Dialectical Behavior Therapy (DBT)

DBT combines elements of Cognitive Behavioral Therapy (CBT) and eastern philosophical concepts such as mindfulness and acceptance.   This “dialectical” approach, meaning that it integrates two seemingly disparate ideas (i.e., acceptance vs. change), was initially developed by Marsha Linehan, Ph.D. and designed to specifically treat Borderline Personality Disorder (BPD).   DBT has proven effective in reducing the anger, identity disturbance, abandonment fears, and self-harm behaviors found in this condition.  Studies have also shown that DBT is helpful for other populations, including individuals who have experienced trauma or abuse, as well as individuals with substance abuse issues and eating disorders.

DBT is based on the premise that, for a variety of reasons, people may lack adequate skills to regulate their emotions, tolerate distress, or get their interpersonal needs met in constructive ways. Or, perhaps they have the skills, but have lacked adequate opportunities to practice using such skills as a result of their life circumstances.

An essential aspect of DBT is that it aims to balance the need for change with the need to accept oneself in the present moment, in an effort to create “a life worth living.”  A defining characteristic of DBT is its emphasis on teaching more adaptive behaviors in individual therapy, as well as in an accompanying “Skills Group.”

In DBT, the patient learns and practices skills focused in four main areas:  Mindfulness, Interpersonal Effectiveness, Emotional Regulation, and Distress Tolerance.   The goal is for patients to gradually develop the skills to act more effectively in challenging situations.  For example, in the Distress Tolerance Module, the patient learns skills to help tolerate difficult situations.  These skills include modifying erroneous thinking and utilizing self-soothing, self-acceptance, and other coping strategies.  DBT encourages balancing self-respect and assertiveness with respect for the feelings and boundaries of other people.

For patients whose self-regulation problems are creating a continued state of crises in their lives, especially those who have not been able to progress in their current therapies, DBT is a well-researched and clinically established option.