Dialectical Behavioral Therapy
What is Dialectical Behavioral Therapy (DBT)?
Dialectical Behavioral Therapy (often shortened to DBT) is a skills-based approach to psychotherapy that includes aspects of mindfulness and cognitive-behavioral therapy. DBT was originally developed for women coping with borderline personality disorder, but its use has since been expanded to include treatment for a wide variety of individuals.
The word “dialectical” refers to this therapy’s focus on learning to balance and tolerate opposites, with the goal of releasing attachment to black-and-white thinking. The philosophical foundation of dialectics underlies DBT treatment, which strives to help individuals accept present realities while also working toward for change.
DBT usually includes both individual talk therapy sessions and group sessions focused on developing four central sets of skills. These skill areas are:
- Mindfulness: How to be present in the moment and observe yourself and the world around you in a nonjudgmental way.
- Distress tolerance: How to cope with unpleasant situations and emotions in healthy ways.
- Interpersonal effectiveness: How to interact with other people thoughtfully and resolve conflicts effectively.
- Emotional regulation: How to identify your emotions as they occur and manage your reactions to them.
Both individual sessions and group sessions usually occur weekly over the course of several months, though the length of treatment may vary. DBT is more structured than some other varieties of psychotherapy, but that said, your therapist may recommend a more flexible approach that focuses more on either individual or group work.
Though DBT is used to treat a variety of different mental health conditions, its goals usually include the improvement of overall mood, more effective management of emotions and difficult situations, and improved interpersonal skills.
What can DBT help with?
DBT was originally developed for use with women who have borderline personality disorder, but now it may also be used as a treatment for a variety of mental health concerns, including:
- Borderline personality disorder
- Eating disorders
- Substance use problems
- Post-traumatic stress disorder
- Emotion regulation
- Interpersonal skills
- Other mental health conditions
Increasingly, therapy based on DBT is considered a treatment possibility for anyone struggling with issues around emotional regulation, interpersonal skills, and/or tolerance of distressing realities.
Does DBT work?
The most extensive body of research about DBT’s effectiveness concerns its use in the treatment of borderline personality disorder. For these individuals, several studies have found that DBT can be very effective in improving coping skills, stabilizing mood, improving interpersonal skills, and reducing risk of suicide. However, a smaller body of more recent research also suggests that DBT also can be effective for treating other conditions. While DBT has traditionally been implemented as a series of complementary components, some studies also suggest that using just some of its skills or components might also be a helpful treatment option for a variety of mental health diagnoses.
How does DBT work?
DBT integrates strategies and techniques from a range of mental health treatments to form one comprehensive treatment program. Individual sessions often have a lot in common with traditional talk therapy sessions and may incorporate aspects of cognitive-behavioral therapy such as checklists, worksheets, and examining thoughts for cognitive distortions. The individual session also serves the purpose of reinforcing the skills learned in group sessions and discussing how you’ve been applying them in your day-to-day life.
In contrast, group sessions for DBT usually focus on building specific skills and competencies. Some exercises you might explore in group DBT sessions include:
- Mindfulness activities: Includes relaxation, visualization, breathing exercises, and meditation.
- Strategies for distress tolerance: Includes finding distractions, self-soothing, and evaluating and creating alternatives to change unpleasant situations.
- Techniques for interpersonal effectiveness: Includes setting healthy boundaries, clarifying expectations for relationships with others, and coping with conflict assertively rather than combatively.
- Methods for improving emotional regulation: Includes practice identifying and labeling different emotions, identifying personal emotional triggers, and planning ahead for how to apply distress tolerance techniques.
Sometimes, DBT also includes regular check-ins with a therapist over the phone in order to provide added support around implementing these skills.
All aspects of DBT include rely on the philosophy of dialectics, and both individual and group sessions will likely include exploration of its concepts and how to apply them in daily life.
Structure of DBT sessions
In an individual DBT session, your therapist will likely begin by checking in with you about your experiences since the last session, with a focus on how you may have coped with any challenges. Many therapists also include formal assessments or other written tools at the beginning of each session to help track your progress and offer perspective on the skills you’re gaining. Additionally, individual sessions will include attention to the skills you’ve been working on in group sessions and discussion of how you’ve been applying these skills to real-life situations. Often, your individual therapist will also guide you in working toward viewing your life through the lens of dialectics, in which acknowledgement of current realities is balanced with goals for practical change.
In a group DBT session, a therapist will lead you and other participating individuals through exercises designed to help you learn and practice concrete skills in the four focus areas outlined above. Most session will be a mixture of educational content and hands-on practice (for example, your therapist might describe a new breathing exercise and explain why it could be useful, and then ask the group to try out the exercise together). Group session are also likely to include review of the previous week’s content and a discussion of how group members have been applying the skills learned, as well as attention to any challenges experienced in doing so. Often, therapists will assign group members specific homework to complete between sessions, so sessions might involve going over this homework. Finally, the therapist will give instructions for what group members might focus on in preparation for the next session.
What to look for in a DBT therapist
When looking for a DBT therapist, you’ll want to make sure that they have advanced training and/or certification in DBT. Many DBT therapists have certification from the DBT-Linehan Board of Certification, which requires that providers demonstrate competence in using evidence-based DBT techniques.
Additionally, you may want to discuss potential therapists’ experience using DBT as a treatment for your particular concern, since some may, for example, know how to use DBT for depression but not for eating disorders.
Finally, you’ll also want to clarify what kind of expectations your therapist has for the structure and frequency of DBT sessions. Some have strict rules about participation in the full DBT program (including weekly individual and group sessions) while others may offer more flexible treatment options.
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