In the late 1980, Marsha M. Linehan developed Dialectical Behavior Therapy (DBT) as a therapeutic method to better treat individuals diagnosed with borderline personality disorder (BPD), suffering from pervasive suicidal thoughts and/ or attempts. It is currently recognized as an effective therapeutic method for treatment in a wide range of other mental health disorders, such as depression, anxiety, post-traumatic stress disorder (PTSD), substance use disorder (SUD), eating disorders, and more. The philosophical perspective of dialectics, balancing opposites, influences the DBT process. A mental health clinician offering DBT services works with an individual to identify ways to hold two seemingly opposite perspectives simultaneously. This, in turn, promotes balance and minimizes the tendencies to think in absolutes (i.e. viewing all in black and white, all-or-nothing style of thinking, etc.…). DBT encourages an inclusive worldview and perspective (both- and) instead of an exclusive (either- or) outlook on life. DBT is a specific type of cognitive-behavioral therapy (CBT) that greatly emphasizes the psychosocial aspects of treatment.
The DBT process is comprised of group therapy, also known as DBT skills group sessions, and individual psychotherapy sessions. One-on-one therapy sessions are a helpful component of the DBT process as they can provide the individual in treatment with the opportunity to focus on his or her nuanced challenges. Individual therapy sessions can provide a forum to go over any confusion regarding DBT skills as well as process and improve problem-solving behaviors. The two types of structured sessions are held in conjunction with on another and compliment the different areas of focus, respectively. Though the general idea is for the individual in treatment is to attend the DBT skills group session and have a one-on-one therapy session weekly, the exact number of weekly sessions can be adjusted based in the specific needs of the individual.
The DBT skills group session make up an imperative component to the overall DBT program. DBT skills group sessions are focused on enhancing the capabilities of each participant by teaching behavioral skills. These group sessions offer participants an emotionally safe environment to practice implementing the DBT skills alongside others working on the same thing. Group members are encouraged to share their experiences and provide mutual support. DBT skills group sessions are usually held on a weekly basis and are conducted by a qualified mental health practitioner. DBT focuses on providing therapeutic skills in four areas that make up the pillars of DBT, which include the following:
- Mindfulness: the practice of being fully aware and wholly present in the current moment
- Distress Tolerance: learning tools and techniques to effectively tolerate pain that may arise from difficult situations, instead of attempting to avoid and/ or change it
- Interpersonal Effectiveness: learning assertive communication methods that enable an individual to engage with others in a way that maintains self-respect and simultaneously strengthens relationships
- Emotion Regulation: explores strategies that aid in changing unwanted emotions, by way of managing and/ or shifting the intense emotions that may be causing problems in one’s life
In DBT skills group session the clinician running the session will follow the lessons provided in the DBT curriculum, teach the skills and facilitate activities to allow the participants to practice using the DBT skills learned. After each DBT skills group session the clinician will assign homework to help practice and reinforce the information taught during the session. It is also important to note that the DBT skills extend beyond the individuals in treatment. In fact, an integral part of DBT is the assumption that effective treatment places equal emphasis on the behavior and experience of the mental health clinicians working with the individuals in treatment as it does on the experience and behaviors of the individuals in treatment. Hence, it is common practice for mental health providers offering DBT to integrate and regularly practice the DBT skills into their daily lives.
The full DBT skills curriculum is intended to take twenty-four weeks long to complete. According to the Linehan Institute, this curriculum is often repeated to create a one-year long program. Shorter options that teach only a subset of the DBT skills have also been developed and are used in particular populations and settings. Although these timeframes are usually adhered to, the exact timeframe of a particular DBT program will depend on the specific needs of its participants, as the program may conclude in less time than the scheduled twenty-four weeks, or extend beyond, lasting longer than the twenty-four week period.