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What is Dialectical Behavior Therapy (DBT)?

Dialectical behavior therapy (DBT) is an evidence-based psychotherapy that began with efforts to treat personality disorders and interpersonal conflicts. Evidence suggests that DBT can be useful in treating mood disorders and suicidal ideation, as well as for changing behavioral patterns such as self-harm and substance use. DBT evolved into a process in which the therapist and client work with acceptance and change-oriented strategies and ultimately balance and synthesize them, comparable to the philosophical dialectical process of thesis and antithesis, followed by synthesis.

What are Some Common Goals in DBT?

DBT’s ultimate goal is to help you live a life you feel good about. A meaningful, fulfilling life looks different for each person. This is why therapists help people hone in on what’s important to them.

Another critical goal of DBT is to address behaviors that pose a life-threatening risk, such as suicidal thoughts, suicide attempts, and self-harm. It’s also important to address behaviors that interfere with therapy and prevent you from making progress. Therapy-hampering behaviors can include anything from missing appointments to arriving late or not completing homework.

As a team, you and your therapist will identify behaviors you’d like to decrease along with behaviors you’d like to increase. For example, someone might use DBT to address behaviors related to alcohol use or binge eating disorder.

What is DBT Used For?

Dialectical Behavior Therapy (DBT) is primarily used to help people who experience intense emotions and have difficulty managing them. It was originally developed to treat Borderline Personality Disorder (BPD), but its use has since expanded to a range of mental health conditions. Here's what DBT is commonly used for:

- Attention-deficit/hyperactivity disorder (ADHD)

- Bipolar disorder

- Borderline personality disorder (BPD)

- Eating disorders (such as anorexia nervosa, binge eating disorder, and bulimia nervosa)

- Generalized anxiety disorder (GAD)

- Major depressive disorder (including treatment-resistant major depression and chronic depression)

- Non-suicidal self-injury

- Obsessive-compulsive disorder (OCD)

- Post-traumatic stress disorder (PTSD)

- Substance use disorder

- Suicidal behavior

Who Can Conduct DBT?

DBT can be provided by a range of mental health professionals, including psychologists, psychiatrists, licensed clinical social workers (LCSW), licensed marriage and family therapists (LMFT), and licensed professional counselors (LPC), among others. It is recommended that people seeking treatment find a licensed mental health professional who has completed a specialized DBT training or certificate program.

What is the Difference Between Cognitive Behavioral Therapy and Dialectical Behavioral Therapy?

DBT, or Dialectical Behavior Therapy, comes from CBT (Cognitive Behavioral Therapy), but with a softer, more validating approach. While CBT focuses on challenging distorted thoughts, DBT recognizes that for some people, especially those with intense emotions, that can feel invalidating. Instead, DBT therapists focus on validating a person’s feelings and experiences, even if they don’t agree with them. That validation is a huge part of what makes DBT effective. At its core, DBT embraces the idea that two opposite things can be true at once, like wanting to change while accepting yourself as you are. It’s all about balance, nuance, and finding a middle ground instead of seeing things as all good or all bad.

Does Dialectical Behavior Therapy Work?

Because this approach to therapy can help people successfully improve their coping skills, they can develop effective ways to manage and express strong emotions. Researchers have also found that dialectical behavior therapy (DBT) is effective regardless of a person's age, sex, gender identity, sexual orientation, and race/ethnicity.

1. For BPD: Studies have found that DBT is effective in the treatment of borderline personality disorder (BPD) and reducing suicide risk in individuals with BPD. One study found that after a year of treatment, more than 75% of people with BPD no longer met the diagnostic criteria for the condition.

2. For suicidal behavior: Another study found that interventions that incorporated skills training as a treatment component appeared to be more effective in reducing suicidality than DBT without skills training.

3. For other conditions: Most DBT research has focused on its effectiveness for people with borderline personality disorder who have thoughts of suicide and self-harm, but the method could also be a successful treatment for other mental health conditions. For example, research has found that this type of therapy also appears to be effective in the treatment of PTSD, depression, and anxiety.

How Long Does it Take to Complete DBT?

The time it takes for someone to complete a DBT treatment program varies, depending on individual treatment goals and response to the therapy. In general, outpatient DBT requires at least six months of treatment, but it often takes a year or longer to complete.

The four DBT skills (mindfulness, distress tolerance, interpersonal effectiveness, and emotion regulation) are taught in separate group skills training modules. The standard DBT training schedule begins with two weeks of mindfulness training followed by five- to seven-week training modules in distress tolerance, interpersonal effectiveness, and emotion regulation. A two-week module of mindfulness training is interspersed between each five- to seven-week module.

In all, it takes around six months to complete the skills training modules following the standard DBT schedule. The modules are often repeated, however, meaning that many people spend a year or longer in a DBT program.

DBT programs may not follow the standard schedule. For instance, inpatient and partial hospitalization day programs may offer shortened skills training schedules.

When is DBT Not Appropriate?

Dialectical Behavior Therapy (DBT) may not be suitable for individuals with maladaptive overcontrol or specific mental health conditions. It may not be recommended for those with intellectual disabilities, uncontrolled schizophrenia, or a preference for less structured therapies. DBT's six-month to a-year timeframe might not be suitable for everyone.

While effective for reducing suicide attempts, it may not always be the best choice for borderline personality disorder. Criticisms from trauma survivors and the recommendation to complete DBT before trauma treatment highlight its limitations. For those unsuitable for DBT, alternative treatments are available. Consultation with a trained therapist is crucial to assess appropriateness.

What is the 24-hour Rule in DBT?

The 24-hour rule in Dialectical Behavior Therapy (DBT) requires clients to wait 24 hours before reaching out to their therapist after a self-harm incident. This pause promotes accountability and encourages clients to use DBT skills to manage emotions before seeking immediate support.

Can I Do DBT on My Own?

DBT is complex, and it's generally not something that people can do on their own without the guidance of a trained therapist. However, there are some things you can do on your own to help you develop new coping skills. For example, mindfulness, breathing exercises, and progressive muscle relaxation are all skills you can utilize to improve your ability to tolerate distress. It is important to remember that this should not be used in place of professional help. If you're struggling with a mental health condition, it's always best to seek out the help of a qualified mental health professional.

How Much Does DBT Cost?

Individual DBT sessions typically range from $250 to $300 per hour, depending on the provider’s credentials, location, and level of experience. Group DBT sessions, which are a core component of the treatment, generally cost around $100 per hour. It's important to note that not all DBT providers accept insurance, and coverage can vary widely depending on your plan and whether the provider is in-network. Clients may also encounter additional fees for phone coaching, skills training materials, or assessments, so it’s a good idea to confirm all costs upfront before beginning treatment.

History of DBT

Dr. Marsha Linehan developed the modern form of DBT in the 1970s. Linehan, a psychologist with a personal history of mental illness, knew she could use her experience and skills to develop a new therapy that would help people with mental health challenges.

While treating patients, she experienced her challenges, but worked with her care team to manage her conditions. Linehan found that behavioral therapy alone wasn’t effective for helping people with BPD. She also tried humanistic therapy, and it wasn’t helpful for her patients either.

Ultimately, she blended components of both approaches to offer patients a balance of support in creating the changes they desired and a compassionate and validating stance. This balance of change and acceptance is a core component of DBT.

As a result, DBT was the first type of Western treatment that formally used mindfulness. Mindfulness helps people focus on the current moment. Because of this, the practice allows people to overcome many of the issues that contribute to their mental illness.

Dialectical behavior therapy has been fine-tuned since it was first developed. While DBT helps patients who have severe forms of mental illness, this is not its only use. DBT can treat a variety of mental illnesses.

The 4 Stages of DBT

Dialectical behavior therapy is also divided into four stages of treatment:

Stage 1: During the beginning of treatment, the most serious and self-destructive behaviors are the first things addressed. This may include issues such as self-injury or suicidal behaviors.

Stage 2: Next, treatment moves on to address issues that affect a person's quality of life, such as their interpersonal effectiveness, emotional regulation skills, and ability to tolerate distress.

Stage 3: The next step is to focus on issues related to self-esteem and interpersonal relationships.

Stage 4: At this point, treatment is focused on helping people get the most out of their lives, including finding ways to experience greater happiness, strengthen their relationships, and pursue their life goals.

How Dialectical Behavior Therapy Works

DBT involves more than one visit to a therapist. It's a structured process that requires time and patience.

1. DBT pre-assessment: First, you'll meet with a therapist who has special training in DBT. They'll ask questions about you and what's going on in your life. If they think DBT is the right fit for you, they'll explain more about DBT and what your next steps will be.

2. Individual therapy: Weekly sessions with a DBT-trained therapist are the norm. These usually last 45 minutes to an hour. You'll discuss the goals you want to reach and issues that might be getting in your way. This could mean talking about your personal life as well as your mental health.

3. Group training: You'll also attend a weekly group session with others who are in DBT. This isn't a support group. It's more like a class. Your therapist will teach DBT skills that you can use on your own to better manage your feelings and your relationships with others. You could also do group exercises, such as role-playing certain stressful situations.

4. Phone crisis coaching: You may need extra support between sessions. That's common, so your therapist may suggest check-ins by phone. These are typically short phone calls of 5-15 minutes. You'll have a chance to tell your therapist how things are going and address any urgent concerns.

5. DBT workbook: You'll be given homework that allows you a chance to practice new skills. For instance, you might be asked to keep a daily journal where you keep track of your emotions, urges, reactions, and behaviors. Or you could get a DBT workbook with brief exercises that help reinforce the new concepts that you're learning.

6. DBT worksheets: Your therapist could give you handouts instead of, or along with, a DBT workbook. They'll also break down skill-building strategies step by step so you remember how to use them. For instance, you could get a DBT worksheet on ways to quickly calm down.

What are the Six Main Points of Dialectical Behavior Therapy?

Dialectical Behavior Therapy (DBT), developed by Dr. Marsha Linehan, is based on six main points or components that work together to help individuals regulate emotions, improve relationships, and build coping skills. Here are the six main points of DBT:

1. Acceptance and change: You’ll learn strategies to accept and tolerate your life circumstances, emotions, and yourself. You will also develop skills that can help you make positive changes in your behaviors and interactions with others.

2. Behavioral: You'll learn to analyze problems or destructive behavior patterns and replace them with healthier and effective ones.

3. Cognitive: You'll focus on changing thoughts and beliefs that are not effective or helpful.

4. Collaboration: You'll learn to communicate effectively and work together as a team (therapist, group therapist, psychiatrist).

5. Skill sets: You’ll learn new skills to enhance your capabilities.

6. Support: You'll be encouraged to recognize your positive strengths and attributes and develop and use them.

What Skills are Taught in DBT?

During DBT, people are taught skills in four areas:

1. Mindfulness skills help people focus on and accept the present moment without judgment. Mindfulness in DBT involves three “what” skills (observing, describing, and participating in the present moment) and three “how” skills (a nonjudgmental state of mind, paying attention to one thing at a time, and doing what is needed in the present moment).

2. Distress tolerance skills help people better tolerate and accept distress and pain. In DBT, people are taught that distress and pain cannot be entirely avoided in life, but by using certain strategies, they can be tolerated.

3. Interpersonal effectiveness skills include strategies people can use to assert themselves in social situations, including saying no, asking for what they want, and dealing with conflict in relationships. Additionally, these skills also emphasize building new and maintaining existing relationships, as well as maintaining self-respect in them.

4. Emotion regulation skills help people better understand and control their emotions. In DBT, people learn several strategies to improve their emotion regulation, including identifying and labeling their current emotions, identifying obstacles that prevent them from changing their emotions, and engaging in positive events and experiences, among others.

Benefits of Dialectical Behavior Therapy

There can be many advantages to DBT in terms of improvements in your quality of life. Research shows that the effects are long-lasting for gaining more control over your emotions, being able to deal with difficult situations, and having healthier relationships.

Here are some specific benefits of DBT:

1. Reduces anxiety, stress, depression, and self-harming behaviors.

2. Increases your self-confidence and self-esteem.

3. Provides accessibility to connect with a mental health professional at any time.

4. Teaches you how to utilize mindfulness practices in your daily life.

5. Teaches skills you can practice and employ in daily life to improve your overall well-being.

Drawbacks of DBT

As with any type of therapy, you should not expect DBT to be a magical cure or a quick fix. It’s a comprehensive program that involves a significant commitment of time and effort to see the desired results.

Here are some potential drawbacks to consider:

1. You will need to learn and apply many different skills, with a focus on mindfulness.

2. There is homework to complete after each session.

3. DBT entails both individual and group counseling.

4. DBT requires that you adhere to a structured format.

5. You may not have a complete resolution of all your symptoms.

While many people benefit from the social support and bonding that takes place in the group therapy portion of DBT, others may prefer a form of therapy that doesn’t require group participation. You may feel more comfortable with just individual therapy to explore confidential issues in a private space.

Tips on How to Get the Most Out of DBT

As with most other things in life, the more effort you put into the therapeutic process, the more you’re likely to get out. When you’re ready and motivated to make changes that will improve your life, DBT can be well worth the investment.

1. Know what you want to achieve with DBT. Ask yourself, “What do I want to change?” You might want to better manage impulsive eating habits or assert yourself more in a relationship. Taking time to reflect on specific behaviors you want to improve allows you to track your progress.

2. Find a therapist you connect with. Having a therapist who’s a good fit can make all the difference to your experience. You want to find someone whom you can trust, feel comfortable discussing difficult subjects with, and who has experience in dialectical behavior therapy. Ask plenty of questions when talking to potential therapists, and don’t be afraid to make a switch if you have to.

3. Fully commit. To get the most benefit from DBT, it’s important to commit fully to all the components of the program. This includes setting goals, learning new skills, actively participating in all aspects, and completing any homework assignments.

4. Stay engaged. Between sessions, practice applying the skills you’ve learned in real-life situations. For example, you can apply mindfulness exercises while you’re feeling impatient at the grocery store. This reinforces what you’ve learned and allows for better discussions with your therapist later.

5. Evaluate your progress. The diary card you complete in DBT is one way to track and assess your progress. Your therapist will also help you evaluate how you’re feeling and the progress you’re making toward your goals at various stages. But as the treatment progresses, reflect on whether you’re noticing improvements in how you cope with stress, anger, and personal relationships. Are you less reactive to conflicts or disagreements with family and friends? Are you better able to focus on your good qualities rather than the negatives?

6. Reward yourself and celebrate small victories. Have a list of ways to reward yourself after completing homework. This might be as simple as engaging in your favorite hobby or self-care activities. In addition, take time to acknowledge your victories, such as any time you successfully use a new coping skill.

7. Continue learning. Think of DBT therapy as a continuous process. Once you feel like you’ve reached a goal, set a new one. You’ll find that there is always room to grow and areas of your life you can work on.

How to Find a Dialectical Behavior Therapist Near Me

If you think DBT could be a good fit for you, ask your doctor if they can suggest a therapist. You can also search online for dialectical behavior therapy near me. 

Once you find a potential therapist, ask about:

1. Training. What type of DBT training do they have?

2. Experience. For instance, do they often see clients with the same issues that you have?

3. Health insurance. Do they accept your plan if you have one?

4. Where sessions will take place. Will they be in-person or virtual? 

5. Check-ins. Will you touch base over the phone or email?

6. Fees. If you'll be charged for missing a session, it's good to know that upfront.

Finding a therapist you feel comfortable with and trust may take some time, but it will be a key part of your treatment. You may talk to several people before you find the right match. Depending on where you live, you may have trouble finding a complete dialectical behavior therapy program that includes individual sessions, group skills classes, and phone coaching. If so, you can look for a therapist who uses DBT techniques in their practice.

Sources:

Sofia Health

Wikipedia

Harvard Health

Very Well Mind

WebMD

Yale Medicine

McLean Hospital

Psych Central

Grove Treatment

Help Guide

Positive Psychology

The content herein is provided for general informational purposes only and is not a substitute for professional medical advice, diagnosis or treatment. Medical information changes constantly, and therefore the content on this website should not be assumed to be current, complete or exhaustive. Always seek the advice of your doctor before starting or changing treatment. If you think you may have a medical emergency, please call your doctor or 9-1-1 (in the United States) immediately.