Dialectical Behavioral Therapy: The Benefits Of Behavior Therapy

Dialectical behavior therapy (DBT) was invented by psychologist Dr. Marsha Linehan to treat the symptoms of borderline personality disorder (BPD). However, this form of therapy has since been used to treat many mental health conditions, life challenges, and symptoms. DBT is a structured form of therapy that many individuals appreciate due to its direct approach to healing. Learning more about DBT can help you make an informed decision on the most effective care type for your goals. 

What is dialectical behavioral therapy (DBT)?

Dialectical behavior therapy (DBT) is a form of mental health treatment with a basis in cognitive-behavioral therapy (CBT). It is often used to treat personality disorders and those who experience intense emotions or treatment-resistant symptoms. It involves four modules, including the following: 

• Mindfulness
• Emotional control
• Interpersonal effectiveness
• Distress tolerance 

A therapist teaches clients to accept what they cannot change while changing what they can. Using new skills from the DBT workbook, clients can make long-term changes in their lives. 

The history of DBT 

DBT is rooted in cognitive behavioral therapy (CBT) and was developed by Dr. Marsha Linehan to treat patients with borderline personality disorder Dr. Linehan herself had borderline personality disorder, which was misdiagnosed and mistreated as schizophrenia. A newer form of treatment, it has become a popular format for many clients due to its direct approach to treating symptoms that may not be as widely discussed in other modalities. Although DBT was developed to treat BPD, it can also be used for conditions like anxiety depression, binge eating disorder, or challenges like relationship conflicts. 

Dr. Linehan initially used CBT to treat her clients, and many of the elements of CBT can be found in dialectical behavior therapy. However, CBT focused too much on changing the client, which prevented many clients from continuing. The clients felt that their emotional needs were being ignored. As a result, clients often stopped treatment. 

Upon realizing this, Linehan noticed that the clients stayed whenever their emotional needs were fulfilled. These involve strategies to help clients tolerate their emotions develop emotional regulation skills, and learn techniques to help them live better lives. Soon, the clients felt the therapists could empathize better with them and that there was hope for their concerns. 

What can DBT treat? 

DBT is often used in the treatment of the following mental health conditions: 

• Substance use disorders 
• Post-traumatic stress disorder (PTSD) 
• Eating disorders such as binge eating disorder and anorexia nervosa
• Suicide attempts or ideation
• Depression
• Borderline personality disorder
• Other personality disorders 

If you struggle with your emotions, feel misunderstood by others, aren't finding CBT effective, or have been diagnosed with a personality disorder, you might benefit from DBT. However, you do not have to have a mental health diagnosis to receive benefits from dialectical therapy. 

If you are struggling with substance use, contact the SAMHSA National Helpline at (800) 662-4357 to receive support and resources.

If you are experiencing suicidal thoughts or urges, call the National Suicide Prevention Lifeline at 988 to talk to someone over SMS. They are available 24/7 to offer support.

The elements of DBT 

As with many forms of treatment, there are multiple components, principles, and terms that DBT uses. While goals may vary for treatment, the main therapeutic agenda of DBT is often for the client to learn to cope with distressing emotions and symptoms healthily while feeling empowered by their emotions. Below are the five components of DBT treatment. 

Component 1: Capability enhancement

DBT is set on the foundation that each person has unique abilities and skills. This form of therapy focuses on teaching skills to modify behavior. When you go to skills training sessions with a DBT therapist, it may be in a classroom-like format. You may be in a group, alone, or with a partner.

Your therapist might also assign homework to practice what you've learned in sessions, fill out worksheets, and complete a daily mood-tracking card. If you encounter a situation where you can use the skill you learned, you can report to your therapist afterward and let them know how it went. Many DBT sessions are longer than traditional therapy sessions to account for the skills training. However, some classes aren't as long, so talk to your therapist for a shorter session. 

The component of capability enhancement involves skills training in the following four categories: 

• Emotional control/regulation skills: This section teaches you how to be aware of your emotions, label them, accept them, and change them when you want to. 
• Mindfulness: Mindfulness teaches people to be aware of the present, self-soothe, and connect with others. DBT has several mindfulness skills to learn. 
• Distress tolerance: In DBT, distress tolerance skills focus on coping with extreme emotional distress and reducing challenging emotions the moment they occur. 
• Interpersonal effectiveness: Interpersonal effectiveness can teach clients to say no, ask for a favor, or end unhealthy relationships. 

Component 2: Motivation enhancement

In DBT, motivation to continue practicing the skills is essential, even when difficult. The therapist may keep the client accountable by asking them to always complete their homework, attend sessions on time, and participate when asked. Although it can feel scary, let your therapist know if you need help with any area of DBT. 

Component 3: Coaching

DBT therapists often offer the option of coaching outside of sessions in case of an emergency or a question. Some therapists may offer an after-hours number to call or text, whereas others might point you to a helpline from one of their colleagues or a local crisis line. 

Component 4: Case management

Part of DBT is learning to be self-sufficient. DBT therapists can teach their clients how to make use of resources in their community and stand up for themselves when asking for something from others. They may also help the client set up appointments in other areas of care, such as primary care or psychiatry. 

Component 5: Supporting the supporters

Many DBT therapists use a consultation team to ask for advice if they are struggling to support a client. They might meet weekly and ask for advice from others offering DBT groups or sessions. The therapists can also learn and practice the DBT skills and use them themselves, so the client knows the therapist also benefits from what they are teaching. 

The priorities of DBT

Many clients who sign up for DBT have more than one symptom or challenge they'd like to address, so the goals for DBT can vary. One client might prioritize learning mindfulness, whereas another might benefit more from learning interpersonal skills. Although all clients are often taught all modules, the goals for treatment can be personalized. 

The most challenging topics may be targeted first. Then, a therapist can target behaviors that may stop the treatment from going smoothly. For example, if a client struggles to attend appointments, that behavior can be addressed before moving on with treatment. This often involves discussing the behavior's motives and how the therapist can help the client improve their quality of life. The client's goals and priorities are often also prioritized by the therapist. 

How treatment works

DBT is a structured form of counseling that might sometimes seem more like a class than a therapy session. However, every DBT therapist may be different. Below are a few standard stages of DBT treatment. 

• Stage 1: The first stage of DBT often involves helping the client learn how to understand and control their behaviors. To do so, they may start with mindfulness to feel grounded and capable. Then, they can move on to specific skills to start practicing immediately. 
• Stage 2: In the second stage, emotions are identified, labeled, and understood on a deeper level. Clients can start to learn how to separate thoughts from behaviors, and therefore, better control their responses. 
• Stage 3: Acceptance and change are prioritized, and the client may learn more intense distress tolerance skills to handle more challenging emotions. 
• Stage 4: In the fourth stage, the client can learn to find a more profound meaning in life, no matter how that might look for them. This stage can be optional. 

After DBT ends, many clients go through graduation, where their therapist congratulates and rewards them for completing the workbook and meeting their goals. The time it takes to graduate from DBT is relative and can differ for each client. In groups, clients may still graduate at different times and offer peer support to one another. 

Is dialectical behavior therapy effective? 

DBT can be highly effective for many mental health conditions and challenges. It has been found especially effective for treating borderline personality disorder but has also been effective in studies about anger management and generalized anxiety disorder. 

Counseling options 

Suppose you want to modify an undesirable behavior, learn to be more mindful of the world around you, and cope with distressing emotions. In that case, DBT may be a beneficial treatment for you. You can partake in DBT through group or individual therapy, and some people take part in DBT online for a convenient and cost-effective approach. 

Online DBT can be as beneficial for mental health as in-person therapy. According to studies, online DBT was associated with more remarkable symptom improvement and higher attendance rates than in-person options. With online options often costing hundreds of dollars less monthly than those in-office, clients can often receive the same quality of care without breaking the bank or leaving home. 

If you're interested in trying an online DBT session with an individual or couples therapist, you can sign up with a platform like BetterHelp for individuals or Regain for couples. Both platforms offer opportunities for reaching out to a growing database of licensed therapists specializing in various conditions and modalities.