What Is A DBT Worksheet?

Dialectical behavior therapy (DBT) is a type of cognitive behavioral therapy (CBT) that places primary emphasis on the psychosocial aspect of therapy. Intended as a means to better treat chronically suicidal individuals and those diagnosed with borderline personality disorder (BPD), Marsha M. Linehan developed DBT in the late 1980s. The purpose of DBT is to teach individuals applicable skills that enable them to effectively manage painful emotions and decrease conflict in relationships. Dialectical Behavior Therapy is composed of four components that include:  weekly individual therapy sessions, weekly group skills classes, 24/7 skills coaching with the therapist and DBT Team Consult for the therapists.  Research shows that DBT has the best result if patients stay in treatment for a minimum of one year; our program asks that patients commit to an initial six months and then renew their commitment at the end of each six month period. 

Four DBT Modules

DBT group skills training sessions specifically focuses on providing distinct therapeutic skills in the following four key areas:

  • Mindfulness: the practice of being fully present and aware in the moment 
  • Distress tolerance: becoming tolerant of pain in difficult situations instead of attempting to change it
  • Emotion regulation: decreasing emotional impulsivity, learning to manage and shift intense, problematic emotions   
  • Interpersonal effectiveness: authentically advocating for one’s wants and needs in a relationship in a way that is both self-respecting and non-damaging

Dialectical behavior therapy provides a somewhat differentiated teaching strategy when introducing and teaching DBT skills. This is helpful because DBT is mindful of the fact that all individuals learn and retain information differently. For example, some individuals may be primarily visual learners, while others may be experiential learners. Through the three different components of DBT (individual therapy sessions, DBT group skills training sessions, and skills coaching) the unique and nuanced needs of each individual are sure to be aptly accommodated. Further, DBT group skills training session facilitators assign homework, including DBT worksheets, to be completed by participants when they are not in session.  

DBT Worksheets

DBT worksheets are an integral tool used throughout the DBT process. In order to fully implement the information addressed during DBT group skills training sessions, participants are provided with relevant DBT worksheets that they are expected to complete. There are certain DBT worksheets that directly relate to specific topics covered in the different DBT group skills training sessions. 

As such, there are a variety of DBT worksheets that are assigned at different times throughout the program. There are some random DBT worksheet templates that are easily accessible on the Internet. For individuals interested in accessing a more complete, chronologically organized set of DBT worksheets, please feel free to refer to any of the following DBT supportive resources and publications:

DBT relies on supportive resources, including workbooks and worksheets, to help reinforce the skills taught during group DBT skills training sessions and to provide additional opportunities for participants to continue to practice implementing the learned skills.

Disclaimer: 

The information above is provided for the use of informational purposes only. The above content is not to be substituted for professional advice, diagnosis, or treatment, as in no way is it intended as an attempt to practice medicine, give specific medical advice, including, without limitation, advice concerning the topic of mental health.  As such, please do not use any material provided above as a means to disregard professional advice or delay seeking treatment. 

DBT Therapy for Children – What You Need to Know

Dialectical behavior therapy (DBT) is an evidence-based psychotherapy. DBT stems from and includes many components of the cognitive behavioral therapy (CBT) approach. DBT differs from CBT in that dialectical behavior therapy prioritizes focusing on the psychosocial aspect of therapy. It was developed by Marsha M. Linehan in the late 1980s, intended to be used as a means to treat chronically suicidal individuals diagnosed with borderline personality disorder (BPD). In addition to DBT currently being recognized as the gold standard treatment method for BPD it has also become known as an effective treatment method for other mental health conditions (e.g. bulimia, binge-eating disorder, substance use disorder, depression, bipolar disorder, attention-deficit hyperactivity disorder, and more). Further, standard DBT has been adapted and DBT for children (DBT-C) is used to treat pre-adolescent children.

Standard DBT

Dialectical behavior therapy is comprised of three components: weekly individual psychotherapy, weekly DBT group skills training sessions, and optional phone coaching. One-on-one therapy sessions offer individualized support to go over any confusion surrounding DBT skills, address personal challenges and discuss successes that occurred during the pervious week. The DBT group skills training sessions focus on four behavioral skill modules, two of which are acceptance-oriented and two of which are change-oriented:

  • Core mindfulness (acceptance-oriented): learning to be present and fully aware in the moment
  • Distress tolerance (acceptance-oriented): learning to tolerate pain in difficult situation, instead of attempting to change it
  • Emotion regulation (change-oriented): learning to honor boundaries, and advocate for one’s wants and needs in relationships in a way that is both self-respecting and non-damaging 
  • Interpersonal effectiveness (change-oriented): learning to manage and deal with primary emotional reactions before they have a chance to turn into distressing secondary reactions

As additional support, phone coaching is available between sessions and can be used at the individual’s discretion. The entire DBT program (assuming skills modules are not repeated) typically lasts about six months long, as approximately six weeks are allocated for each of the four skills module. 

Adaptations

According to Behavioral Tech, DBT for children (DBT-C) was developed to “address treatment needs of pre-adolescent children with severe emotional dysregulation and corresponding behavioral discontrol.” DBT-C relies on the same principals, theoretical model and therapeutic strategies of standard DBT. However, the DBT-C curriculum is re-framed in a way that considers and accommodates the developmental and cognitive levels of pre-adolescent children and provides age-appropriate services. DBT-C is comprised of three main categories, which are subdivided into the following subcategories, as provided by Behavioral Tech

  1. Decrease risk of psychopathology in the future
    1. Life-threatening behaviors of a child
    2. Therapy-destroying behaviors of a child
    3. Therapy-interfering behavior of a child
    4. Parental emotion regulation
    5. Effective parenting techniques
  2. Target parent-child relationship
    1. Improve parent-child relationship
  3. Target child’s presenting problems
    1. Risky, unsafe, and aggressive behaviors
    2. Quality-of-life-interfering problems
    3. Skills training
    4. Therapy-interfering behaviors of a child

As is articulated in Behavioral Tech, the goal of DBT-C is to eliminate the “harmful transaction between a child and an environment and replace it with an adaptive pattern of responding to ameliorate presenting problems, as well as to reduce the risk of associated psychopathology in the future.” Through DBT-C a young person will learn a variety of adaptive coping skills and effective problem-solving strategies. Further, DBT-C helps the parents of the pre-adolescent learn how to create a supportive, validating and stabilizing environment. 

Disclaimer: 

The information above is provided for the use of informational purposes only. The above content is not to be substituted for professional advice, diagnosis, or treatment, as in no way is it intended as an attempt to practice medicine, give specific medical advice, including, without limitation, advice concerning the topic of mental health.  As such, please do not use any material provided above as a means to disregard professional advice or delay seeking treatment. 

Finding The Best DBT Workbook

DBT workbook

Dialectical behavior therapy (DBT) is an evidence-based psychotherapy that is founded on the principals of cognitive behavioral therapy (CBT). In the 1980s, Marsha M. Linehan developed DBT as a means to treat chronically suicidal individuals diagnosed with borderline personality disorder (BPD). While dialectical behavior therapy incorporates many aspects of the CBT approach, it differs in that DBT places primary emphasis on the psychosocial aspect of treatment. Since its inception, dialectical behavior therapy has not only become the gold standard for treating individuals with BPD, but has also become known an effective treatment method for other mental health disorders (e.g. depression, bulimia, bing-eating disorder, bipolar disorder, substance use disorder, etc.). 

The purpose of DBT, according to Psychology Today is to teach individuals applicable skills to manage painful emotions and decrease conflicts in relationships. 

DBT Basics

Dialectical behavior therapy is comprised of three distinct components: weekly individual psychotherapy sessions, weekly group DBT skills training sessions, and as-needed phone coaching. One-on-one therapy sessions are intended to provide personalized support for individuals with processing experiences, addressing issues, navigating challenges and identifying successes that occurred in the previous week. The group DBT skills training sessions are used to teach and help facilitate building upon skills in four core areas:

  • Mindfulness: skills focused on improving an individual’s ability to accept and be present in any given moment.
  • Distress tolerance: skills focused on increasing an individual’s tolerance of negative emotions instead of attempting to avoid or escape from them.
  • Interpersonal effectiveness: skills focused on increasing an individual’s communication strategies.
  • Emotion regulation: skills focused on helping an individual identify, name, and understand the function of emotions, and increasing one’s ability to regulate emotions.

Dialectical behavior therapy has a homework component, which is to be completed by participants outside of the DBT group skills training session. Additional support is provided via phone coaching, which is available between sessions, if needed. Approximately six weeks are spent on focusing on each of the four areas. The entire DBT program (if skills modules are not repeated) will last about six months long.  

Supportive Resources and DBT Workbooks

Dialectical behavior therapy has been in existence for less than fifty years, yet there is a plethora of DBT-specific supportive resources available, including a variety of DBT workbooks that have been published. Some of the most widely known and commonly used DBT workbooks include, but are not limited to the following:

Please note that there continue to be additional supportive DBT resources, including different DBT workbooks published, regularly. Dialectical behavior therapy encourages individuals to take an active role in the treatment process, and by working in a DBT workbook participants are left with a tangible and personalized resource. 

Disclaimer: 

The information above is provided for the use of informational purposes only. The above content is not to be substituted for professional advice, diagnosis, or treatment, as in no way is it intended as an attempt to practice medicine, give specific medical advice, including, without limitation, advice concerning the topic of mental health.  As such, please do not use any material provided above as a means to disregard professional advice or delay seeking treatment. 

A Guide To DBT How Skills

people holding hands

Dialectical behavior therapy (DBT) is an evidence-based psychotherapy that was developed in the late 1980s by Marsha M. Linehan. It is based on principles of cognitive behavioral therapy (CBT), but places greater emphasis on the psychosocial aspect of treatment. Psychology Today explains that the “goal of DBT is to transform negative thinking patterns and destructive behaviors into positive outcomes.” Dialectical behavior therapy was initially developed as a treatment method for individuals diagnosed with borderline personality disorder (BPD) and people experiencing severe suicidal thoughts. DBT is not only the gold standard form of treatment for individuals diagnosed with BPD, but according to Behavioral Tech has been found to be effective in treating other mental health conditions such as bipolar disorder, eating disorders (e.g. bulimia nervosa, binge eating disorder, etc.), transdiagnostic emotion dysregulation, attention deficit hyperactivity disorder (ADHD), depression, and more. The DBT process is comprised of various components: individual psychotherapy sessions, group DBT skills sessions, and optional phone coaching.

How Does It Work?

The components that make up dialectical behavior therapy each have a distinct purpose. Individual psychotherapy sessions are typically held on a weekly basis. They are intended to provide an individual with the opportunity to focus on and address specific issues and solutions that had arisen in the previous week. The DBT skills group sessions are also held on a weekly basis. There are four main skill areas that are:

  1. Interpersonal effectiveness: teaching skills related to effectively interacting with others and advocating for one’s needs within a relationship in a way that is non-damaging and productive. 
  2. Distress tolerance: teaching skills related to accepting, tolerating, and learning from suffering.
  3. Emotion regulation: teaching skills related to managing and dealing with primary emotional reactions prior to them leading to distressing secondary reactions. 
  4. Core Mindfulness: teaching skills related to remaining aware and accepting in the present moment.

About six weeks are allocated to each of the four DBT skills areas. The entire dialectical behavior therapy program usually lasts for twenty-four weeks, but some programs repeat the skills training modules, which doubles the length of time, making the program last a full year long. During the group sessions, individuals will learn the skills and engage in various group activities designed to help each member practice the skills. After each group skills session there will be homework assigned to further facilitate implementing and integrating the skills learned. 

DBT How Skills

The mindfulness module of dialectical behavior therapy is divided between two sets of skills: DBT what skills and DBT how skills. ‘What’ skills are practiced one at a time and include: observing, describing, and participating. ‘What’ skills help an individual learn to identify and pinpoint what he or she is focusing on (e.g. emotions, thoughts, sensations, the present, separating emotions and sensations from thoughts, etc.). The ‘how’ skills are how an individual practices the ‘what’ skills. ‘How’ skills should be practiced concurrently, and include the following: nonjudgmentally, one-mindfully, and effectively. ‘How’ skills help an individual learn to how to be more mindful (e.g. balancing rational thoughts with emotions, taking effective action, regularly using mindfulness skills, etc.). When practicing the ‘what’ and ‘how’ skills referred to in the core mindfulness module of DBT, individuals will learn to be wholly present in each moment, with awareness and without judgment. 

Disclaimer: 

The information above is provided for the use of informational purposes only. The above content is not to be substituted for professional advice, diagnosis, or treatment, as in no way is it intended as an attempt to practice medicine, give specific medical advice, including, without limitation, advice concerning the topic of mental health.  As such, please do not use any material provided above as a means to disregard professional advice or delay seeking treatment. 

Books About Dialectical Behavior Therapy

open book at a library

Marsha M. Linehan developed dialectical behavior therapy (DBT) in the late 1980s. It was founded on and includes many of the principals of the cognitive behavioral therapy (CBT) approach. CBT is a short-term psychotherapeutic treatment option that, according to Psychology Today, focuses on “modifying dysfunctional emotions, behaviors, and thoughts by interrogating and uprooting negative or irrational beliefs.” DBT was developed to better treat chronically suicidal individuals diagnosed with borderline personality disorder (BPD). It is considered a longer therapeutic process than CBT, as it lasts between six to twelve months long (depending on if certain modules are repeated). DBT places primary emphasis on the psychosocial aspect of treatment. 

DBT Basics

DBT is comprised of different therapeutic settings: weekly one-on-one therapy session, weekly group DBT skills session, and as-needed phone coaching (i.e. support between sessions). The four main modules that are focused on and taught during the group DBT skills sessions include:

  • Core mindfulness: teaches focusing skills to enable an individual to be fully present in any given moment.
  • Distress tolerance: teaches survival skills to help an individual learn to increase his or her tolerance of negative emotion, instead of trying to avoid or escape it.  
  • Emotion regulation: teaches de-escalation skills to enable a person to identify, understand, fully experience and de-escalate his or her emotions without instinctively reacting to them. 
  • Interpersonal effectiveness: teaches social skills to help an individual learn to communicate with others in an assertive, self-respecting way that simultaneously strengthens relationships. 

One-on-one therapy sessions offer an individual an emotionally safe environment to delve further into the DBT skills, clarify any confusion, and dissect personal experiences related to the implementation of the DBT skills that had been applied in one’s own life in and/ or outside of the DBT group skills session. Should crisis arise, and/ or an individual need additional support between session, phone coaching is available twenty-four-hours a day, seven days a week. 

DBT Books

Considering it is a relatively new form of psychotherapy, there is an extensive amount of literature that has been published regarding dialectical behavior therapy. Some of the most notable publications, and DBT workbooks include the following:

It is important to bear in mind that DBT is an evidence-based form of psychotherapy, and as such new books with more current DBT data as well as alternative DBT workbooks with additional resources, exercises, and/ or worksheets continue to be published. 

Integrating DBT And The 12 Steps

People using the 12 step program

Dialectical behavior therapy (DBT) is a form of psychotherapy that is based from the cognitive behavioral therapy (CBT) approach. As explained in Psychology Today, CBT “focuses on modifying dysfunctional emotions, behaviors, and thoughts by interrogating and uprooting negative or irrational beliefs.” While DBT incorporates many aspects of the CBT approach, DBT places greater emphasis on the psychosocial aspects of treatment. Marsha M. Linehan developed DBT in the late 1980s. It was originally intended as an alternative treatment method specifically designed for chronically suicidal individuals diagnosed with borderline personality disorder (BPD). DBT is currently, not only, considered to be the gold standard method of treatment for individuals diagnosed with BPD, but evidence has shown it to be a successful treatment method for individuals diagnosed with other mental health illnesses (e.g. eating disorders, bipolar disorder, substance use disorder, etc.). The purpose of DBT is to incorporate and apply the therapeutic skills into all areas of one’s life. 

12 Steps

Twelve-step programs are mutual aid organizations that support recovery from substance addictions, compulsions and/ or behavioral addictions. The first twelve-step program, Alcoholics Anonymous (AA) was developed in the 1930s and continues to be one of the most widely known addiction recovery organizations in the world. AA’s 12-step approach is comprised of the following distinct guidelines, each intended as a step toward recovery, as provided by Alcoholics Anonymous World Services:

  1. We admitted we were powerless over alcohol—that our lives had become unmanageable.
  2. Came to believe that a Power greater than ourselves could restore us to sanity.
  3. Made a decision to turn our will and our lives over to the care of God, as we understood Him.
  4. Made a searching and fearless moral inventory of ourselves.
  5. Admitted to God, to ourselves, and to another human being the exact nature of our wrongs.
  6. We were entirely ready to have God remove all the defects of character.
  7. Humbly asked Him to remove our shortcomings.
  8. Made a list of all persons we had harmed, and became willing to make amends to them all.
  9. Made direct amends to such people wherever possible, expect when to do so would injure them or others.
  10.  Continued to take personal inventory and when we were wrong promptly admitted it.
  11.  Sought through prayer and meditation to improve our conscious contact with God, as we understood Him, praying only for knowledge of His will for us and the power to carry that out.
  12.  Having had a spiritual awakening as the result of these Steps, we tried to carry this message to alcoholics, and to practice these principles in all our affairs. 

12 Steps and DBT 

There are a variety of treatment options available for individuals struggling with substance abuse and/ or addiction. An individual diagnosed with substance use disorder, and/ or another mental health illness will likely require a tailored treatment plan, as every person is different. Depending on the needs of the individual a treatment plan could consist, but is not limited to, any combination of the following treatment methods:

  • Psychotherapy
    • Cognitive behavioral therapy
    • Dialectical behavior therapy
    • Group therapy
  • Creative arts therapy
  • Support group meetings
    • Alcoholics Anonymous (AA)
    • Narcotics Anonymous (NA)
  • Medication

A customized treatment plan can incorporate a variety of therapeutic modalities so as to ensure the individual’s nuanced needs are properly accommodated. Addiction is a serious mental health illness, and if left untreated can lead to severe, and in some cases life-threatening, consequences. If you or someone you know is struggling with substance abuse, do not delay in seeking treatment. With proper treatment and continued commitment to one’s recovery process, an individual diagnosed with substance use disorder can go on to live a healthy, sober, fulfilling life. 

What Is Radically Open DBT?

woman receiving treatment

Dialectical behavior therapy (DBT) is an evidence-based psychotherapy approach that is based on cognitive behavioral therapy (CBT). Aaron Beck developed CBT in the 1960s. According to Psychology Today, CBT focuses on “modifying dysfunctional emotions, behaviors, and thoughts by interrogating and uprooting negative or irrational beliefs.” Not long after, in the late 1980s, Marsha M. Linehan developed dialectical behavior therapy. DBT is founded on the principals of CBT, but places greater emphasis on the psychosocial aspect of treatment. It was developed as a means to better treat chronically suicidal individuals diagnosed with borderline personality disorder (BPD). Currently, DBT is not only considered the gold standard method of treatment for people diagnosed with BPD, but evidence has shown it to be a successful therapeutic method in treating individuals with other mental health illnesses (e.g. eating disorders, substance use disorder, bipolar disorder, depression, etc.). Building upon the work of DBT, in the early 2000s, Thomas R. Lynch developed a new therapeutic approach called Radically Open Dialectical Behavior Therapy (RO-DBT). 

Who Is RO-DBT For?

RO-DBT is a trans diagnostic approach that was specifically developed to better treat individuals that struggle with extremely difficult-to-treat over control disorders, such as obsessive-compulsive disorder (OCD), anorexia, chronic depression, autism spectrum disorder, and more. The RO-DBT approach can help people that struggle with any combination of the following, as provided by the Child Mind Institute

  • Rigid, rule-governed behavior and excessive self-control
  • Difficulty adapting to changing environmental circumstances
  • Trouble making and/ or deepening current friendships
  • Perfectionism, disciplined behavior, and a hyper-focus on achievement
  • Excessive delay of gratification
  • Issues with connectedness and/ or intimacy
  • Hiding or avoiding experiencing and expressing emotions
  • Over-tolerance of negative emotions
  • Depression and/ or anxiety, especially when these issues remain unresolved after participating in therapies such as CBT
  • Loneliness
  • Social isolation
  • Envy and/ or bitterness

Every individual is different and will respond distinctly to the variety of therapeutic treatment options available. That said RO-DBT is an excellent comprehensive treatment option for individuals struggling with emotional over-control. 

The Format

RO-DBT was originally developed as an outpatient treatment program, but has since been applied in some inpatient treatment settings. The entire program takes at least thirty weeks to complete. Similar to DBT, RO-DBT is comprised of different therapeutic settings including weekly one hour long individual psychotherapy sessions, weekly two and a half hour long group skills sessions and phone coaching between sessions, if needed. RO-DBT focus on and addresses the following five unhealthy themes: inhibited and disingenuous emotional expression, hyper-detailed focused and overly cautious behavior, rigid and rule-governed behavior, aloof and distant style of relating, and high social comparison and envy/bitterness. 

RO-DBT Skills Training: Weekly Breakdown

The primary underlying principal of RO-DBT is radical openness. Through the group skills training sessions, individuals learn helpful coping mechanisms, useful tools, and emotional strategies to shed unhealthy emotional over-controlling habits, patterns and behaviors. The Behavior Therapist published a reader identifying an overview of the 30 weekly skills class lessons and different applications of RO-DBT to include the following:

  1. Radical openness
  2. Understanding emotions
  3. Activating social safety 
  4. Enhancing openness and social connectedness via loving-kindness
  5. Engaging in novel behavior
  6. How do emotions help us?
  7. Understanding over controlled coping
  8. Tribe matters: understanding rejection and self-conscious emotions
  9. Social signaling matters
  10.  Using social signaling to live by your values
  11.  Mindfulness training part 1: over controlled states of mind
  12.  Mindfulness training part 2: the “what” skills
  13.  Mindfulness training part 3: the core mindfulness “how” skill with self-enquiry
  14.  Mindfulness training part 4: the “how” skills
  15.  Interpersonal integrity part 1: saying what we really mean
  16.  Interpersonal integrity part 2: flexible mind REVEALs
  17.  Interpersonal effectiveness: kindness first and foremost
  18.  Being assertive with an open mind
  19.  Using validation to signal social inclusion
  20.  Enhancing social connectedness, part 1
  21.  Enhancing social connectedness, part 2
  22.  Learning from corrective feedback
  23.  Mindfulness training part 1: lesson 11 repeat
  24.  Mindfulness training part 2: lesson 12 repeat
  25.  Mindfulness training part 3: lesson 13 repeat
  26.  Mindfulness training part 4: lesson 14 repeat
  27.  Envy and resentment
  28.  Cynicism, bitterness, and resignation
  29.  Learning to forgive
  30.  RO integration week

The goal of RO-DBT is to help people develop optimal control over their emotions that is neither over-controlled nor under-controlled. 

Is DBT Effective For Bipolar Disorder? 

woman with bipolar disorder

Dialectical behavior therapy (DBT) is a form of psychotherapy that is derived from cognitive behavioral therapy (CBT). Marsha M. Linehan developed DBT in the late 1980s as a means to better treat suicidal individuals diagnosed with borderline personality disorder (BPD). DBT is founded on the CBT approach, but DBT places greater emphasis on the psychosocial aspect of treatment. Dialectical behavior therapy is made up of three distinct therapeutic settings, which include: weekly group DBT skills sessions, weekly individual psychotherapy sessions, and phone coaching. The DBT group skills sessions focus on different modules in the following four areas:

  • Core mindfulness: focusing skills
  • Distress tolerance: crisis survival skills
  • Emotion regulation: de-escalation skills
  • Interpersonal effectiveness: relationship/ people skills

The individual therapy sessions provide one-on-one attention to help the person go over skills learned in the group sessions. It enables an individual to further explore and dissect how the processes of implementing the skills has been effective throughout the week as well as identify areas that may need further attention. Phone coaching is available as support between sessions should crisis arise. Although DBT was originally developed to treat individuals diagnosed with borderline personality disorder, evidence has shown it to be a successful treatment method for individuals diagnosed with other mental health ailments, including bipolar disorder. The goals of the DBT approach are to provide individuals with new skills to effectively manage painful and difficult emotions and to minimize conflict in relationships. 

Bipolar Disorder

Bipolar disorder was formerly referred to as manic-depressive disorder or manic depression. It is currently listed in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) as a chronic mental health illness. It is characterized by extreme mood swings that include mania or hypomania (emotional highs) and depression (emotional lows). Although bipolar disorder can manifest at any age, it is most commonly diagnosed in teenagers and young adults. The symptoms and severity of symptoms will vary from person to person and may shift over time. It is important to note, that despite the mood extremes, individuals with bipolar disorder often do not recognize the severity and pervasive disruption their emotional instability causes in their own lives as well as in the lives of their loved ones. 

Treatment

There are an array of treatment options for individuals diagnosed with bipolar disorder. Every individual is different and will require a somewhat distinct treatment plan, which can comprise of a variety of therapeutic methods. While DBT has become the gold standard for treating individuals diagnosed with borderline personality disorder, it has also been effective in treating people diagnosed with bipolar disorder. An individual’s treatment plan could consist of any single method or combination of the following therapeutic modalities, as suggested by the Mayo Clinic:

  • Cognitive behavioral therapy (CBT): focuses on challenging and changing unhelpful cognitive distortions and behaviors, improving emotional regulation, and developing personal coping strategies to problem solve effectively. 
  • Interpersonal and social rhythm therapy (IPSRT): focuses on helping individuals “improve their moods by understanding and working with their biological and social rhythms.”
  • Dialectical behavior therapy (DBT)
  • Medication: different medications may be prescribed to individuals to supplement psychotherapy, including: mood stabilizers, antidepressants, antipsychotics, anti-anxiety medications, and antidepressant-antipsychotic medications. 

Depending on the needs of the individual, his or her treatment plan could also include creative arts therapies as well as focusing on a variety of self-care practices and the development of healthy daily habits, including maintaining a nutritious diet, engaging in regular exercise, obtaining ample nightly sleep, and integrating relaxation tools (e.g. yoga, meditation, etc.). Although bipolar disorder is a life-long disease, with proper treatment and continued support an individual can go on to lead a healthy and fulfilling life. 

Dialectical Behavior Therapy With Suicidal Adolescents

suicidal teenager

Dialectical behavior therapy is a form of cognitive behavioral therapy (CBT). Marsha M. Linehan developed DBT in the late 1980s. It was originally developed as a treatment method for suicidal individuals struggling with borderline personality disorder (BPD). Borderline personality disorder is a severe mental health illness. It is listed in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), and is characterized by unpredictable moods and behaviors and a long-term pattern of unstable relationships. Evidence has shown that dialectical behavior therapy has also become useful in treating individuals with other mental health ailments (e.g. eating disorders, depression, bipolar disorder, substance abuse, etc.). Nowadays, DBT is more widely known an evidence-based form of psychotherapy that is intended to help individuals who have difficulty with emotional regulation and/ or are exhibiting self-destructive behaviors.

DBT Overview

Dialectical behavior therapy is conducted in three different therapeutic settings, each with distinct goals. DBT includes weekly individual therapy sessions, weekly group DBT skills sessions, and phone coaching (between sessions) when needed. The individual therapy sessions provide one-on-one support where an individual can go over any challenging situations that have arisen throughout the week as well as enable the individual review the lessons learned in the group skills sessions. The phone coaching allows a young person twenty-four hour access to support between sessions, should crisis arise. DBT group skills sessions focus on four skill modules, which include the following:

  • Core mindfulness: this area focuses on improving an individual’s ability to accept and be present in any given moment. The skills in this module help individuals learn to the importance and value of slowing down and taking pause instead of succumbing to intense emotions and acting in destructive ways. 
  • Distress tolerance: focuses on increasing an individual’s tolerance of negative emotion as opposed to attempting to avoid or escape from it. The skills in this module help individuals learn various techniques for handling crisis (e.g. distraction, self-soothing, improving the moment, etc.). 
  • Emotion regulation: focuses on helping an individual identify, name, understand the function of, and regulate their emotions. The skills taught in this module are intended to help an individual learn to decrease the intensity of their emotions, sit with and experience strong emotions that are causing problems in one’s life, without impulsively acting on them.
  • Interpersonal effectiveness: focuses on increasing individual’s communication strategies. The skills taught in this module help an individual learn to identify what their own needs are in a relationship and develop assertive and effective communication methods to ensure those needs are met in a healthy way. 

The entire DBT program typically lasts about six months long, as six weeks are allocated to focusing on each of the four DBT skills modules. There are some partial options that focus only on certain modules, which would reduce its overall duration. Depending on the needs of the individual, there are some longer options that repeat each module, doubling the time it takes to complete the program. 

Suicidal Teens

Adolescence is a stage in one’s life that is filled with immense growth. It is a time when young people are faced with countless lessons to help prepare for the future and learn the tools needed to effectively navigate adulthood. It is to be expected that teens will experience a wide range of emotions, including extreme sadness, frustration, and even despair at some points in their youth. However, it is imperative to seek professional guidance in situations where a teenager’s emotions become so overwhelming that he or she becomes suicidal. The combination of the four DBT skills modules help a young person learn to acknowledge, accept and learn from difficult emotions that arise and experiences that occur throughout one’s life. DBT also helps an individual learn to communicate in an authentic and assertive fashion that can help improve relationships and simultaneously increase one’s sense of self-worth.

What Is The Criticism Of DBT? 

criticizing DBT therapy

Dialectical behavior therapy, also known as DBT, is a form of psychotherapy that is founded on the principals of cognitive behavioral therapy (CBT). Psychologist Marsha M. Linehan developed DBT in the late 1980s as a means to help better treat chronically suicidal individuals diagnosed with borderline personality disorder (BPD). Although touched upon in cognitive behavioral therapy, DBT places primary emphasis on the psychosocial aspects of treatment. DBT combines standard CBT techniques for emotional regulation and reality testing with concepts derived from Buddhist meditative practice such as awareness, mindfulness and attentiveness to current situations and emotional experiences to encourage acceptance. 

The Basics of DBT

Dialectical behavior therapy is comprised of three distinct therapeutic settings, including weekly individual psychotherapy (one-on-one therapy) sessions; weekly DBT skills group sessions, and access to twenty-four hour support between sessions via phone coaching, when needed. The group skills sessions focus on teaching four sets or modules of behavioral skills, which include: 

  • Mindfulness: focuses on improving a person’s ability to accept and be present in the current moment.
  • Distress tolerance: focuses on increasing an individual’s tolerance of negative emotion instead of trying to avoid or escape from it.
  • Interpersonal effectiveness: focuses on communicating with others in a way that maintains self-respect and strengthens relationships
  • Emotional regulation: focuses on strategies to de-escalate charged emotions.

Homework is often assigned after each group skills sessions to help further facilitate understanding the information taught. The one-on-one therapy sessions provide an individual with the opportunity to go over and learn from his or her diary card. The purpose of a diary card is to track emotions, identify which DBT skills were used and determine if the skills used were effective throughout the week. The therapist will provide support and guidance related to areas of struggle illuminated from one’s diary card, so as to help the individual pinpoint exactly where something may have taken an unproductive turn and avoid a repeat incident. The entire DBT program takes around six months to complete, as six weeks are allocated to each module. Longer DBT programs may elect to repeat the skills modules, going through them twice, which would extend the length of the program to last about twelve months long. 

Critiques of DBT

Although DBT was initially developed to treat individuals diagnosed with borderline personality disorder, it has since become an effective treatment method for other mental health illnesses. As DBT has become a mainstream mental health treatment option, various criticisms have been brought to light. Some individuals that could benefit greatly from dialectical behavior therapy view it as overly complex to the point that they are unwilling to try the treatment. According to the U.S. Department of Veterans Affairs, due to the fact that DBT does not necessarily involve any form of trauma processing, it is not and should not be considered a stand-alone treatment for trauma. The foundation of DBT is rooted in mindfulness practice based on Zen Buddhist teachings. Hence, some conservative Jews, Christians or Muslims may object to certain facets of DBT derived from Eastern religious philosophies. 

Every individual is different and will have unique needs when it comes to mental health treatment. Although DBT has been found to be an effective treatment method for BPD, it does not mean DBT will necessarily resonate with every single individual diagnosed with borderline personality disorder. The same is true for individuals diagnosed with other mental health disorders: this form of treatment may be effective for some and ineffective for others.