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 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.