What is Dialectical Behavior Therapy?
- Video: What is DBT?
- From CBT to DBT
- Underlying Theory of DBT
- DBT Treatment Modalities
- The 4 Modules
- Who Benefits from DBT?
- Finding DBT Treatment
- DBT Resources
Origins of DBTDialectical behavior therapy (DBT) developed in the early 1990’s from the work of Marsha Linehan, Ph.D. (1993a). Linehan, a cognitive behavioral psychologist by training, formed the principles, theory and strategies underlying DBT while working primarily with women who were suicidal and engaged in self-harming behaviors.
Video: What is DBT?
This video by Esme Shaller, Ph.D., Clinical Psychologist at the University of California, San Fransisco (UCSF), provides an excellent overview of DBT, including who it is intended for and what being in treatment might look like.
From CBT to DBT
Over time Linehan made adaptations to her work to address these short-comings. It is these adaptations that developed into DBT. DBT preserves the cognitive behavioral focus on changing problem thoughts and behaviors, particularly in the skills training aspect of treatment. However, it also emphasizes acceptance and validation strategies designed to recognize the difficulty of change, which can help people stay open to and engaged in the process of change.
Underlying Theory of DBT
DBT Treatment Modalities
DBT grew into a treatment with 5 primary modalities:
- Individual therapy.
- Group skills training.
- Coaching in crisis.
- Structuring the environment.
- Consultation team.
Group Skills Training
The 4 Modules
Mindfulness: These skills are fundamental to DBT and are often referred to as ‘core’. They teach how to bring awareness to everyday living. This requires focus in the present moment, a capability many people with impulsive and mood-related behaviors lack. Mindfulness is consciously bringing attention to feelings, thoughts, body sensations, behaviors and events without judgment. It is the opposite of rejecting, suppressing or avoiding current experiences.
Distress Tolerance: In this module, skills center on accepting and coping with pain and distressing life events. These skills answer the question, ‘how do I survive this crisis.’ They focus not on changing the moment, but on accepting the current situation and finding ways to get through it without engaging in problematic behavior.
Emotion Regulation: Emotionally sensitive individuals often are unable to modulate the painful emotions that underlie impulsive, risky behaviors. These skills include understanding current emotions, identifying obstacles to changing emotions, checking facts related to emotional reactivity, problem solving, increasing positive emotions, and changing emotions.
Interpersonal Effectiveness: Interpersonal relationships can bring joy and happiness and cause fury or despair. This module teaches skills to get what we want and need in life, while maintaining relationships and self-respect. They include strategies for asserting your needs, saying no effectively, and coping with conflict. Skills necessary for maintaining friendships, decreasing social isolation, and ending destructive relationships are also covered.
Coaching in Crisis
Structuring the Environment
Today, not all implementations of DBT are structured with all five modalities. For example, studies on binge eating disorder were effective with the skills group alone (Telch, Agras, & Linehan, 2001), and adaptations of DBT have been effective for a variety of populations, including bulimia nervosa (Hill, Craighead, & Safer, 2011) and suicidal teens (Rathus & Miller, 2002).
An overview of the research examining the effectiveness of DBT skills training without individual therapy has been found effective in a number of areas, including to reduce depression, anger and emotion dysregulation and emotion intensity. Review of studies has also found adaptations of DBT skills to be effective for eating disorders, drinking-related problems, and attention/hyperactivity disorder (ADHD) (Linehan, 2015).
Who Benefits from DBT?
The application of DBT has a degree of flexibility based around an underlying theory and set of principles, which has allowed it to grow into an effective treatment for people with a wide variety of diagnoses and problems. As a result, DBT has been adapted as a treatment for a number of disorders characterized by emotional dis-control, such as:
- Binge eating disorder (Telch, Agras & Linehan, 2001).
- Depressed adolescents (Miller, 1999).
- Depressed elderly (Lynch, 2000).
- Individuals dually diagnosed with intellectual disabilities and mental illness (Lew, Matta, Tripp-Tebo & Watts, 2006).
DBT has also been adapted to treat drug dependence and substance abuse (Linehan et. Al. 1999). The 2nd edition of the DBT Skills Training Module includes a section of skills to use when the crisis is addiction in its distress tolerance module. This module was developed based on a series of studies treating individuals with drug dependence with DBT (Linehan, 2015).
Its effectiveness in helping people modulate extreme emotions and reduce impulsive and destructive behaviors makes it an attractive treatment for those with substance use problems, as does its efficacy in keeping individuals in treatment, which is often a particular problem in treating people who struggle with addiction. The modular make up of skills training, along with the different modes of treatment allow treatment providers to intensify or reduce the components of treatment allowing for adaptation to an array of disorders.
Finding DBT Treatment
The Substance Abuse and Mental Health Services Administration (SAMHSA) has an excellent online treatment-finding tool. Search for providers in your area and visit their website, or call, to see if they offer DBT or other treatments of interest. Both outpatient and inpatient programs will be listed.
Contact your insurance company to learn about treatment providers in your area. Specify that you are looking for facilities that offer DBT.
Do an internet search for DBT providers in your area.
If you are looking for co-occurring substance abuse and mental health (dual-diagnosis) treatment:
- Outpatient: Use the SAMHSA treatment-finding tool to search for outpatient facilities near you.
- Inpatient: Use our treatment finder or call 1-888-993-3112Who Answers? to learn about inpatient detox, treatment, and recovery centers.
If you are looking for resources to use on your own, you may want to consider:
- Behavioral Tech: founded by Marsha Linehan and contains numerous free DBT resources.
- Psych Tools has handouts related to regulating emotions through diaphragmatic breathing, mindfulness, and other cognitive-behavioral techniques.
- There are numerous books available on DBT.
Lew M., Matta C., Tripp-Tebo C., Watts D. DBT for individuals with intellectual disabilities: A program description (2006). Mental Health Aspects of Developmental Disabilities, 9(1), 1–13.
Linehan M. Cognitive Behavioral Treatment of Borderline Personality Disorder. New York: Guilford Press; 1993a.
Linehan, M. M. 1993b. Skills Training Manual for Treating Borderline Personality Disorder. New York: Guilford Press.
Linehan, M.M. 2015 DBT Skills Training Manual, Second Edition. New York: The Guilford Press.
Linehan, M. M., H. Schmidt III, L. A. Dimeff, J. C. Craft, J. Kanter and K. A. Comtois. 1999. Dialectical behavior therapy for persons with borderline personality disorder and drug dependence. The American Journal of Addictions 8, 279–292.
Rathus, JH & Miller, AL. (2002). Dialectical behavior therapy adapted for suicidal adolescents. Suicide and Life-Threatenino Behaviors, 32, 2, 146-157.
Telch, Christy F.; Agras, W. Stewart; Linehan, Marsha M. Dialectical behavior therapy for binge eating disorder (2001). Journal of Consulting and Clinical Psychology, 69(6), 1061-1065.