What Is DBT?

Dialectical behavior therapy (DBT) is a specific type of cognitive-behavioral psychotherapy developed in the late 1980s by psychologist Marsha M. Linehan to help better treat borderline personality disorder. Since its development, it has also been used for the treatment of other kinds of mental health disorders. The theory behind the approach is that some people are prone to react in a more intense and out-of-the-ordinary manner toward certain emotional situations, primarily those found in romantic, family and friend relationships. DBT theory suggests that some people’s arousal levels in such situations can increase far more quickly than the average person’s, attain a higher level of emotional stimulation, and take a significant amount of time to return to baseline arousal levels. DBT may be used to treat suicidal and other self-destructive behaviors. It teaches patients skills to cope with, and change, unhealthy behaviors.

The term “dialectical” comes from the idea that bringing together two opposites in therapy — acceptance and change — brings better results than either one alone. A unique aspect of DBT is its focus on acceptance of a patient’s experience as a way for therapists to reassure them — and balance the work needed to change negative behaviors. Dialectical behavioral therapy focuses on high-risk, tough-to-treat patients. These patients often have multiple diagnoses.

Beach WomanDBT was initially designed to treat people with suicidal behavior and borderline personality disorder.

But it has been adapted for other mental health problems that threaten a person’s safety, relationships, work, and emotional well-being.

Borderline personality disorder is a disorder that leads to acute emotional distress. Patients may have intense bursts of anger and aggression, moods that shift rapidly, and extreme sensitivity to rejection. Individuals with borderline personality disorder may have difficulty regulating emotions, and they experience instability in moods, behaviors, self-image, thinking, and relationships. Impulsive behavior, such as substance abuse, risky sex, self-injury, and repeated life crises such as legal troubles and homelessness, are common also common in individuals with borderline personality disorders.

The American Psychiatric Association has endorsed DBT as effective in treating borderline personality disorder. Patients who undergo DBT have shown improvements in the following ways: less frequent and less severe suicidal behavior, shorter hospitalizations, less anger, less likely to drop out of treatment, improved social functioning.

Some Characteristics of DBT

Support-oriented: It helps a person identify their strengths and builds on them so that the person can feel better about him/herself and their life.

Cognitive-based: DBT helps identify thoughts, beliefs, and assumptions that make life harder such as “I have to be perfect at everything.” “If I get angry, I’m a terrible person” and helps people to learn different ways of thinking that will make life more bearable. For example, “I don’t need to be perfect at things for people to care about me.” “Everyone gets angry, and anger is a normal emotion.”

Collaborative: It requires constant attention to relationships between clients and staff. In DBT people are encouraged to work out problems in their relationships with their therapist and the therapists to do the same with them. DBT asks people to complete homework assignments, to role-play new ways of interacting with others, and to practice skills such as soothing yourself when upset. These skills, a crucial part of DBT, are taught in weekly lectures, reviewed in weekly homework groups, and referred to in nearly every group. The individual therapist helps the person to learn, apply and master the DBT skills.