Cognitive behavioral therapy (CBT) and dialectical behavior therapy (DBT) are two types of psychotherapy (“talk therapy”) that are commonly used in the treatment of a variety of mental health ailments. Through both CBT and DBT an individual will work with a mental health professional to learn how to process, cope with, and integrate challenging experiences as well as teach applicable coping mechanisms, and helpful skills to enable an individual to effectively manage future challenges when they arise. While not the primary focus of either, both CBT and DBT can delve into one’s past to help provide a clearer understanding of how certain situations may have influenced and had an impact on an individual’s current circumstance. Dialectical behavior therapy is actually a specific form of cognitive behavioral therapy that emphasizes the psychosocial aspect of treatment. In order to be able to truly understand how CBT and DBT differ, it is helpful to glean an understanding of each form of therapy, respectfully. 

Cognitive-Behavioral Therapy

Cognitive-behavioral therapy is a structured, short-term, goal-oriented therapy that is focused on the present. In CBT, a therapist will encourage his or her client to discuss his or her troubling thoughts and/ or feelings. Cognitive behavioral therapy typically focuses on specific problems and utilizes a goal-oriented approach. The steps of CBT include, as provided by Psychology Today, the following:

1. Identify troubling situations and/ or conditions in your life (i.e. divorce, a medical condition, anger, grief, etc.). 
2. Become aware of your emotions, thoughts, and beliefs connected to these troubling situations.
3. Identify inaccurate and/ or negative thinking that may be contributing to your troubles.
4. Reshape inaccurate and/ or negative thinking. In order to help facilitate this step, a therapist may encourage you to ask yourself if your view of the situation is based off of an inaccurate perception of the situation or off of facts. 

Cognitive behavioral therapy is based on the notion that thoughts and behaviors influence feelings; therefore shifting the way one thinks and reacts to situations can subsequently improve one’s emotional demeanor. Depending on the needs of the individual, the number of CBT sessions range from five to twenty sessions. 

Dialectical Behavior Therapy

Dialectical behavior therapy was originally developed to treat chronically suicidal individuals diagnosed with borderline personality disorder (BPD). DBT employs many of the same components of CBT, but places greater emphasis on the social and emotional aspects. DBT relies heavily on mindfulness skills originating from Zen and Buddhist practices. Dialectical behavior therapy consists of four primary behavioral skill modules, which include: core mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness. DBT includes individual therapy sessions, group skills training sessions, and phone crisis coaching between sessions (if needed). Through DBT clients learn to rely on specific mindfulness techniques that enable them to live with pain in the world and accept the way things are in any given moment instead of having to endure the suffering that comes when trying to change them. 

Primary Difference

The fundamental difference between CBT and DBT is that CBT focuses on how thoughts, feelings and behavior influence one another, while DBT places primary emphasis on mindfulness practices, emotional regulation and learning to accept pain. DBT helps individuals learn to experience and accept the pain that is inevitably experienced in life, without trying to change it. CBT seeks to provide individuals with the ability to identify damaging thoughts, and teaches an individual how to redirect those thoughts.

Borderline personality disorder (BPD) is listed in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) as a mental disorder. As defined by the National Institute of Mental Health (NIH), borderline personality disorder is an illness characterized by an ongoing pattern of varying moods, behavior, and self-image. The combination of these symptoms often results in difficulty maintaining relationships. It is highly common for an individual diagnosed with borderline personality disorder to have a deep-seated fear of abandonment making it difficult to tolerate being alone. This paired with intense, sometimes irrational, expressions of emotional instability often push others away making it exceeding difficult for an individual with borderline personality disorder to foster and maintain meaningful, lasting relationships. The scientific reason as to why an individual develops borderline personality disorder remains unknown. The onset of BPD typically occurs in early adulthood. The symptoms of borderline personality disorder are usually worse in young adults, and although the condition may gradually improve with age, BPD is a lifelong condition. 

Treatment

The first step in the treatment process is to obtain an accurate diagnosis from a qualified mental healthcare provider. Borderline personality disorder is notoriously known as an illness that is exceedingly difficult to diagnose. However, a thorough psychological evaluation can provide the most detailed diagnosis, which in turn will greatly inform treatment recommendations. The treatment plan for a person diagnosed with BPD will be a unique to the individual. In order to accommodate all the needs of an individual diagnosed with borderline personality disorder, a treatment plan could include and/ or emphasize any combination of the following options: 

• Individual psychotherapy, also known as “talk therapy,” some of which can include any of the following:
  • Dialectical behavior therapy (DBT): is a form of cognitive behavior therapy (CBT) that focuses on how one’s thoughts and beliefs can lead to actions and behaviors. This skills-based approach teaches how to manage emotions, tolerate distress and improve relationships though group and individual therapy sessions. 
  • Schema-focused therapy: incorporates aspects of CBT and psychoanalytic theories. It helps to identify unmet needs that have led to unhealthy ways of thinking about the world. Conducted in an individual setting or group setting, schema-focused therapy challenges maladaptive beliefs and behaviors and focuses on promoting positive life patterns. 
  • Mentalization-based therapy (MBT): emphasizes thinking before reacting. This is accomplished through helping an individual identify his or her own thoughts and feelings and creating an alternate perspective on the situation.
  • Transference-focused psychotherapy (TFP): helps an individual understand and process his or her emotions and interpersonal difficulties through the developing relationship between the individual and his or her therapist. 

• Encouraging healthy and frequent self-care practices
  • Eating nutritiously
  • Establishing good sleep habits 
  • Regular exercise
  • Remaining hydrated
  • Practicing calming techniques (i.e. meditation, yoga, journaling, etc.)

• Medication: The Food and Drug Administration (FDA) has yet to approve a medication specifically designed to treat borderline personality disorder. There are, however, certain medications that can help to alleviate and/ or reduce some of the symptoms arising from BPD or co-occurring disorders (i.e. depression, anxiety, etc.). Common examples of types of medication prescribed as a component of one’s BPD treatment plan include: 
  • Antidepressants
    • Celexa (citalopram)
    • Prozac (fluoxetine)
  • Anticonvulsants/ mood stabilizers 
    • Topamax (topiramate)
    • Lamictal (lamotrigine)
  • Anti-anxiety medications/ anxiolytics
    • Lexapro (escitalopram)
    • Zoloft (sertraline)
  • Antipsychotics
    • Rexulti (brexpiprazole)

Customized treatment plans that comprise of a variety of different therapeutic modalities, and are used when treating borderline personality disorder, so as to ensure that the individual’s nuanced needs are appropriately addressed. Every person is different and each will require a distinct combination of the various treatment options when it comes to learning effective coping mechanisms and implementing emotional regulation techniques needed to effectively manage borderline personality disorder, long-term.

The National Institute of Mental Health (NIH) defines eating disorders as “serious medical illnesses marked by severe disturbances to a person’s eating behavior.” Though there are several different types of eating disorders included in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), the three most commonly diagnosed types include anorexia nervosa, bulimia nervosa, and binge eating disorder. According to the Mayo Clinic, anorexia nervosa is characterized by abnormally low body weight, an intense fear of gaining weight and a distorted perception of weight. Johns Hopkins defines bulimia nervosa as uncontrolled episodes of overeating (binging) following by purging (i.e. vomiting, abusing laxatives, excessively exercising, etc.). The NIH characterizes binge eating disorder as repeated episodes of uncontrolled intake of exceedingly large amounts of food in a short period of time. While there is significant overlap, each type of eating disorder comes with its own set of signs and symptoms, short and long-term effects, and treatment methods. 

Causes and Risk Factors

There is no single, identifiable cause as to why someone develops an eating disorder. Research has, however, indicated certain biological, psychological, interpersonal and social risk factors that have been noted to increase one’s susceptibility for developing an eating disorder, which can include the following, as provided by the National Eating Disorders Association (NEDA):

• Biological risk factors: 
  • Scientists continue to research the biochemical and biological causes of eating disorders
  • In some individuals with eating disorders “certain chemicals in the brain that control hunger, appetite and digestion have been found to be unbalanced” 
  • Eating disorders tend to run in families indicating a significant genetic contribution to eating disorders
• Psychological risk factors
  • Feelings of inadequacy
  • Low self-esteem
  • Ineffective coping strategies
  • Depression
  • Anxiety
  • Impulsive behaviors
  • Anger 
• Interpersonal risk factors
  • Overly concerned with other’s opinions
  • Excessively competitive
  • Troubled personal relationships
  • Difficulty expressing emotions
  • History of sexual and/ or physical abuse
  • History of being ridiculed and/ or teased based on size and/ or weight
• Social risk factors
  • Pressure to achieve and succeed 
  • Valuing individuals based solely on their physical appearance
  • Stress related to ethnic, racial, size/ weight-related or other forms of discrimination or prejudice
  • Cultural emphasis placed on thinness as an inextricable part of beauty
  • Media and pop culture’s unrealistic portrayal of people’s bodies and shapes

Constantly engaging in weight loss and diets that involve severely restricting food intake to the point of continued hunger can contribute to the development of an eating disorder. This way of eating can not only cause adverse affects to one’s energy levels, but it can also impact one’s physical health as it prohibits one’s ability to extract and absorb the needed vitamins, minerals, and nutrients that are innately sourced from consuming food. 

Signs, Symptoms, and Treatment

Every person is different and will likely exhibit a somewhat unique set of signs and symptoms as they relate to the presence of an eating disorder. Furthermore, the type of eating disorder an individual struggles with will influence the signs and symptoms experienced. The Mayo Clinic provides a list of examples of behaviors that could be indicative of an eating disorder, some of which include the following: 

• Obsessively focusing on healthy eating
• Skipping meals 
• Withdrawing form social activities
• Making excuses for not eating
• Adhering to an overly restrictive diet 
• Preparing separate meals when eating in a group instead of eating what everyone else is eating
• Excessive exercise
• Constantly checking the mirror and/ or pointing out perceived flaws
• Using laxatives, herbal weight loss products, and/ or dietary supplements
• Regularly excusing oneself during meals to use the restroom
• Eating in secret
• Expressing disgust, shame, and/ or guilt about one’s eating habits

The severity and duration of symptoms will fully depend on the individual. There are a variety of treatment options available to an individual struggling with an eating disorder. If left untreated, continued malnutrition that occurs with an untreated eating disorder can lead to severe short and long-term consequences. Eating disorders are serious mental health illnesses and the sooner one obtains treatment the sooner he or she can begin the recovery process and go on to live a healthy and fulfilling life.

Marriage counseling is a type of psychotherapy that is used to help couples improve their relationship. Marriage counseling provides a couple with an emotionally safe environment to make thoughtful decisions surrounding the status of the relationship, whether or not both parties authentically wish to work towards rebuilding and strengthening the relationship or work towards separating amicably. Through marriage counseling, a mental health clinician works to help couples recognize and resolve conflicts by teaching and facilitating healthy methods of communication and conflict resolution tactics, whether they opt to remain together or not. The saying “you get out of it what you put into it” can be applied to many areas and situations encountered in one’s life, including marriage counseling. 

The Format

A licensed marriage and family therapist typically facilitates marriage counseling sessions. A commonly held credential for mental health clinicians that offer marriage counseling services is obtained through the American Association for Marriage and Family Therapy (AAMFT). While one partner may decide to work with a therapist separately, marriage counseling is usually conducted with both partners present. The specific treatment plan and areas of focus will be wholly dependent upon the unique needs of the couple. Marriage counseling is generally a relatively short-term process lasting between twelve to twenty sessions, and in some cases longer. Most marriage counseling sessions last approximately fifty minutes long. The time between sessions will depend both on the availability of the mental health provider as well as the wants and needs of the couple.  

What Specifically Can Marriage Counseling Help With?

The reasons why a couple decides to go to marriage counseling are wide-ranging. Psychology Today provide the following potential reasons why a couple may seek marriage counseling:

• Poor and/ or lack of communication
• Trust has been broken
• Feelings of unease in the relationship (i.e. being aware that something is wrong but being unable to pinpoint the issue) 
• Diminished emotional intimacy 
• Diminished sexual intimacy 
• Conflicts regarding child rearing and/ or blended families
• Infidelity 
• Consistently becoming dysfunctional during conflict (one or both members)
• Feeling stuck in unhealthy and/ or undesirable patterns
• Addressing and/ or sharing difficult to talk about information with the partner
• Processing situational circumstances that have devastated the relationship (i.e. loss of a child, prolonged unemployment, being diagnosed with a long-term illness, etc.)

Some couples attend marriage counseling as a means to gain better understanding of their partner. Aside from the above, there are many nuanced reasons why a couple may decide to go to marriage counseling. 

What To Expect?

The work that occurs during marriage counseling sessions is guided by the needs of the couple. By nature of participating in marriage counseling both partners engage in shared emotional experiences via the therapy sessions, which can help to foster aligned relationship goals. The work that occurs during marriage counseling can be emotionally charged, elicit difficult to face feelings and seem arduously trying. However, the skills, tools and emotional awareness that can come from actively participating in marriage counseling can be both empowering and insightful. The American Association for Marriage and Family Therapy (AAMFT) reported the findings of a study that indicate, “of couples who try marriage counseling, 90% feel that their emotional health improves, and two-thirds report improvements in their physical health.” The reason behind why a couple elects to participate in marriage counseling will affect its outcome and success.

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.

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.

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.