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Dialectical behavior therapy (DBT) is an evidence-based psychotherapy treatment that was originally developed by Marsha Linehan, in the late 1980s, to help treat individuals diagnosed with borderline personality disorder (BPD). Research has shown that since its inception it has become an effective form of treatment for individuals with other mental health disorders. The DBT approach is now frequently implemented in treatment plans for individuals (both adolescents and adults) struggling with any single or combination of the following ailments, as listed by the Child Mind Institute

  • Drugs and/ or alcohol abuse 
  • Substance use disorder
  • Anxiety/ generalized anxiety disorder (GAD)
  • Impulsive and/ or disruptive behaviors
  • Attention-deficit/ hyperactivity disorder (ADHD)
  • Frequent mood swings
  • Bipolar disorder
  • Self-injuring behaviors
  • Depression/ major depressive disorder (including treatment-resistant major depression and/ or chronic depression)
  • Suicidal behaviors
  • Poor coping skills
  • Anger outbursts
  • Eating disorder behaviors/ bulimia/ binge-eating disorder/ anorexia 
  • Family and/ or peer conflict
  • Post-traumatic stress disorder (PTSD)

DBT is based on the cognitive behavioral therapy (CBT) approach that relies on talk therapy and emphasizes the psychosocial aspects of treatment. Dialectical behavior therapy helps teach individuals healthy coping mechanisms and useful techniques for managing stress, regulating emotions, and improving relationships with others. 

Therapeutic Settings

Dialectical behavior therapy is conducted three therapeutic settings, which include individual therapy sessions, group skills therapy sessions, and coaching. Individual therapy sessions provide a client and his or her clinician the opportunity to co-create behavior plans that incorporate long and short-term goals as well as delve deeper into and process the client’s life journey while also learning skills to improve self-worth, establish self-compassion, acceptance and a positive self-identity. These sessions are empowering in teaching a client skills, many of which will serve them for the rest of their lives. Group therapy sessions provide clients to learn DBT skills and a safe environment to practice implementing skills learned in both group and individual therapy sessions. The structure of group therapy sessions enable an individual to learn important behavioral skills from peers as well as encourage new, healthy ways of interacting with others. Coaching is a component of DBT that provides the client access to his or her clinician between individual and group therapy sessions. An individual can call his or her clinician to receive support and guidance for coping with challenging in-the-moment situations.

DBT Skills Training

DBT utilizes four main strategies for teaching individuals skills that help with effectively changing their behaviors. They include the following: 

  1. Mindfulness: the practice of remaining present and fully in the moment at any given time
  2. Distress Tolerance: learning to tolerate pain in challenging situations, without changing it or escalating it
  3. Interpersonal Effectiveness: increasing one’s self-awareness through learning to effectively advocate for one’s own wants and/ or needs by saying no and/ or expressing one’s desires while maintaining self-respect and without feeling that relationships will be compromised 
  4. Emotion Regulation: learning how to shift and/ or change unwanted emotions

DBT helps individuals transform negative thoughts and behaviors into an understanding of one’s life journey and ultimately helps to establish mindfulness and self-compassions, which are beneficial and can be useful throughout one’s entire lifetime. 

DBT Adolescent Skills Groups

Adolescents, typically between the ages of twelve to nineteen years old, must attend group therapy sessions as a component of DBT.  Adolescent DBT group therapy generally extends to parents and/ or caregivers. By attending group sessions together, the adolescent and his or her support system can learn DBT skills together. In DBT group skills sessions, adolescents learn and practice implementing DBT skills used to help communication, regulate emotions, improve relationships, enhance moods, and practice effective problem solving skills. These group sessions are helpful for parents’ and/ or caregivers as the sessions allows them to learn effective methods of communication and gain an understanding for how to better empower their adolescent to employ the DBT skills to deal with problems and navigate challenges. 

DBT Adult Skills Groups

Much like the adolescent DBT skill groups, adult skills groups are an integral component of one’s DBT treatment. Adult skills groups are comprised of other individuals experiencing similar concerns. The skills addressed in the group sessions reflect the four main pillars of DBT (mindfulness, distress tolerance, interpersonal effectiveness, and emotion regulation). The associated skills are also worked on in a group setting. This provides a client the opportunity to implement the skills, tools, and coping mechanisms learned with peers in a safe and controlled environment. The work that occurs during the skills groups continues, as homework that corresponds to the DBT skills taught or visited during each DBT group session are regularly assigned. 

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