Dialectical Behavior Therapy (DBT)

Dialectical behavior therapy (DBT) is a form of cognitive behavioral therapy developed by Marsha Linehan that is designed to help people change patterns of behavior that are destructive, such as self-harm, suicidal ideation, and substance abuse. This approach emphasizes individual and group skills training to help people increase their emotional and cognitive regulation by learning about the triggers that elicit reactive states of being, which in turn are expressed through unwanted feelings and actions. DBT works to identify effective coping skills, and to then apply them appropriately to interrupt the maladaptive sequence of trigger-reaction-unwanted feeling/action. DBT assumes that every individual is doing the best he or she can, but is either lacking the skills necessary to respond more skillfully, or has unintentionally been reinforced in negative behaviors.

There are four modules in DBT skills training:

  1. Mindfulness: these skills help people focus on the here and now in a calm way. These skills encourage people to slow down and focus on caring for one’s self in the moment.
  2. Distress tolerance: these skills help people to get through the “crisis moments” when emotions are running high. This teaches effective and healthy self-soothing techniques which allow people to make wise decisions about how to take action without falling into reactive and destructive states that often lead to intense and desperate reactions.
  3. Interpersonal effectiveness: helping people understand what their needs are in relationships and develop effective ways of dealing with others to get one’s needs met. This includes listening and communication skills, learning to repair relationships, and being able to say no.
  4. Emotional Regulation: help people understand their emotions, decrease the intensity of strong emotions and learn to ride them out without acting on them.

Much of the time these modules are taught in a group, but they can also be taught in individual therapy, often accompanied by homework between each session.

DBT was originally designed to help chronically suicidal individuals diagnosed with Borderline Personality Disorder, but it is now shown to be effective in the treatment of many other disorders including PTSD, eating disorders, depression, and substance dependence.