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Dialectical Behavior Therapy

Dialectical behavioral therapy (DBT) is a broad and complex method of mental health therapy originated by Dr. Marsha M. Linehan to treat patients with borderline personality disorder (please see our Specialty Areas section on Personality Disorders). Research indicates that DBT may also be effective with Bipolar Disorder and with other mood disorders in which self-injury is a factor. Key theoretical components of DBT are borrowed or adapted from behavior therapy, dialectics, cognitive therapy, and Zen meditation, especially the practice of mindfulness.

DBT must include the 2 components below in order to stay within the confines and recommendations of the model:

1. Individual therapy: In this component the therapist and client discuss issues relevant to mutually established goals of therapy. Self-injury and suicidal ideation, plan, or intent take first priority, followed by a focus on any other such behavior which is likely to interfere with the effectiveness of care. Skill sets learned during group treatment are also a big focus of this component of DBT.

2. Group therapy: In this component, DBT clients meet weekly for two hours, focusing on use of skills that are classified into four modules:

a) mindfulness;
b) emotion regulation;
c) social effectiveness; and
d) distress tolerance.

More description of these skill sets is just below.

Mindfulness

Mindfulness is derived from the centuries' old teachings of the Buddha, who emphasized the practice of bringing the mind back to the present moment and observing its thoughts and emotions without judgment or attachment. This practice is a central method of Zen meditation; however, in DBT, mindfulness is recommended as an active component of one’s daily activities, especially if these activities are upsetting in any way.

Interpersonal Effectiveness

Interpersonal effectiveness includes assertiveness and interpersonal problem-solving skills, such as asking for what one needs, saying no, and coping with interpersonal conflict.

Distress Tolerance

Distress tolerance is somewhat different from an active attempt to change a situation for the better; instead, its focus is upon accepting, tolerating, and finding meaning in stressful circumstances. DBT therapists teach the elegant and skillful forbearance of pain, in situations in which this response is applicable and appropriate.

Emotional Regulation

Patients appropriate for DBT are often intensely emotional and have wide swings of emotion on a frequent basis; e.g., in one day they may cycle between anxiety, depression, suicidality and rage. DBT addresses this tendency by helping clients:

• Consciously identify and label their emotions
• Mindfully observe their emotions
• Mindfully accept their emotions
• Increase positive events in order to offset painful emotions
• Take action which is directly opposite to that which the emotion demands

Further Reading

The Miracle of Mindfulness by Thich Nhat Hanh

Depressed and Anxious: The Dialectical Behavior Therapy Workbook for Overcoming Depression & Anxiety by Thomas Marra