Dialectical Behavioral Therapy (DBT)

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What is Dialectical Behavioral Therapy (DBT)?

Dialectical behavior therapy (DBT) is a therapeutic approach that was first developed to help people with borderline personality disorder (BPD) and chronic suicidal ideation.

Through the years, DBT has also proved to be a beneficial element of care for people who have a variety of other mental and behavioral health concerns, including:

• Anxiety disorders
• Depressive disorders
• Substance use disorders (addictions)
• Posttraumatic stress disorder (PTSD)
• Eating disorders
• Bipolar disorder
• Attention-deficit/hyperactivity disorder (ADHD)

DBT helps people to embrace two ideas that can appear to be contradictory (or dialectically opposed to each other): acceptance and change. 

Through a structured series of therapy and skills-development sessions, DBT patients discover that nonjudgmental acceptance can be an essential step in the process of making meaningful behavioral changes. 

The Components of DBT

Dialectical behavior therapy is often broken down into the following four components:

• Individual therapy – One-on-one sessions with a trained therapist to review recent experiences, process emotions, reinforce developing skills, and address other personal issues
• Group skill development sessions – Small-group gatherings that focus on four key skill areas (which are discussed in greater detail below) 
• Phone coaching – Brief consultations to help patients who are struggling with their emotions or approaching a crisis point 
• Consultation team meetings – Regularly scheduled sessions attended by DBT practitioners to review their work with clients, discuss challenges, and further hone their skills

The skills training component of DBT is designed to enhance participants’ capabilities in the areas of mindfulness, emotion regulation, distress tolerance, and interpersonal effectiveness:

• Mindfulness – This is the practice of being fully present in the moment, acknowledging your thoughts and emotions without judgment or reflexive reaction. This state of attentive, nonjudgmental awareness helps people understand that they do not have to be controlled by their feelings or by the actions of others. Instead, they can choose to respond thoughtfully and intentionally.
• Emotion regulation – This concept builds on the mindfulness skill of acknowledging emotions without judgment or automatic reaction. As people learn to let their feelings arise and pass, they will become better able to regulate their responses. This skill can be particularly valuable during times of emotional distress, when a person may have previously felt compelled to react in counterproductive or self-defeating ways, such as by using alcohol or another drug.
• Distress tolerance – Mindfulness and emotion regulation empower people to experience difficult emotions without criticizing themselves or lashing out at others. But tolerating distress requires more than self-control. In addition to knowing what not to do, a person must also understand the types of positive actions they can take. The distress tolerance skill area focuses on productive responses that promote resilience.
• Interpersonal effectiveness – This area addresses a person’s ability to interact with others in a constructive manner, set and respect boundaries, and build trusting relationships. Skills in this area that may be especially beneficial for someone who has struggled with addiction include solving problems, resolving conflicts, and asking for help.

Mental Health Programs that Provide DBT

DBT can be incorporated into treatment at many levels, including:

• Detoxification (detox)
• Inpatient/residential treatment
• Partial hospitalization program (PHP)
• Intensive outpatient program (IOP)
• Outpatient program (OP)

What To Expect During DBT

Common aspects of DBT include:

• You will take part in regularly scheduled individual and group therapy sessions. You may also be able to contact your therapist in between sessions for help with an immediate concern.
• You will be in a safe and supportive environment. Though some of the topics you discuss in therapy may be difficult for you, you won’t be criticized or judged. Instead, your therapist will help you explore your painful emotions, so that you can learn to accept yourself while also making necessary changes.
• DBT is not a passive experience. You’ll be expected to work in active collaboration, or partnership with your therapist. 
• You will learn and practice skills that can help you address specific challenges, improve your ability to function, and enhance your overall quality of life.
• You’ll learn how to get through difficult times without resorting to substance use or otherwise reacting in a self-defeating manner.
• You may have “homework” assignments between sessions, such as keeping a journal of your experiences and emotions, or completing worksheets to reinforce concepts or skills that were introduced during group sessions.

How Effective is DBT?

Several studies have documented the effectiveness of DBT for a variety of purposes among a range of patient populations. Three recent studies include:

• A February 2023 study in the International Journal of Bipolar Disorders found evidence that DBT-based services may lead to improvements in “several core symptoms” of bipolar disorder, including depression, emotional dysregulation, and suicidality.
• A July 2023 study in the journal Research in Psychotherapy found that DBT improved cognitive functioning among patients who had a range of mental health concerns, including attention-deficit/hyperactivity disorder (ADHD), bipolar disorder, and borderline personality disorder. 
• A January 2024 review in the Iranian Journal of Psychiatry reported that DBT is effective at alleviating suicidal thoughts and reducing acts of self-injury among patients with bipolar disorder. The authors of this study found that DBT can also improve stress-management capabilities and ease depressive symptoms.

The History of DBT

Marsha Linehan, PhD, developed dialectical behavior therapy in the 1970s and 1980s. The new approach grew out of her attempts to use of cognitive behavioral therapy (CBT) to treat suicidal women, many of whom had borderline personality disorder.

Dr. Linehan found that her patients did not respond well to CBT’s focus on negative thoughts as major contributors to emotional distress. Many patients, she discovered, felt that this perspective invalidated the traumatic life experiences that contributed to their suicidal ideation. They were also resistant to CBT’s emphasis on change.

To counter these concerns, Dr. Linehan began to adapt the standard CBT approach to incorporate acceptance and validation. She then developed a structured, modular means of reinforcing these concepts while helping patients develop skills in the four key areas addressed earlier on this page.

In December 1991, Dr. Linehan and colleagues published the results of the first randomized, controlled clinical trial using DBT. That study, which appeared in the journal Archives of General Psychiatry, was based on a yearlong evaluation of patients who received either DBT or what was then considered to be standard community-based care.

“At most assessment points and during the entire year,” her research team reported, “the subjects who received dialectical behavior therapy had fewer incidences of parasuicide and less medically severe parasuicides, were more likely to stay in individual therapy, and had fewer inpatient psychiatric days. 

Why New Mind Wellness?

When you’re considering getting help for an addiction to alcohol or another drug, it’s important to review your options and find the provider whose services and overall approach best align with your goals and expectations.

Here are just a few of the many reasons why Time Wellness Detox may be the perfect place for you:

• Throughout your time at our center, you will be in a safe, closely supervised, and highly supportive environment.
• Your treatment will be guided by a customized plan that reflects your unique needs, goals, and expectations.
• Your treatment team will encourage you to ask questions, share your concerns, and otherwise play an active role in all aspects of your care.
• Depending on your specific needs, you may receive prescription medication to ease withdrawal symptoms or address co-occurring mental health concerns. 
• CBT and other therapeutic interventions can help you manage withdrawal symptoms, address co-occurring mental health concerns, and begin to build a framework for successful, long-term recovery.
• Your team will document your progress and identify areas of continued need. Before you transition out of detox, we’ll review this information with you and use it to recommend the most appropriate types of follow-on treatment.