Dialectical Behavior Therapy (DBT)

Definition

Dialectical behavior therapy, or DBT, is an evidence-based treatment for a variety of mental health concerns. This includes trauma, substance abuse, suicidal thoughts, emotional dysregulation and others. Skills are a vital part of life — they help individuals achieve their goals.

However, not everyone has had the same opportunities to learn, develop, and practice the skills needed to create the life they want. DBT focuses on helping patients develop skills. Learning mindfulness, emotion regulation, distress tolerance and interpersonal effectiveness can help someone build a life they feel is worth living.

Alternative names

• Dialectical behavior therapy
• Dialectical behavioral therapy
• DBT skills training
• Mindfulness-based DBT
• Linehan’s DBT

Description

DBT is structured around helping individuals balance acceptance and change. DBT is a comprehensive treatment that uses four modes to help patients achieve their goals. Patients are seen in individual therapy and skills group.

Patients are also provided with phone coaching to assist in the generalization of skills between sessions. In addition, therapists work together on a consultation team to ensure the highest quality of care and making sure they stay true to the treatment.

The skills group provides patients with information on the following four topics:

1. Mindfulness: Teaching individuals how to stay present and increase awareness of their thoughts and feelings without judgment

2. Distress tolerance: Helping individuals tolerate and manage emotional distress without resorting to harmful behavior

3. Emotional regulation: Learning how to identify, understand and manage intense emotions effectively

4. Interpersonal effectiveness: Building skills to communicate effectively and maintain healthy relationships

Symptoms

DBT is particularly effective for people who experience intense and overwhelming emotions. Individuals may struggle with:

• Intense mood swings or emotional dysregulation

• Impulsive behaviors

• Difficulty maintaining relationships or frequent interpersonal conflicts

• Chronic feelings of emptiness or abandonment

• Fear of rejection or criticism

• Suicidal thoughts or behaviors

DBT aims to help individuals learn how to regulate their emotions, develop healthier coping strategies and improve their interpersonal skills.

Treatment

The DBT program includes weekly individual therapy sessions and skills groups. The weekly individual therapy sessions last one hour. However, the skills group sessions are two hours long. Each week, patients attend for a total of three hours of therapy. They will focus on learning skills to effectively regulate emotions and behaviors.

The program lasts a year, and a minimum of 25 weeks of skills group is required. After completing a round of skills group, patients may request a second round to strengthen their skills further. Alternatively, they may be recommended for a second round, depending on their progress.

Before beginning the program

Before beginning DBT treatment, your physician must make a referral to the program. Once referred, you will meet with a DBT therapist for an evaluation. This evaluation typically includes:

• Clinical interviews

• Psychological assessments

• Referral for specialized testing if needed

After the evaluation, your health care team will determine whether DBT is an appropriate modality for you. If it is, they will guide you. Patients will complete a “pre-DBT” period, lasting approximately 4-6 weeks.

During this time, you will meet weekly with your therapist to learn more about the program and what to expect — helping you build trust and get comfortable with the process. The therapist will also give assignments, such as completing “diary cards,” to assess your commitment to the program. At the conclusion of the pre-DBT period, your therapist will help you prepare to begin the skills group.

Potential side effects

While DBT is generally a safe and effective treatment, it may cause some to experience emotional discomfort. This may include feeling overwhelmed when discussing complex topics or practicing new skills. However, these feelings are normal, and learning to cope with them effectively is part of the therapeutic process.

Seek help right away if you:

• Feel the urge to hurt yourself or others

The 988 Suicide & Crisis Lifeline provides free and confidential support 24/7 anytime, day or night. If you are thinking about hurting yourself or others, call or text 988 or chat at 988lifeline.org. You can also call 1 (800) 273-8255 (TALK), 911 or the Alachua County Crisis Hotline (352) 264-6789. You may also go to the emergency room. DO NOT delay.

If someone you know has attempted suicide, call 911 or the local emergency number right away. DO NOT leave the person alone, even after you have called for help.

Outlook

The outlook for individuals who participate in DBT can be very positive. Many people report significant improvements in their ability to regulate their emotions. There is an increase in skillful behaviors and building better relationships. DBT is a long-term commitment, but with support and consistency, it can help patients build a life they experience as worth living.

This entry was written by Jennifer Cruz-Urbano, marketing specialist, and reviewed for accuracy by Jennifer Hedrick, Rachel C. Parker, and Elizabeth T. Pratt, licensed mental health counselors. Generative AI was leveraged as part of the content creation process.