What is DBT?

Dialectical Behavioral Therapy is a type of cognitive-behavioral psychotherapy that emphasizes the psychosocial aspects of treatment. This type of treatment centers around problem-solving and acceptance strategies. DBT is often used to treat individuals who have had little to no success with other treatment methods. It is used to develop techniques for achieving goals and decreasing harmful behaviors such as addiction, eating disorders, and PTSD.

What to Expect

DBT treatment usually consists of individual therapy sessions as well as DBT skills groups. Individual therapy sessions are one-on-one with a trained practitioner, ensuring that all therapeutic needs of the client are addressed. Therapists that specialize in DBT provide acceptance and support to clients while helping to keep them motivated, using DBT skills in daily life, and addressing obstacles that may arise.

Group participants practice their learned skills alongside others. In the group setting, members are encouraged to share their individual experiences and provide mutual support. A trained professional leads the group exercises and teaches additional skills. Usually, the therapist will assign group members “homework”, like practicing mindfulness exercises on their own time.

How it Works

DBT was developed by Marsha Linehan, Ph.D. ABPP originally to treat chronic borderline personality disorder. It is now recognized as the standard for treating that along with a wide range of other disorders. The goal of DBT is to assist people in building a life that they see as worth living. This includes replacing negative harmful behaviors with positive, life-enhancing behaviors.

There are three main components of DBT that help accomplish the client’s personal goals. Dialectical Behavioral Therapy is:

• Support-oriented. Professionals demonstrate unconditional support for their clients to help them identify and build up their strengths. This helps the individual feel better about themselves and their lives.
• Cognitive-based. Treatment is based on identifying negative thoughts, assumptions, and beliefs that make life more difficult. It helps people learn different ways of thinking that change their perception and makes life more bearable.
• Collaborative. This treatment method requires continuous attention to the relationship between staff and clients. Clients are encouraged to work on their newly learned tasks, roleplay new interaction methods with others, and practice skills. All of these new skills are taught in weekly lectures and groups with the therapist. Throughout treatment, the therapist helps the person learn, apply, and master the DBT skills. This is why it is so important to foster the trusting collaborative relationship.

Stages of DBT

Treatment for DBT is divided into four stages. The stages are determined by the severity of the client’s case and behaviors. Each stage is defined to support clients in achieving their unique goals. There is no set time frame for each stage, as it is independent based on the individual. Instead, a therapist will work with the individual and spend as much time needed based on their goals.

Stage 1: In the initial stage, the focus is on stabilizing the individual. They may be dealing with destructive behaviors like suicidal thoughts, self-harm, or addiction. This is usually when the person feels they have hit their all-time low point in life. This stage of DBT is concentrated on crisis intervention and safety. The primary goal of stage 1 is to help individuals gain some control over their thoughts and behaviors and reducing behavioral risks.

Stage 2:During stage 2, behaviors are more stable but mental health issues are usually still persisting. Therapists encourage clients to explore their emotional pain, as opposed to avoiding it. If the individual is suffering from post-traumatic stress disorder, this is the stage in which it is treated. The main goal of stage 2 is for clients to acknowledge and experience their emotions.

Stage 3: In stage 3 of treatment, the challenge for the individual is to learn how to live and find peace. Goals are established, self-respect is built, and the focus is happiness. The goal of this stage is for the client to lead a normal healthy life and maintain progress.

Stage 4:For some people, stage 4 is essential to find a deeper meaning to oneself through a spiritual existence. Some individuals may still have a sense of incompleteness after stage 3, and this was created for them to resolve that feeling. People are encouraged to find freedom and joy and develop an ongoing capacity for happiness and success.

The 4 Skill Modules of DBT

DBT is useful for struggling individuals who are prone to react in a more intense manner toward emotional situations in romantic, family, and friend relationships. The emotional stimulation in such situations tends to increase much more quickly than the average. Through this treatment methods, individuals learn a variety of different skills to combat these sudden, intense surges of emotions. This includes:

1. Mindfulness. Individuals learn to be present in the moment and understand the signs of irrational, unregulated emotions. It is important to practice mindfulness skills in a manner that is non-judgmental, one-mindful, and effective.
2. Interpersonal Effectiveness. DBT works to change the individual’s interpersonal response patterns- how they interact with people around them as well as their personal relationships. People learn new strategies for asking what one needs, how to effectively and assertively say no, and learning to cope with unavoidable interpersonal conflict.
3. Distress Tolerance. In DBT treatment, clients are taught how to accept, tolerate, and find meaning for distress. Instead of avoiding it, people learn how to accept life in the present, even if they don’t approve of it.
4. Emotion Regulation. Clients struggling with emotional issues can benefit from learning to regulate these emotions. They will learn to properly identify emotions, reduce vulnerability, and increase positive emotions. Along with that, DBT also helps clients increase mindfulness of their emotions, taking opposite action with positive behavior, and apply tolerance techniques.

Dialectical behavioral therapy has proven to be effective for alleviating urges for harmful behavior. Clients begin to feel empowered and can effectively manage their feelings. DBT is part of healing the person as a whole- learning to balance their thoughts and feelings in a way that promotes both mental and physical health.