Mental health conditions can be challenging to treat and often involve problematic ways of thinking and behaving. Several types of therapy can address these symptoms and improve a patient’s quality of life and level of functioning. Dialectical behavior therapy (DBT) is one such type of therapy that can effectively address a range of psychiatric conditions. There are several strategies and methods for delivering DBT therapy. Learning the history of and current processes used in DBT can help determine if DBT might be an appropriate therapy for someone that is suffering from a difficult-to-treat mental health condition.
What Is Dialectical Behavior Therapy (DBT)?
Dialectical behavior therapy combines elements of many typical behavioral therapies, like cognitive behavioral therapy (CBT) and mindfulness practices. Dialectical behavior therapy aims to balance two ideas that seem to be opposites: acceptance of the present and the desire to change.
DBT therapy helps patients accept current circumstances without judgment and develop skills and strategies to change thoughts and behavior in a helpful way. Acceptance is a unique component of this therapy that can help patients feel more in control of and at peace with their current symptoms and life circumstances.
Marsha Linehan and the History of DBT
The history of DBT began when clinicians in the 1970s failed to see improvements in their suicidal patients when using traditional cognitive and behavioral treatments. Patients were frustrated by the focus on change without acknowledgment of their present symptoms or circumstances. Therapy that was focused only on making dramatic changes caused patients to disengage during treatment and prevented them from improving.
As a result, DBT was originally developed by psychologist Dr. Marsha Linehan and was initially used in patients who were chronically suicidal. DBT was developed based on the concept that people with mental illness might lack skills like emotional regulation or the ability to manage distressing situations. They also might be in circumstances that keep them from using any helpful skills or coping strategies that they do have.
To address this, DBT was developed to include a focus on acceptance of the present, while still aiming to make positive changes. An emphasis on accepting the present was included to acknowledge the patient’s current situation and symptoms, which, in turn, increases their willingness to change.
DBT Versus CBT
Although CBT and DBT share similar strategies, there are also key differences. Cognitive behavioral therapy is a broad category of therapy, and DBT is a type of therapy within this category.
CBT aims to help patients identify and change unhelpful thought patterns. This type of therapy focuses on disrupting negative thinking using logic and reason and teaches patients how their thoughts impact their behavior. These skills have been shown to be helpful in treating certain mental illnesses, like depression or anxiety.
While DBT also utilizes some of these methods, DBT includes more acceptance and mindfulness strategies. DBT can specifically help patients who tend to experience extreme emotional responses. The main difference in DBT vs. CBT is that DBT includes more acceptance-based practices that help regulate emotional responses.
What Is Dialectical Behavior Therapy Used For?
Although originally designed for people who were chronically suicidal, DBT is now used for a range of mental health conditions. Dialectical behavior therapy can be used for:
- Borderline personality disorder
- Hard-to-treat behavioral and emotional disorders
- Binge eating disorder
- Substance use disorders
- Suicidality in adolescents
DBT can be used for many mental health conditions, as it teaches acceptance of the present, whatever that may look like for a patient. DBT also includes strategies to adjust unhelpful thought patterns and behavior, which are common in many mental health conditions. While DBT can and should be tailored to an individual’s condition, its therapeutic concepts are beneficial in many settings.
How DBT Works
There are several dialectical behavior therapy techniques that help a patient move through different stages of treatment. DBT first aims to stabilize a patient and remove immediate threats. Additional techniques help patients improve functioning and work toward improving their overall well-being.
The following 4 DBT modules or techniques are used in DBT therapy:
- Mindfulness: The practice of dialectical behavior therapy mindfulness helps bring attention to the present moment. Mindfulness is non-judgmental and brings awareness to how an individual contributes to their current situation and experiences.
- Distress Tolerance: Through mindfulness and other exposure techniques, patients learn to sit with discomfort and recognize that it is tolerable. DBT distress tolerance helps patients develop a less extreme response to distress and produce a different response to difficult situations.
- Interpersonal Effectiveness: DBT interpersonal effectiveness helps teach patients how to manage and maintain relationships. These can include skills like listening, flexibility or being dependable. This training can help patients in their romantic, social and professional relationships and improve their general level of functioning.
- Emotion Regulation: With improved awareness about how patients react to distress, DBT can help patients better regulate their feelings and reactions. DBT emotional regulation can alter how patients see their illness or circumstances. This altered perspective can help them change the meaning of certain situations from bad to good or neutral.
Effectiveness of DBT
DBT is an evidence-based and effective type of therapy for complex mental disorders. There is good evidence to support that DBT is effective in treating several types of mental health conditions. Studies show a reduction in suicidality, depression, and borderline personality disorder symptoms in individuals who undergo DBT.
DBT effectiveness lies in its ability to alter how a patient processes their symptoms and experiences. This improved perspective can allow them to adjust their behavior and thinking in a helpful way. On top of improving patient symptoms, DBT has been shown to improve functioning and social adjustment.
4 Modes of DBT
There are different DBT modes and components designed to support a patient through treatment. There are several components of DBT that help teach patients new skills and support their learning.
- Individual Therapy: DBT individual therapy is an opportunity for the therapist and patient to connect, and for the patient to learn the skills and techniques used in DBT. Individual therapy can be used to identify problems unique to the patient and solve them by changing behavior. Individual therapy can also be helpful in setting DBT treatment goals and objectives for the patient and therapist.
- Group Skills Training: DBT group training includes group sessions where patients focus on learning new skills like mindfulness or active listening. These sessions give people the opportunity to engage with others and practice skills and techniques that can help in recovery.
- Phone Coaching: DBT phone coaching can be used to help a patient to encourage skills and techniques in therapy settings to a person’s usual environment. The phone is also used as a coaching tool to help patients manage crises.
- Consultation Team: A DBT consultation team approach is often taken, as a way to also monitor and modify a therapist’s behavior as they help a patient through DBT. This team uses DBT concepts to help keep the therapist motivated.
DBT in South Florida
DBT is a common psychological therapy that can be administered by a certified psychiatrist, psychologist or other mental health professional. DBT therapy is available at certain clinics throughout Miami and South Florida. DBT can be part of inpatient or outpatient therapy, depending on the severity of illness.
How The Recovery Village Palm Beach Can Help
The Recovery Village Palm Beach offers personalized, evidence-based treatments for substance use and related mental health disorders. The Recovery Village offers evidence-based therapies for addiction and co-occurring mental health conditions and has same-day approval and admissions to help patients begin their recovery.
If you or someone you love is suffering from a substance use disorder and related mental health condition, contact The Recovery Village today to discuss treatment options.
Panos, Patrick T. “Meta-Analysis and Systematic Review Assessing the Efficacy of Dialectical Behavior Therapy (DBT).” Research on Social Work Practice, September 19, 2013. Accessed July 10, 2019.
Dimeff, Linda, Linehan, Marsha M. “Dialectical Behavior Therapy in a Nutshell.” The California Psychologist, 2001. Accessed July 11, 2019.
Kliem S, Kroger C, Kosfelder J. “Dialectical behavior therapy for borderline personality disorder: a meta-analysis using mixed-effects modeling.” Centre for Reviews and Dissemination, 2010. Accessed July 12, 2019.
Swales, Michaela A. “Implementing DBT: selecting, training and supervising a team.” The Cognitive Behaviour Therapist, June 15, 2010. Accessed July 12, 2019.
Pistorello, Jacqueline et al. “Dialectical behavior therapy (DBT) applied to college students: a randomized clinical trial.” Journal of consulting and clinical psychology, June 25, 2012. Accessed July 12, 2019.