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.