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.