Dialectical Behavior Therapy (DBT)

Do you have a hard time managing intense emotions?

Is it difficult to know what you are feeling in the moment, or do you feel your emotions are all-or-nothing? Perhaps you frequently feel things are easiest described as “love or hate”. Have you felt the need to cling to those around you out of fear of abandonment?

What is Dialectical Behavior Therapy?

Dialectical Behavioral Therapy (DBT) is a cognitive-behavioral therapy with proven effectiveness for people who struggle with emotional regulation. Emotional regulation can be seen on its own, or as a part of other conditions such as eating disorders and borderline personality disorder.

Its main goal in Dialectical Behavioral Therapy is to change negative thinking patterns and behaviors. It also helps people develop better skills for regulating their emotions and managing their day-to-day lives by improving destructive patterns into more adaptive responses and behaviors. 

Does Dialectical Behavioral Therapy (DBT) work?

The short answer is yes. DBT was originally intended for people with borderline personality disorder (BPD). Clinical research has repeatedly shown it to be very effective for individuals with personality disorders which are generally considered difficult to treat. It has also studied as an intervention for eating disorders and also appears effective for these conditions. Today, DBT is considered an effective intervention for a variety of conditions and problems, such as borderline personality disorder, eating disorders, and suicidal thoughts, among others.

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“Emotions are not good, bad, right, or wrong. The first step to changing our relationship to feelings is to be curious about them and the messages they send to us.”

-Dr. Lane Pederson
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Who developed DBT?

Dr. Marsha Linehan developed this approach in the 1980s when she saw that cognitive-behavioral therapy, though generally effective, did not work very well with patients who had BPD. These patients had unique needs that were not being met, so this approach tried to help them specifically. Later, the approach was also used for other problems because it seemed that many of these issues were shared by others.

DBT has a philosophical foundation in the form of dialectics that considers the idea that everything that exists is composed of opposites and change happens when the two opposites can be reconciled.

In DBT, the core element is the resolution of the contradictory ideas of self-acceptance and positive change. The therapy examines a person’s actions, emotions, and experiences and validates them as something that makes sense in the person’s unique context, even if it might not be the best solution to the problem at hand. This approach is especially powerful for BPD because people often find themselves acting impulsively, practicing self-harm, and often changing the way they experience the world.

By making sense of these behaviors and experiences rather than simply trying to change them, there are better outcomes. Something similar could happen with eating disorders, as, on one hand, the person might be suffering because of it and seeing their health get worse, and, on the other, also experiencing their weight loss or extreme dieting as something positive. DBT can help reconcile these opposites and promote positive change as a result.

How does Dialectical Behavior Therapy work?

Like other types of cognitive-behavioral therapies, DBT tries to help clients shift thought patterns and behaviors to be more constructive. The term dialectical refers to a core difference that distinguishes dialectical behavior therapy vs. CBT or other treatments. Dialectical means bringing together two opposites, acceptance and change. It provides acceptance for the situation rather than just attempts to change it, which can lead to better outcomes. Acceptance is a critical part of the process. DBT operates through four domains that include the following:

Distress Tolerance:

It helps individuals accept that they feel intense emotions but changes the patterns of coping. Many individuals with borderline personality disorder or other conditions may experience intense emotions and react impulsively or turn to self-harm. The therapy helps shift the behaviors towards acceptance and avoid destructive reactions.

Emotional Regulation:

Emotion regulation is a significant goal in the therapeutic process. These skills help individuals understand, identify, and express emotions in a healthier way.

Mindfulness:

Mindfulness involves becoming more aware of the self and the experience that is happening at the moment without trying to change it or judging it. Mindfulness helps limit our emotional responses to the current or present moment, which often helps us realize our current experiences are less impactful than originally believed thus lowering the emotional intensity of that experience. Further, taking  

Interpersonal Effectiveness:

Finally, interpersonal effectiveness skills help individuals manage relationships and reducing conflict with others. These domains distinguish DBT from other therapeutic approaches.

Who is dialectical behavior therapy for?

While DBT is most often thought of to be for individuals with borderline personality disorder and eating disorders, or those who often experience intense emotions or suicidal ideation, almost anyone can benefit from DBT skills training as it helps regulate emotions and behaviors. There are studies showing the effectiveness of this condition for problems such as depression, bipolar disorder, and anxiety (see some of our coping skills for anxiety). DBT is focused on helping the person cope with their emotional state and better manage any destructive behaviors, which can be helpful for a wide variety of individuals.

DBT does not try to simply change the person’s experience but to help them find the right balance between change and acceptance, which can work better in a lot of cases. It is recognized as an evidence-based treatment and the evidence base it has is expanding rapidly. It has been used for a variety of conditions with positive results, showing its effectiveness for helping a person regulate emotions and change the behaviors associated with these. DBT is rather unique in its focus and philosophical approach but it does appear effective, especially for BPD and eating disorders, although there are also attempts to apply it to other conditions.

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