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June 7, 2024


What is Dialectical Behavioral Therapy (DBT)?

At its heart, DBT is about acceptance and change.

Thirty-year-old “Vanessa” had just broken up with her partner. She struggled with depression, low self-esteem, lack of motivation, and feelings of helplessness. Together, we created strategies based on DBT. She learned mindfulness–the ability to observe her own emotional experience–noting the frequency, intensity, and duration of emotions, along with cyclical spirals. This led to the ability to use emotional regulation like breathing techniques and progressive muscle relaxation to self-soothe. Then we delved deeper into relationship patterns. Vanessa learned how her core beliefs (“I’m not ok, unless you’re ok”) led to unrealistic expectations. We practiced assertive communication using DEARMAN: Describe, Express, Assert, Reinforce, Mindfully ask, Appear confident, and Negotiate. Vanessa now has improved self-esteem, the skills to manage her relationships, and she expresses her feelings, including: “I’m ready to date again!”

Dialectical Behavioral Therapy (DBT) is a type of Cognitive Behavioral Therapy (CBT). CBT attempts to help individuals identify and change negative or unhelpful thinking patterns and make positive behavioral changes. While DBT is most commonly used to help with personality disorders, most notably Borderline Personality Disorder, it has been proven useful for a wide range of mental health conditions characterized by emotional reactivity, suicidal thoughts and behaviors, self-harm, and other destructive patterns. DBT, developed by Marsha Linehan at the University of Washington, teaches clients behaviors to better cope with distressing thoughts or self-destructive urges.

Dialectical means to “bring two ideas together.” Often these are ideas that might seem to be complete opposites, such as acceptance versus change or fear versus love. People often struggle with “black or white thinking,” or “catastrophizing,” which can lead to an “all or nothing” attitude, and may cause ongoing psychological distress.

Learning how to achieve a balance between opposite concepts, behaviors, and urges allows individuals to better tolerate and navigate emotional distress as it comes up in their lives. Dialectical thinking can help people see that problems can be “both–and” rather than “either–or.” At its heart, DBT is about acceptance and change.

There are four components of DBT:

  1. Mindfulness – promoting self-acceptance and non-judgement
  2. Distress Tolerance – how to cope with the emotional pain of challenging situations and letting go of how things “should be”
  3. Emotional Regulation – how to work through intense emotions and use strategies and skills to regulate them
  4. Interpersonal Effectiveness – how to problem solve, maintain relationships, and maintain self-respect

DBT skills have been proven to:

  • Help individuals find more helpful and fulfilling ways to navigate relationships, jobs, and daily tasks that may have seemed daunting or impossible before.
  • Improve social functioning.
  • Keep people motivated in treatment and further their progression in treatment.
  • Make people feel less emotionally reactive, less impulsive, less self-destructive, and less isolated.

The skills learned in DBT can help people to live fuller, more integrated, and more satisfying lives and promote community acceptance and belonging. If you are committed to making positive changes in yourself, working hard and progressing in therapy, and focusing on your present and future rather than the past, DBT may be helpful to you.

Interested in exploring DBT in therapy? Foresight can help.