBT help with?
Borderline Personality Disorder
Borderline personality disorder (BPD) was the first condition treated using DBT.
BPD is a condition that affects how a person feels about themselves. Intense emotions are characteristic of BPD — as are unstable relationships with others. Research shows DBT is effective in managing these BPD symptoms, especially in people with BPD who also self-harm.
Eating Disorders
Although CBT is effective for many people with eating disorders, it does not work for everyone. Research suggests DBT could be an effective alternative.
For some people with eating disorders, their condition is a way to escape, control or manage intense emotions. In these cases, DBT can help the individual learn other methods of coping with emotions. This is likely to work best for people with bulimia nervosa or binge eating disorder, rather than anorexia nervosa.
Self-Harm
Deliberate self-harm can exist either on its own or alongside another mental health condition.
People who self-harm tend to do so as a means to escape difficult feelings or experiences.
DBT can help these people learn other ways to cope with these emotions, memories and urges. First of all, DBT helps the individual to accept their feelings as a valid part of their experience — and then it builds tolerance to distress and better regulates emotions.
Depression and Suicidal Thoughts
The link between suicidal ideation and BPD was first discovered by Dr Marsha Linehan, who created DBT. She noted that treating people with BPD with DBT significantly reduced the risk of suicide attempts — a key feature of borderline personality disorder.
This makes sense. People experiencing suicidal thoughts often struggle to tolerate their distress, manage intense emotions and communicate with others. DBT addresses each of these — and helps the individual develop alternative coping strategies.
What are the Benefits of DBT?
1. It Improves Your Relationships
A good support network is key when dealing with mental health challenges. Many types of therapy fail to take this into account, expecting you to go it alone.
But DBT advocates understanding the importance of our social relationships in overcoming challenges. Creating healthy relationships — with respectful boundaries and trust — can improve health and wellbeing in a multitude of ways.
2. The Skills Go Beyond Mental Illness
Although the aim of DBT is to improve the symptoms of people living with mental illnesses, it doesn’t end there. The skills taught by the DBT therapist can be applied to many other areas of life too.
For example, research links mindfulness to many other aspects of health and wellbeing. Once you have learned this skill, it can help in many aspects of life — including at work, home and play.
3. It Improves Quality of Life
One of the main focuses of DBT is to improve the quality of life. The truth is, we can’t always change what happens to us. For some, mental health challenges will be a part of life forever — and acceptance of this fact is, therefore, key to moving forward.
DBT aims to improve quality of life by gently helping people make changes to move them in the right direction, whilst simultaneously letting them know it’s okay to find things difficult.
For those experiencing intense and disruptive emotions, quality of life can be impacted quite severely. Here, the distress tolerance and emotion regulation modules really come into their own.
Conclusion
To conclude, DBT can be an effective choice of treatment for those who have not been able to get results using traditional CBT courses.
It is especially useful for people with borderline personality disorder, suicidal ideation or self-harm — helping sufferers develop a more mindful, resilient and adaptable outlook. It does this using four modules. Two of them are focused on cultivating greater acceptance, whilst the other two are focused on behavioural changes to promote recovery.
Get in touch to find out more, and to learn whether DBT is suitable for you.
References:
https://www.lexico.com/en/definition/dialectical
https://www.sane.org/information-stories/facts-and-guides/dialectical-behaviour-therapy-dbt
https://www.mind.org.uk/information-support/drugs-and-treatments/dialectical-behaviour-therapy-dbt/about-dbt/#.XXLS4ZNKh8c
https://www.verywellmind.com/dialectical-behavior-therapy-dbt-for-bpd-425454
https://www.verywellmind.com/dialectical-behavior-therapy-for-eating-disorders-1138350
