Dialectical Behavior Therapy (DBT) is a type of cognitive-behavioral psychotherapy developed by Dr. Marsha Linehan in the late 1980s. It was originally designed to treat individuals with borderline personality disorder (BPD) and chronic suicidal ideation, but over time, it has proven effective for a variety of mental health issues, including other personality disorders, depression, eating disorders, and substance abuse.
DBT is called “dialectical” because it involves finding a balance between acceptance and change. It integrates strategies of acceptance (derived from mindfulness and acceptance-based practices) with strategies of change (derived from cognitive-behavioral therapy). The primary dialectic within DBT is between accepting reality as it is and simultaneously working to change it.
Key aspects of DBT include:
- Mindfulness: Mindfulness is the core skill in DBT, involving being fully aware and present in the moment. This skill helps individuals accept and tolerate the powerful emotions they may feel.
- Distress Tolerance: This refers to increasing a person’s tolerance of negative emotion, rather than trying to escape from it. It includes skills like self-soothing, improving the moment, and thinking of pros and cons.
- Emotion Regulation: These skills help to manage and change intense emotions that are causing problems in a person’s life. It includes understanding and naming emotions, increasing positive emotional events, decreasing vulnerability to emotion mind, and applying distress tolerance techniques.
- Interpersonal Effectiveness: This aspect of DBT focuses on effective strategies for asking for what one needs, saying no, and coping with interpersonal conflict. It helps individuals to communicate effectively and assert their needs while maintaining self-respect and relationships with others.
- Walking the Middle Path: This skill is about balancing acceptance and change, understanding dialectics, and reducing black-and-white, all-or-nothing styles of thinking.
DBT typically involves a combination of individual psychotherapy sessions and DBT skills training in a group setting. The individual therapist helps the person to learn, apply, and master the DBT skills. The group sessions, which usually meet once a week for about 2-2.5 hours, provide a setting in which individuals can learn and practice skills together.
An important aspect of DBT is the focus on the therapeutic relationship. The therapist and client work towards creating a relationship where the client feels understood and accepted, and where the therapist helps the client to recognize and change dysfunctional behaviors.
DBT has been found to be particularly effective in reducing self-harm behaviors, suicide attempts, and hospitalizations, and in improving overall functioning. It is a well-researched and evidence-based therapy approach.