Psychologist, Marsha M. Linehan, developed dialectical behavior therapy (DBT) in the late 1980s as a means to more effectively treat chronically suicidal individuals diagnosed with Borderline Personality Disorder (BPD). DBT is a type of cognitive behavioral therapy (CBT) that places greater emphasis on the psychosocial aspect of therapy. Since its inception, dialectical behavior therapy has been and remains the gold standard method of treatment for individuals diagnosed with BPD, and has also proven effective in treating individuals with eating disorders (e.g. anorexia, bulimia, etc.), severe anxiety, substance use disorder, other personality disorders, and certain mood disorders. DBT is comprised of three distinct settings: weekly individual therapy sessions, weekly DBT group skills training sessions, and phone coaching. 

4 Skills Modules

DBT utilizes four main strategies for teaching individuals skills that help with effectively changing their behaviors. They include the following, as provided by Behavioral Tech: 

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 advocate for one’s own wants and/ or needs by saying no and/ or expressing one’s desires while maintaining self-respect 
4. Emotion Regulation: learning how to understand, shift and/ or change unwanted emotions 

The entire DBT program (provided skills modules are not repeated) usually lasts about six months long, as approximately six weeks are allocated to each of the four skills modules. 

COVID-19 DBT Modifications

The swift arrival of the extraordinarily contagious novel coronavirus (SARS-CoV-2), also known as COVID-19, quickly plunged all corners of the world into a universal pandemic. In efforts to slow the spread of COVID-19, America implemented strict stay-at-home orders for all non-essential workers, closed schools, prohibited in-restaurant dining, shuttered movie theaters, museums, sports and exercise clubs, and more. Mental health treatment services are included on the list of essential businesses and provided they adhered to the evolving health and safety protocols set forth by the CDC, they were able to remain open and operational throughout the pandemic. 

Although many mental health providers were able to facilitate dialectical behavior therapy for their clients, several modifications, including shifting certain therapeutic settings, were implemented in order to accommodate the continuously evolving safety guidelines. While the precise adjustments are left to the discretion of each mental health provider, commonly implemented changes to the DBT therapeutic settings included: 

• Individual sessions: 

• Hold the weekly individual therapy sessions remotely over videoconference platforms (e.g. Skype, FaceTime, Google Meet, Zoom, etc.)

• Hold the weekly individual therapy sessions in person, while both clinician and patient remain masked and a minimum of six feet apart

• DBT group skills training sessions:

• Hold the weekly sessions remotely over videoconference platforms (e.g. Skype, Google Meet, Zoom, etc.)

• Hold the weekly sessions in person, in a highly ventilated location (e.g. outdoors), while all members present remain masked, and seated a minimum of six feet apart

• Phone coaching: this component does require much modification for COVID-19, as it is already carried out in a socially distant fashion.

Dialectical behavior therapy aims to teach individuals healthy coping mechanisms and useful techniques for managing stress, regulating emotions, and improving relationships with others. Rest assured, regardless of the modifications, every mental health clinician that continued providing DBT services during the pandemic did so with deep consideration for his or her client’s physical and mental wellbeing, and rendered services in the safest manner possible. 

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.