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Norman

Can Dialectical Behavior Therapy Treat Dissociative Identity Disorder?

Dissociative identity disorder (DID) was formerly referred to as multiple personality disorder until 1994, when the name changed to denote a clearer understanding of the disorder. It is currently listed in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) as dissociative identity disorder and is described as a disruption of identity that is characterized by two or more distinct personality states or an experience of possession. Psychology Today defines dissociative identity disorder as a “rare condition in which two or more distinct identities, or personality states, are present in—and alternately take control of—an individual.” An individual that has been diagnosed with DID has essentially failed to integrate various aspects of his or her identity, memory and/ or consciousness into a single multidimensional self. The DSM-5 has reported over seventy percent of individuals diagnosed with DID have attempted suicide at least once in their life, and self-harming behavior is highly common among individuals with DID.

Dialectical Behavior Therapy

Dialectical behavior therapy (DBT) is a specific type of cognitive-behavioral therapy (CBT) that places significant emphasis on the psychosocial aspects of treatment. Psychologist Marsha M. Linehan developed DBT in the late 1980s to better treat chronically suicidal individuals diagnosed with borderline personality disorder (BPD). DBT is currently not only the most heavily relied upon method of treatment for individuals diagnosed with BPD, but has also proven to be effective in treating other mental health disorders such as depression, post-traumatic stress disorder (PTSD), eating disorders, anxiety, substance use disorder (SUD) and more. Dialectical behavior therapy focuses on providing therapeutic skills in the following four modules:

  • Mindfulness: the practice of being wholly aware in the present moment
  • Distress Tolerance: learning strategies to tolerate pain in difficult situations instead of trying to change and/ or avoid it
  • Interpersonal effectiveness: focuses on skills that enable an individual the ability to communicate with others in a way that is assertive, maintains self-respect and simultaneously strengthens his or her relationships
  • Emotion regulation: learning how techniques to shift and change unwanted emotions

DBT is comprised of two therapeutic formats: individual psychotherapy sessions and DBT skills group sessions. Individual therapy sessions provide one-on-one therapeutic attention to provide customized treatment and focus in the nuanced mental health needs of the individual. They are also a place for individuals to further process and practice implementing the skills learned during the DBT skill group sessions. Individual therapy sessions are often held once a week for the duration of the DBT program. A trained mental health provider holds the DBT skills group sessions once a week. The leader teaches the DBT skills, facilities group exercises and assigns homework to be completed outside of the group sessions. Participants are often encouraged to share their experiences and provide mutual support to the other group members. The DBT skills group sessions offer participants the ability to learn and practice new skills alongside other individuals that are working on similar issues.

Can DBT Treat Dissociative Identity Disorder?

Every individual is different and will respond distinctly to the variety of mental health treatment options available. The first step in securing mental health treatment is to be properly diagnosed by a qualified mental health provider. It is imperative to obtain an accurate diagnosis when it comes to mental health illnesses, as one’s diagnosis greatly informs his or her methods for treatment. An individual diagnosed with DID should seek immediate mental health treatment to assist in managing its symptoms. Many individuals will require tailored treatment plans that incorporate a variety of therapeutic modalities when it comes to DID. This helps to ensure all nuanced mental health needs of the individual are fully addressed. For example, it is not uncommon for an individual with DID to experience the feeling of becoming suddenly detached from his or her body, speech and/ or actions. 

Research has noted that the distress tolerance and emotion regulation skills can reduce impulsive behaviors that occur from DID. Additionally, due to the fact that suicidal ideation and self-harming behaviors are so widely spread in the DID population, often certain components of dialectical behavior therapy are frequently integrated into treatment plans that are developed by a mental health clinician working with an individual diagnosed with DID. However, traditional DBT focuses on treating the whole person as a single individual and does not recognize nor acknowledge the presence of dissociative identities. Although this aspect of DBT can be harmful to one’s treatment process, the ultimate goal of DBT is to shift negative thinking patterns and destructive behaviors into positive outcomes.

DBT And Asperger’s Patients

Asperger’s syndrome is a developmental disorder that affects an individual’s ability to effectively socialize and communicate with others. According to the Mayo Clinic, Asperger’s syndrome is a condition that is on the autism spectrum, leaning towards the higher functioning end (mild end) of the spectrum. Asperger’s syndrome was previously listed as a stand alone disorder in earlier publications of the Diagnostic and Statistical Manual of Mental Disorders, but is currently listed in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) under the umbrella diagnosis known as “autism spectrum disorder.” There are a variety of treatment options available to individuals struggling with Asperger’s syndrome, many of which involve fostering improved behavior, social and communication skills. Depending on the specific needs of the individual, medications, speech therapy, occupational therapy and more may be integrated into his or her treatment plan. 

Dialectical Behavior Therapy

Psychologist Marsha M. Linehan developed dialectical Behavior Therapy (DBT) in the late 1980s. It was originally developed to help treat individuals diagnosed with borderline personality disorder (BPD) experiencing pervasive suicidal thoughts and/ or attempts. DBT is a specialized form of cognitive behavioral therapy (CBT) that places great emphasis on the psychosocial aspects of treatment. DBT continues to be considered the primary and most effective form of treatment for individuals diagnosed with BPD. Furthermore, continued research on its applicability in the treatment of other mental health ailments has indicated that it has become increasingly effective in treating mental health illnesses such as eating disorders, post-traumatic stress disorder (PTSD), substance use disorder (SUD), anxiety, depression, and more. 

Dialectical behavior therapy is comprised of two main components: individual therapy sessions and DBT skills group sessions. The individual therapy component consists of one-on-one contact with a mental health practitioner to ensure all therapeutic needs are being addressed and met. One-on-one therapy provides an individual in treatment with a consistent outlet to discuss obstacles that may manifest throughout the duration of the program, as well as a safe emotional environment to begin to practice implementing the skills learned in the DBT skills group sessions. Individual therapy can provide insight into areas that may need to be further addressed, shed light on therapeutic successes, and help to motivate the individual to remain committed to the DBT process. Individual therapy sessions are often held once a week for the duration of the DBT program.

DBT skills group sessions are intended to enhance a participant’s capabilities by teaching useful and applicable behavioral skills. The Linehan Institute asserts the four primary areas of therapeutic skills that are focused on in DBT include:

  1. Mindfulness: focuses on the practice of being fully aware and completely present in the moment
  2. Distress Tolerance: focuses on learning techniques to effectively tolerate pain that arises in difficult situations, instead of attempting to avoid and/ or change it
  3. Interpersonal Effectiveness: focuses on utilizing assertive communication methods that allows the individual to effectively express his or her wants, while simultaneously maintaining self-respect and strengthening relationships
  4. Emotion Regulation: focuses on learning strategies to change unwanted emotions

In the DBT skills group sessions, participants are taught the DBT skills by a qualified mental health professional. The leader will facilitate relevant exercises during the group sessions, as well as assign homework to be completed outside of the group sessions. Participants are encouraged to share their experiences during the group sessions as well as provide feedback and support to their peers. The DBT skills group sessions typically last between two to two and a half hours long, and are held once a week for the twenty-four week program. Mastering each of these skills can be invaluable to an individual diagnosed with Asperger’s syndrome. 

Asperger’s Syndrome and DBT

Every individual is different and will have a unique set of needs when it comes to the treatment of a mental health condition. Many mental health practitioners develop tailored treatment plans that cater to the nuanced needs of the individual. The development of DBT was intended to assist individuals diagnosed with BPD in managing emotional challenges and social difficulties. Traits such as emotional dysregulation and social struggles are noted as common side effects of both Asperger’s syndrome and borderline personality disorder. Increased tendencies towards suicidal ideation and/ or self-harm thoughts and/ or behaviors are also common side effects of both BPD as well as Asperger’s syndrome. With these overlaps, and the fact that DBT was specifically developed to address these issues, it often serves as an effective treatment method for individuals with Asperger’s syndrome.

Using DBT For Binge Eating Disorder

woman getting help for OCD

Binge eating disorder (BED) is listed in the Diagnostic and Statistical Manual for Mental Disorders, Fifth Edition (DSM-5) as a severe, life-threatening eating disorder. According to National Eating Disorder Association (NEDA), it is characterized by “recurrent episodes of eating large quantities of food (often very quickly and to the point of discomfort); a feeling of a loss of control during the binge; experiencing shame, distress or guilt afterwards and not regularly using unhealthy compensatory measures (e.g., purging) to counter the binge eating.” Binge eating disorder is currently known to be the most common eating disorder in the United States. 

How Is It Diagnosed?

According to the DSM-5, in order to be diagnosed with binge eating disorder, an individual must meet the following diagnostic criteria for BED:

  • Recurrent episodes of binge eating, as characterized by both:
    • Eating discretely (within any two hour period) an amount of food that exceeds what most people would eat in the same amount of time under similar circumstances
    • Experience a lack of control over eating during the episode (i.e. feeling unable to stop eating and/ or an inability to control the amount of food one consumes)
  • Binge eating episodes are associated with three or more of the following:
    • Eating until feeling uncomfortably full
    • Eating faster than normal
    • Eating excessive amounts of food when not physically hungry
    • Eating alone due to embarrassment of the quantity of food being consumed
    • Feelings of disgust, guilt, depression after an episode
  • Binge eating episodes occur (on average) at least once a week for a minimum of three months
  • The binge eating episodes are not associated with the recurrent use of inappropriate compensatory behaviors (i.e. purging, abuse of diuretics, excessive exercise, etc.)

Obtaining an accurate mental health diagnosis is imperative to one’s treatment process. Specifically as it relates to binge eating disorder, it is important to note, that BED is a relatively new type of eating disorder recognized in the DSM-5. Due to its new status, without a proper DSM diagnosis, some insurance companies may not provide coverage for its treatment. 

Treatment and DBT

Every individual is different and will require a customized treatment plan when it comes to struggling with binge eating disorder. Many individuals struggling with binge eating disorder are likely to have dialectical behavior therapy (DBT) incorporated into their treatment plan. Although DBT was originally developed to help better treat individuals diagnosed with borderline personality disorder (BPD), it has since become increasing effective for the treatment of additional mental health illnesses such as depression, anxiety, post-traumatic stress disorder (PTSD), substance use disorder, and eating disorders, including BED. More specifically, DBT helps individuals establish coping mechanisms to reduce anxiety in situations and environments that elicit the stress response associated with food. 

Dialectical behavior therapy is comprised of individual psychotherapy sessions and DBT skills group sessions. Each component is essential to the efficacy of DBT. The individual therapy sessions provide the individual in treatment for binge eating disorder the ability co create behavioral plans and goals surrounding mindful eating with his or her mental health clinician. One-on-one therapy sessions are also used to help empower the formation of a positive self-identity, which helps to foster acceptance, an increased sense of self-worth, and self-compassion. They are also a space to process the information learned in the DBT skills group sessions, address any challenges that arose from the previous week and reinforce the practice of implementing the DBT skills learned. 

The DBT skills group sessions are conducted by a qualified mental health professional and he or she teaches therapeutic skills in direct relation to the following four main areas, as described by the Linehan Institute:

  1. Mindfulness: the practice of being wholly aware and present in the given moment
  2. Distress Tolerance: skills to learn how to tolerate pain in difficult situations instead of attempting to change or avoid it
  3. Interpersonal Effectiveness: techniques that enable an individual to communicate with others in an assertive manner, while simultaneously maintaining self-respect and strengthening relationships
  4. Emotional Regulation: learning effective methods to adjust, shift, and/ or change unwanted emotions

After each DBT skills group session the facilitator will assign homework to encourage the participants to continue practicing the skills taught in the session. Participants are encouraged to share their experiences during the group sessions and provide supportive feedback to the peers in the group. Both one-on-one therapy sessions and DBT skills group sessions are usually held once a week and the entire program generally takes twenty-four weeks to complete.

Tips for Finding a Therapist In Los Angeles

Los Angeles Skyline

While seeking professional help for mental health ailments was once greatly stigmatized in America, society has come a long way in its understanding of mental illness. Nowadays, not only has treatment for mental health issues become mainstream but also seeing a therapist seems to be the norm rather than the exception in the United States. There are a plethora of recognized mental health illnesses that are currently listed in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). As the list of mental health illnesses increased so too have the therapeutic modalities. There are countless mental health professionals in America with a wide variety of specialties. Hence, the idea of beginning the search for a therapist in Los Angeles can seem like an incredibly overwhelming feat, even with the set geographic limitation. Below are some helpful considerations that may make the process a bit easier. 

  • Ask for referrals: delve into your network of trusted friends and family for referrals. Even in situations where the therapist you are referred to is unable to take you on as a client, he or she will likely be able to provide you with professional alternatives.
  • Accreditations: note the accreditations of the mental health provider you are considering. While many mental healthcare workers are required to hold degrees in higher education, they are also obliged to pass certain certification tests and many hold relevant mental health accreditations. Certifications are earned through programs or service that may be based within or associated with a healthcare organization. An individual must earn a passing score on the National Clinical Mental Health Counseling Examination (NCMHCE) to become certified in mental health. Accreditations can be earned by an entire health care organization (i.e. hospitals, nursing homes, etc.). Both certification and accreditation require an evaluation by The Joint Commission.
  • Be aware of the different therapeutic modalities offered: According to Psychology Today, there are over sixty-five different types of therapeutic modalities currently offered in the mental health field. Most mental health professionals will incorporate a variety of different therapy methods into their treatment plans. Some of types of therapy listed by Psychology Today include the following:
    • Cognitive Behavioral Therapy (CBT)
    • Emotionally Focused Therapy
    • Experiential Therapy
    • Dialectical Behavior Therapy (DBT)
    • Integrative Therapy
    • Psychodynamic Therapy
  • Plan an initial meeting with several therapists: although it may seem time consuming, planning on and meeting with more than one therapist can help you make an informed decision. Sometimes it takes sitting with someone to really understand if they resonate with you. If you have several first therapy sessions lined up with different clinicians, you can give yourself the chance to experience different styles and delineate which feels like the best fit. It can also help to alleviate any undue pressure you may inadvertently put on a first therapy session when you feel you only have one option. 
  • Know your out-of-pocket cost: every mental health provider will charge a fee for his or her services. Some will accept insurance, and some will not. Insurance companies are different, as are their respective tiered insurance plans they offer to members. Insurance companies are required to provide full or partial coverage when it comes to the treatment of mental health conditions; however, the exact amount is variable. Some insurance plans provide extensive in-network and out-of-network mental health coverage with little to no out-of-pocket cost to members, while others may only offer specified coverage for services rendered by in-network providers only. Depending on the health insurance plan, there may be a cap placed on the amount of money a plan will cover and/ or the frequency of sessions allotted for the treatment of mental health illness. It is essential to know how much therapy your insurance plan will cover, both cost and frequency.  

 

Each individual is different and as such will likely require a tailored treatment plan when it comes to treatment for mental health disorders. As unique as each individual is, so too are mental health therapists. Every mental health clinician will have his or her own method for developing treatment plans for his or her patients, hold different certifications, as well as rely on a distinctive subset of therapeutic modalities. When searching for a therapist it is imperative have patience and bear in mind that not all therapists will be a perfect fit immediately. Furthermore, in order for therapy to yield the most successful results, an individual must feel comfortable with his or her therapist. If a therapist does not feel like a good fit, make an appointment with another one.

How Long Does a DBT Program Last?

woman getting help for OCD

In the late 1980, Marsha M. Linehan developed Dialectical Behavior Therapy (DBT) as a therapeutic method to better treat individuals diagnosed with borderline personality disorder (BPD), suffering from pervasive suicidal thoughts and/ or attempts. It is currently recognized as an effective therapeutic method for treatment in a wide range of other mental health disorders, such as depression, anxiety, post-traumatic stress disorder (PTSD), substance use disorder (SUD), eating disorders, and more. The philosophical perspective of dialectics, balancing opposites, influences the DBT process. A mental health clinician offering DBT services works with an individual to identify ways to hold two seemingly opposite perspectives simultaneously. This, in turn, promotes balance and minimizes the tendencies to think in absolutes (i.e. viewing all in black and white, all-or-nothing style of thinking, etc.…). DBT encourages an inclusive worldview and perspective (both- and) instead of an exclusive (either- or) outlook on life. DBT is a specific type of cognitive-behavioral therapy (CBT) that greatly emphasizes the psychosocial aspects of treatment.

DBT Overview

The DBT process is comprised of group therapy, also known as DBT skills group sessions, and individual psychotherapy sessions. One-on-one therapy sessions are a helpful component of the DBT process as they can provide the individual in treatment with the opportunity to focus on his or her nuanced challenges. Individual therapy sessions can provide a forum to go over any confusion regarding DBT skills as well as process and improve problem-solving behaviors. The two types of structured sessions are held in conjunction with on another and compliment the different areas of focus, respectively. Though the general idea is for the individual in treatment is to attend the DBT skills group session and have a one-on-one therapy session weekly, the exact number of weekly sessions can be adjusted based in the specific needs of the individual. 

DBT Skills

The DBT skills group session make up an imperative component to the overall DBT program. DBT skills group sessions are focused on enhancing the capabilities of each participant by teaching behavioral skills. These group sessions offer participants an emotionally safe environment to practice implementing the DBT skills alongside others working on the same thing. Group members are encouraged to share their experiences and provide mutual support. DBT skills group sessions are usually held on a weekly basis and are conducted by a qualified mental health practitioner. DBT focuses on providing therapeutic skills in four areas that make up the pillars of DBT, which include the following:

  1. Mindfulness: the practice of being fully aware and wholly present in the current moment
  2. Distress Tolerance: learning tools and techniques to effectively tolerate pain that may arise from difficult situations, instead of attempting to avoid and/ or change it
  3. Interpersonal Effectiveness: learning assertive communication methods that enable an individual to engage with others in a way that maintains self-respect and simultaneously strengthens relationships
  4. Emotion Regulation: explores strategies that aid in changing unwanted emotions, by way of managing and/ or shifting the intense emotions that may be causing problems in one’s life

In DBT skills group session the clinician running the session will follow the lessons provided in the DBT curriculum, teach the skills and facilitate activities to allow the participants to practice using the DBT skills learned. After each DBT skills group session the clinician will assign homework to help practice and reinforce the information taught during the session. It is also important to note that the DBT skills extend beyond the individuals in treatment. In fact, an integral part of DBT is the assumption that effective treatment places equal emphasis on the behavior and experience of the mental health clinicians working with the individuals in treatment as it does on the experience and behaviors of the individuals in treatment. Hence, it is common practice for mental health providers offering DBT to integrate and regularly practice the DBT skills into their daily lives. 

Duration

The full DBT skills curriculum is intended to take twenty-four weeks long to complete. According to the Linehan Institute, this curriculum is often repeated to create a one-year long program. Shorter options that teach only a subset of the DBT skills have also been developed and are used in particular populations and settings. Although these timeframes are usually adhered to, the exact timeframe of a particular DBT program will depend on the specific needs of its participants, as the program may conclude in less time than the scheduled twenty-four weeks, or extend beyond, lasting longer than the twenty-four week period. 

Is DBT Effective In Treating Anxiety?

Psychologist Marsha M. Linehan developed dialectical Behavior Therapy (DBT) in the late 1980s. It was initially intended to help better treat chronically suicidal individuals diagnosed with borderline personality disorder (BPD). It is a specific type of cognitive-behavioral therapy (CBT) that prioritizes the psychosocial aspects of treatment. Since its development, DBT has proven to be an effective treatment method for other kinds of mental health disorders, such as substance use disorder (SUD), depression, post-traumatic stress disorder (PTSD), anxiety, eating disorders, and more. DBT works by providing individuals with new skills to manage painful emotions and reduce relationship conflicts. When regularly applied, the DBT skills can help an individual improve his or her ability to regulate emotions, learn to better tolerate distress and negative emotions, remain mindful and present in the moment, and learn to communicate and interact more effectively with others. 

Anxiety

While it is normal for an individual to experience bouts of anxiety at various time throughout his or her life, if the worry becomes debilitating it may be indicative of a clinical mental health disorder. Anxiety is listed in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), as Generalized Anxiety Disorder (GAD). According to the Anxiety and Depression Association of America (AADA), in order to be clinically diagnosed with GAD an individual must experience severe difficulty controlling his or her worry on more days than not for at least six months and present with at least three or more of following signs and symptoms:

  • Nervousness
  • Edginess 
  • Irritability
  • Having a sense of impending danger, panic and/ or doom
  • Increased heart rate
  • Difficulty sleeping (due to trouble falling asleep and/ or staying asleep, restlessness at night, and/ or unsatisfying sleep)
  • Hyperventilation (breathing rapidly)
  • Excessive sweating
  • Trembling
  • Feeling weak and/ or tired
  • Impaired concentration and/ or feeling as though the mind goes blank
  • Increased muscle aches and/ or soreness
  • Gastrointestinal (GI) problems (i.e. nausea, diarrhea, vomiting…etc.)

The above criteria differentiate GAD from normal bouts of anxiety and/ or worry that may manifest from a specific set of stressors or for a more limited period of time. An individual that struggles with GAD will likely experience a large percentage of his or her waking hours excessively worrying about something, even when there is no specific threat present. Reports have noted that GAD affects nearly 6.8 million adults, which makes up over 3% of the population in America.

DBT Overview

DBT is comprised of individual therapy sessions and DBT skills group sessions. One-on-one therapy sessions allow the providing mental health clinician the ability to focus on the nuanced mental health needs of the individual in treatment. The individual therapy sessions are also a place for the individual to process any challenges that may arise during the week and practice applying and integrating the DBT skills learned into his or her daily life. A qualified mental health clinician conducts the DBT skills group sessions. DBT focuses on providing therapeutic skills in four fundamental areas, which include the following (as provided by the Linehan Institute):

  1. Mindfulness: focuses on improving an individual’s ability to accept and be present in the current moment
  2. Distress Tolerance: focuses on increasing an individual’s ability to tolerate pain that may arise from difficult situations, as opposed to trying to change and/ or escape it
  3. Interpersonal Effectiveness: focuses on teaching techniques that enable a person to communicate with others in a way that is assertive, maintains self-respect, and simultaneously strengthens relationships
  4. Emotion Regulation: focuses on methods to successfully change unwanted emotions

The participants of the group are encouraged to share their experience and provide mutual support. After each DBT skills group session the facilitator will assign homework to reinforce actively practicing the material taught in the session. The DBT skills group sessions are typically held on a weekly basis and meet for around six months, though the timeframe can vary depending on the specific needs of the group members. The individual therapy sessions are often held once a week in conjunction with the DBT skills group sessions, though frequency of one-on-one sessions can be increased or reduced based on the individual’s needs. Every individual is different and when in treatment for a mental health illness, such as anxiety, will likely respond best to a tailored treatment plan. DBT offers both the ability to provide customized therapeutic support through the individual therapy sessions, as well as peer support though the DBT skills group sessions.  Depending on the individual’s specific needs, DBT may be a suitable treatment option for an individual struggling with anxiety.

Who Invented DBT?

Dialectical Behavior Therapy, DBT, is a type of cognitive-behavioral psychotherapy. DBT was originally developed to help better treat individuals with suicidal behaviors and borderline personality disorder (BPD). DBT is a modification of standard cognitive behavioral therapy (CBT). DBT utilizes a cognitive-behavioral approach while placing greater emphasis on the psychosocial aspects of treatment. A psychologist named, Marsha M. Linehan, developed DBT in the late 1980s after the result of her own transformation that occurred in 1967, according to Psych Central. Interestingly, at the time of its development, Linehan was a suicide researcher, with negligible knowledge of borderline personality disorder. Although DBT was initially developed as a means to be used primarily in the treatment of individuals with BPD, it is now recognized as an effective treatment method for individuals diagnosed with a variety of mental health illnesses, particularly those that involve serious emotion dysregulation such as depression, eating disorders, post traumatic stress disorder (PTSD), substance use disorder (SUD), and more. Furthermore, DBT has been evaluated and found to be effective among individuals from diverse backgrounds.

Marsha M. Linehan

Marsha M. Linehan is a pioneer in the treatment of mental health ailments, with extensive notoriety. She retired from serving as a Professor Emeritus of Psychology in the Department of Psychology at the University of Washington in 2019. She served as president of both the Association for the Advancement of Behavior Therapy and the Society of Clinical Psychology, Division 12, American Psychology Association. Linehan was also a fellow of the American Psychological Association and the American Psychopathological Association and was a diplomat of the American Board of Behavioral Psychology. Linehan has written the following four books, including two manuals:

  • Cognitive-Behavioral Treatment for Borderline Personality Disorder 
  • Skills Training Manual for Treating Borderline Personality Disorder
  • DBT Skills Training
  • Building a Life Worth Living: A Memoir

Additionally, Linehan has published extensively in scientific journals, as well as served on a plethora of editorial boards. Some of the many awards Linehan received recognizing her clinical and research contributions to the study and treatment of suicidal behaviors include the following:

  • The Distinguished Research in Suicide Award (American Foundation of Suicide Prevention
  • The Louis I. Dublin Award for Lifetime Achievement in the Field of Suicide
  • The creation of the Marsha Linehan Award for Outstanding Research in the Treatment of Suicidal Behavior established by the American Association of Suicidology
  • The Distinguished Scientist Award from the Society for a Science of Clinical Psychology

She is the co-founder of DBT-Linehan Board of Certification (DBT-LBC), which is an organization that identifies providers and programs that offer reliable DBT services, which conform to the evidence-based research for treatment. Linehan is the founder of Behavioral Tech LLC, which is an origination that provides DBT training to mental health professionals and healthcare systems. 

DBT Basics

Dialectical behavior therapy is comprised of one-on-one psychotherapeutic sessions and DBT skills group training sessions. The individual therapy sessions are used to assure the individual in treatment can focus on all of his or her nuanced mental health needs, as well as to provide support and encouragement to integrate the skills learned in group sessions into his or her daily life. One-on-one therapy sessions emphasize problem-solving behaviors, and provide the individual with an emotionally safe environment to process and address any problems that arise in the individual’s life. The DBT skills group sessions are conducted by a qualified mental health professional that teaches the DBT skills as well as provides relevant exercises for participants to practice the skills learned. DBT specifically focuses on providing therapeutic skills in the following four key areas, as provided by the Linehan Institute:

  1. Mindfulness: integrating the practice of being fully aware and present in the moment
  2. Distress Tolerance: learning how to tolerate pain in difficult situation instead of attempting to change it
  3. Interpersonal Effectiveness: learning how to advocate for and assert one’s wants, including the ability to say no, while simultaneously maintaining self-respect and relationships with others
  4. Emotion regulation: learning how to change unwanted emotions. 

DBT skills group sessions generally last about two hours, and are often held on a weekly basis. After each DBT skills group session the facilitator will assign homework to the participants to help reinforce the information taught during the session. The combination of one-on-one therapy sessions and the DBT skills group sessions help an individual in treatment learn, apply and master the DBT skills. DBT usually lasts about six months long, though depending on the needs of the participants the process can last a shorter or longer length of time. 

Is DBT Covered By Insurance?

Dialectical Behavioral Therapy (DBT) is a combination of behavioral and cognitive therapies. The main goal of DBT is to transform negative thought patterns and destructive behaviors into positive outcomes. Although DBT was originally developed to treat individuals diagnosed with borderline personality disorder (BPD), it is now often used to treat individuals with suicidal ideations and/ or other self-destructive behaviors as well as other mental health conditions such as depression, post-traumatic stress disorder (PTSD), substance use disorder (SUD), and more. Additionally, it is highly common to integrate DBT into a treatment plan for an individual struggling with an eating disorder. Research has found that DBT has been shown to help with emotional regulation, building self-management skills, reducing anxiety, lowering stress and learning to effectively control destructive eating behaviors.  

How DBT Works

DBT treatment is generally a combination of individual therapy sessions and DBT skills group sessions. An individual will engage in one-on-one psychotherapeutic sessions with a trained therapist to address all the individual’s nuanced mental health needs, as well as help to encourage the individual to remain motivated to address obstacles that arise throughout the course of treatment, and apply the DBT skills learned in group sessions to his or her daily life. The DBT skills group sessions provide a forum and an emotionally safe environment for participants to learn and practice the DBT skills with other individuals going through the same experience. In the DBT skills group sessions a trained therapist introduces and teaches the DBT skills to the participants as well as facilitates relevant therapeutic exercises. Group members are assigned homework (i.e. practicing mindfulness exercises) to reinforce the lessons from the previous DBT skills session. Each DBT group skills session usually lasts about two hours, and the DBT skills group meetings are generally held once a week for about six months. 

The needs of the group members can increase or decrease the duration, greater or shorter than six months, of the DBT group skills sessions. Additionally, the format can change, as it will be tailored to the unique needs of the individual in treatment. For example, depending on the individual, some may benefit from the one-on-one therapy sessions without attending the weekly DBT skills group sessions, while others may benefit from participating in the weekly DBT skills group sessions without attending a regularly scheduled one-on-one therapy session. 

A fundamental component of DBT is the assumption that effective treatment, which includes the group skills training sessions, must place equal focus on the behavior and experience of the mental health provider working with the individual in treatment as it does to the behaviors and experiences of the individual in treatment. Hence, most mental health clinicians that offer DBT often practice the skills themselves. This helps the mental health clinician providing DBT reinforce his or her knowledge of basic behavior techniques as well as remain current with all DBT treatment strategies.

Insurance Coverage

At one point in time, the need for mental health treatment was stigmatized and health insurance companies did not prioritize this component of healthcare coverage. Fortunately, this has shifted as many mental health ailments are recognized as potentially equally debilitating as other physical health ailments (i.e. diabetes, physical disabilities…etc.) and are included in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). While the details of mental health coverage will vary and the out-of-pocket responsibility will depend on the specific type of health insurance coverage, all health insurance companies are required to provide partial or full coverage for mental health treatment, including DBT carried out by a registered, certified mental health clinician. 

It is important to note that in America, there are a plethora of different types of healthcare insurance coverage options, including the array of health insurance companies and the variety of tiered health insurance coverage plans offered by each company. The health insurance premiums can range from $30 a month to over $1,900 a month depending on the insurance company selected and type of plan selected. Some plans will offer coverage only for services rendered by in-network providers, while others may offer full or partial coverage for services provided by out-of-network providers. The out-of-pocket responsibility will be wholly dependent upon one’s elected health insurance plan. In order to avoid any surprise healthcare bills it is essential to fully understand the intricacies of one’s health insurance plan. Make sure to call customer support on the backside of the health insurance card and inquire about coverage, out-of-pocket responsibility and/ or the need for any referrals and/or preauthorization requirements.