Dialectical Behavior Therapy (DBT)

🧠 What is Dialectical Behavior Therapy?

Dialectical Behavior Therapy (DBT) is a type of cognitive-behavioral therapy (CBT) developed in the late 1980s by Dr. Marsha Linehan. It was originally created to treat Borderline Personality Disorder (BPD) but has since been adapted for many other conditions.

DBT focuses on helping people:

• Manage intense emotions

• Reduce self-destructive behaviors

• Improve relationships

• Build a life worth living

🧩 The Term “Dialectical”

The word "dialectical" refers to the idea of two seemingly opposing things being true at once—in DBT, this is usually:

Acceptance and Change

For example:

“I am doing the best I can” AND “I need to do better.”

This balance helps clients feel validated while still working toward growth.

🏛️ Core Components of DBT

DBT is made up of four key components:

1. Individual Therapy

• Weekly one-on-one sessions

• Focus on the client’s specific problems and goals

• Helps apply DBT skills to daily life and build motivation

2. Skills Training Group

• Like a classroom: usually weekly 2-hour sessions

• Clients learn and practice DBT skills

• Often runs in cycles of 6 months

3. Phone Coaching

• Clients can call their therapist between sessions

• Helps apply skills in real-life, high-stress moments

4. Therapist Consultation Team

• Therapists also meet regularly for supervision

• Supports the therapist emotionally and intellectually

📘 The 4 DBT Skills Modules

These are the core skills clients learn and practice:

1. Mindfulness

“Be here now.”

• Being fully present in the moment

• Observing thoughts and feelings without judgment

• Foundation for all other DBT skills

Key skills:

• Observe

• Describe

• Participate

• Non-judgmentally

• One-mindfully

• Effectively

2. Distress Tolerance

“Survive the crisis without making it worse.”

• Skills to tolerate painful emotions and situations

• Focus on acceptance, not change

Key skills:

• TIPP (Temperature, Intense exercise, Paced breathing, Progressive relaxation)

• Distract with ACCEPTS

• Self-soothe

• Radical acceptance

• Pros & cons

3. Emotion Regulation

“Understand and manage intense emotions.”

• Learn what emotions are and how they work

• Reduce vulnerability to negative emotions

• Increase positive emotions

Key skills:

• Identifying and labeling emotions

• PLEASE (treat Physical illness, Eat balanced, Avoid mood-altering drugs, Sleep, Exercise)

• Opposite action

• Check the facts

4. Interpersonal Effectiveness

“Maintain relationships while respecting yourself.”

• Build and maintain healthy relationships

• Set boundaries and assert needs

• Maintain self-respect

Key skills:

• DEAR MAN (Describe, Express, Assert, Reinforce, Mindful, Appear confident, Negotiate)

• GIVE (Gentle, Interested, Validate, Easy manner)

• FAST (Fair, Apologies (no over-apologizing), Stick to values, Truthful)

🧠 Who Can Benefit from DBT?

While originally for Borderline Personality Disorder, DBT is now used for:

• Emotion dysregulation

• Chronic suicidality

• Self-harm

• Eating disorders (especially binge eating & bulimia)

• PTSD

• Substance use disorders

• Depression

• Anxiety

• ADHD

🔬 Evidence-Based Success

Numerous studies have shown that DBT:

• Reduces suicide attempts

• Decreases hospitalization

• Improves emotion regulation and interpersonal functioning

• Increases quality of life

It’s one of the most researched and validated therapies available today.

🧭 Structure of a Typical DBT Program

A full DBT program (often 6 months to 1 year) may include:

• Weekly individual sessions (45–60 min)

• Weekly group skills training (2 hrs)

• As-needed phone coaching

• Optional family sessions

Clients often complete more than one cycle to fully internalize the skills.

💬 Real-Life Application

DBT isn’t just about talking—it’s about doing. Clients track behaviors, practice skills with homework, and actively problem-solve in therapy. Over time, they learn to:

• Pause before reacting

• Make mindful decisions

• End destructive cycles

• Respond instead of react