Dialectical Behavior Therapy (DBT) is a form of psychotherapy developed by Marsha Linehan, Ph.D. at the University of Washington. Although originally developed for the treatment of borderline personality disorder, DBT is now widely used in a variety of applications. DBT specifically helps with problems in regulating emotions, behavior and thinking, such as:
Emotions
- Heightened emotional sensitivity
- Quick and intense emotional reactions
- Slow return to normal mood following a highly reactive period
- Chronic problems with depression, anxiety, anger, or anger expression
Behaviors
- Relationship difficulties including hypersensitivity to criticism, disapproval, rejection or abandonment
- Repeated suicide threats or attempts
- Self-harm behavior such as cutting or burning
Thinking
- Extreme (black or white) thinking
- Difficulty with problem solving and decision making
- Unstable self-image or sense of self
- “Detached” thinking, i.e., not recognizing ones role in personal circumstances
The underlying theoretical assumption of DBT is that emotional difficulties are biologically-based disorders of the emotion regulation system in which the client has great difficulty regulating emotion and tolerating emotional distress. Problematic behavior (self-harm, impulsiveness, etc.) is both an unsuccessful attempt to reduce emotional distress, as well as a consequence of impulsive decision-making that takes place when the client is emotionally dysregulated. A primary objective of DBT is to teach the client concrete behavioral skills to tolerate distress, regulate emotions, and improve interpersonal relationships.
For DBT to be successful, the treatment has to do two things effectively:
- Teach skills that the client needs in order to move closer to their life goals.
- Help clients develop the ability to use those skills in their daily lives.
The skills are taught through weekly DBT Skills groups. The protocol adopted is a sixteen (16) week program and assumes continued participation in weekly Individual Therapy and weekly DBT Skills groups.
Individual DBT psychotherapy and DBT Skills groups are two ways of developing and sharpening the ability to apply new skills in real life. Individual DBT therapy is personalized and based on specific goals determined in partnership with the client’s present therapist. DBT Skills group offers the client social support and the opportunity to see how others use DBT skills in their lives. DBT clients are encouraged meet with their therapist at least once a week for approximately 50-minutes. It is in these sessions that therapists work with their clients to discover behaviors and emotions that the client would like to change. With the help of their therapist, the client can discuss current situations that are of concern. Together, they will problem solve and practice choosing and applying DBT skills and strategies.
The DBT skills group will meet once a week for approximately 50-minutes each time. The Skills Group is run very much like a class. Participants are provided with notebooks that go along with the skills being taught in group. Homework corresponding to the skills topics is routinely assigned and reviewed. Groups take place over the entire 16-week program and include four (4) learning modules. The skills groups teach clients the strategies they need in order to reach their goals and provide regular opportunities to practice using those skills in their daily lives.
The skills modules include:
- Mindfulness – Mindfulness is being present in the moment, learning how to effectively participate and respond rather than just react. Mindfulness is useful in helping one stay in the moment instead of focusing on the pain of the past or trying to prevent pain in the future
- Interpersonal Effectiveness – Learning how to ask for what you want and how to say “no” effectively;
- Distress Tolerance – Learning how to put up with emotions that hurt but can’t be changed
- Emotion Regulation – Learning how to change emotions so that emotions that hurt you linger less and emotions that you like linger more.
For more information on DBT as well as a list of outcome research on DBT to date, please visit the Behavioral Technology Transfer Group.
