Dialectical Behavior Therapy

What is Dialectical Behavior Therapy (DBT)?

Dialectical behavior therapy (DBT) is a psychotherapy technique that helps people experiencing intense emotional dysregulation and behavior problems. The term “dialectical” refers to accepting and changing simultaneously.

DBT is a version of cognitive behavior therapy (CBT), which is a general form of talk therapy led by a counselor who teaches someone how their thoughts influence behaviors. Changing negative thought patterns can lead to improved behaviors. DBT adapts CBT to focus specifically on skills for mindfulness, regulating emotions, stress reduction, and improving interpersonal relations. Therapists may teach the skills in individual or group sessions in a classroom format. They may also assign homework to have their client practice specific skills outside of therapy in real-life situations.

What Is Dialectical Behavior Therapy (DBT) Used To Treat?

Originally, DBT was used to treat bipolar disorder and other mental conditions in which people could not regulate their extreme emotions. Today, DBT helps people with various mental health issues, including the following:

• Anxiety
• Depression
• Bipolar disorder
• Emotional control
• ADHD
• Post-traumatic stress
• Suicidal ideations
• Substance abuse
• Self-harm
• Eating disorders

DBT effectively teaches people to use healthy coping skills to deal with their emotions instead of using harmful coping methods.

How Does Dialectical Behavior Therapy Work?

DBT helps people understand how their thoughts influence their behaviors. Negative thoughts often lead to negative behaviors, so changing a person’s thought processes can lead to healthier behaviors. With DBT, therapists teach four components to help someone make changes.

Mindfulness Skills

Mindfulness is the ability to pay attention and be aware of what is going on in the present without judgment. It helps people have more control over their thoughts, emotions, and behaviors. It improves attention, motivation, and learning while reducing stress.

Mindfulness skills for DBT may include observing an object to teach how to maintain focus, a mental body scan to aid relaxation, and mindful breathing for calming the mind. Out of hundreds of mindfulness activities, a therapist may teach skills like being non-judgmental, mental noting, describing emotions, counting, and mindful eating.

Acceptance And Stress Tolerance

When stressful situations occur, it is easy to get stuck in a cycle of having negative thoughts that lead to adverse reactions, like self-harming behaviors. DBT helps someone accept that things are out of their control and focus on things within their control.

DBT teaches distress tolerance skills, including self-soothing skills to use when encountering emotional stress. One method involves using the senses of touch, sound, hearing, taste, and smell for sensory grounding. Other skills include the TIPP method, which stands for “temperature, intense exercise, paced breathing, and paired muscle relaxation.” Each step distracts someone from the emotional stressor, allowing them to approach the situation calmly.

Interpersonal Effectiveness

Self-care and improving personal skills, such as communication, conflict resolution, and problem-solving, increase a person’s interpersonal effectiveness. People learn to build healthier relationships, set boundaries, and become assertive without being aggressive.

A popular method for interpersonal effectiveness is the DEARMAN technique, which stands for “Describe, Express, Assert, Reinforce, Mindful, Appear, Negotiate.” This skill teaches people how to meet their needs by improving communication and personal relations.

Similarly, the GIVE technique instructs someone to “be Gentle, act Interested, Validate, and use an Easy manner.” GIVE is similar to FAST, as it teaches someone to be assertive but keep their self-respect and values while communicating. FAST stands for “be Fair, no Apologies, Stick to values, and be Truthful.” Other skills focus on recognizing, setting, and maintaining healthy boundaries with others.

Emotional Regulation

DBT helps people control their emotions, giving those emotions less power to influence their thoughts and behaviors. People can choose which emotions they express and how to use them by:

• Learning to recognize physical reactions to emotions
• Taking a break before reacting
• Labeling emotions
• Accepting them without judgment

Essential skills for emotional regulation include creating a space between a trigger and an emotional response. Therapists may also teach people how to become aware of their physical and psychological reactions, how the body is feeling, which parts are involved in the reaction, and how to use the physical reaction to control their response. Someone can then learn to name and accept emotions.

What To Expect During A DBT Session

Dialectical behavior therapy typically consists of weekly individual and group therapy sessions. Individual DBT refers to meeting one-on-one with a therapist to discuss the issues faced in the prior week. The therapist discusses how someone used their DBT skills and the situations that made them feel the need to practice DBT. Someone may explain how they used mindfulness, distress tolerance, interpersonal effectiveness, and emotional regulation in their real-life experiences.

Group DBT sessions consist of learning and practicing skills with peers experiencing similar mental health conditions. Meeting with peers helps participants feel less alone. Groups train to improve their skills in the four DBT components, and social interactions are key success factors.

In group DBT therapy, therapists may have participants role-play current real-life experiences and situations with one another. Participants may also work together to solve problems, practice guided imagery, and prepare a positive reaction to a potential stressor ahead of time. Writing exercises are a tool that teaches group members how to express themselves and then discuss with the group. Behavioral change analysis is a peer-assisted activity that helps someone break down a behavior, the triggers that led to the behavior, and how to use DBT skills for a better outcome.

Between DBT sessions, therapists are often available for consultation if needed. The meetings are shorter than usual but can help someone get advice or stay on track.

What Are The Benefits And Risks Of Dialectical Behavior Therapy (DBT)?

DBT works in treating multiple mental health disorders. Additionally, DBT helps someone:

• Feel better in control of their emotions
• Boost confidence and resilience
• Reduce negative emotions and behaviors
• Build peer support
• Improve relationships
• Manage co-occurring disorders
• Increase hope and motivation for change

Someone receiving DBT can ultimately learn to increase their overall quality of life, as it helps motivate people to make changes and increases their hope that life can improve.

To experience the most benefits of DBT, one must be ready to make positive changes. It typically requires participants to complete homework assignments and requires a time commitment to attend individual and group therapy sessions.

A less discussed factor is that some facets of DBT, like mindfulness, are based on Zen Buddhist teachings, and those from other faiths may not feel comfortable participating in its practices.

How Long Will I Need Dialectical Behavior Therapy?

Many factors determine the length of time someone needs DBT. Factors may include their primary mental health condition, as well as secondary issues. Many programs last between six months to a year.

Acquiring new DBT skills can take longer for some, while others may develop the skills quickly but experience a relapse of mental health symptoms. Therefore, they may need extra time in treatment. Some may learn the skills quickly and see significant improvements in less than six months. You should talk with your therapist to discuss when it’s time to end treatment.

Cognitive Behavior Therapy Vs. Dialectical Behavior Therapy

DBT is a type of CBT that has similarities and differences. Both treatments have structure and guidelines, and they help people improve their thoughts and behaviors using skills they learn in therapy. CBT and DBT are effective in treating numerous mental health conditions.

Differences include the following:

• A person’s time in treatment varies based on their unique needs. DBT is typically longer.
• CBT participants may not need individual and group therapies. DBT requires both.
• DBT has a spiritual component based on Eastern religion. CBT does not have a religious component.
• CBT focuses on substituting negative thought patterns with positive ones to improve behaviors. DBT focuses on regulating emotions to improve behaviors.
• While CBT and DBT treat many disorders, CBT can treat more.

DBT is often the first recommendation for bipolar disorders and other conditions involving extreme emotions. While much more research has been done on CBT, both treatments have proven effective.

How Do I Find A DBT Therapist?

Finding a therapist who specializes in dialectical behavior therapy involves some research and knowing who to ask for a referral. The first place to start a search is with a family doctor. Physicians offer a list of area resources based on mental health needs.

Another way to find a DBT therapist is to contact your insurance company representatives, who can help you perform a search. You can also conduct searches online at nationwide organizations, like the Substance Abuse and Mental Health Services Administration website.

What To Look For In A Dialectical Behavior Therapist

Finding a therapist requires knowing your personal needs and preferences. Some questions to consider include:

• Do you prefer meeting online, in person, or a hybrid version?
• Do you prefer to work with someone of a particular gender, age, ethnicity, etc.?
• Where are they located?
• What are their hours of operation?
• How much does each session cost?
• What is their educational background?

Feel free to request an initial consultation to seek answers to your questions. You will be able to see if your personalities are a match. It is okay to interview more than one DBT therapist before deciding. The most important thing is getting the help you need to achieve a better quality of life.