What is DBT?

Dialectical Behavioral Therapy (DBT) is a type of cognitive behavioral therapy developed by Marsha Linehan at the University of Washington. Cognitive Behavioral Therapy attempts to help individuals identify and change mistaken or unhelpful thinking patterns and encourages clients to make positive behavioral changes. While DBT is most commonly associated with personality disorders (most notably Borderline Personality Disorder), it can be helpful for a wide range of mental health diagnoses that are characterized by emotional reactivity, suicidal thoughts, suicidal behaviors, self-injury, and other self-destructive patterns. DBT teaches clients skillful behaviors that they can utilize when faced with a distressing or self-destructive urge.

“Dialectical” means to “bring two ideas together.” Often these are ideas that might seem to be complete opposites, such as acceptance vs change, or fear vs love. Persons with Borderline Personality Disorder often struggle with “Black or White thinking” which leads to an “all or nothing” attitude. These are ideas and concepts that people may struggle with reconciling, and which may cause them severe psychological distress. This type of approach to life makes situations into a zero sum game where the individual rarely wins. By learning how to achieve a balance between dichotomous concepts, behaviors, and urges, individuals are better able to 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.

The four modules of DBT skills work are:

  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 can help individuals find more helpful and fulfilling ways to navigate relationships, jobs, and tasks of daily living that may have seemed daunting or impossible before. There is strong evidence that shows that DBT can reduce suicidal behavior, reduce hospital visits and inpatient stays, can help improve social functioning, and can help individuals stay motivated for, and progress in, treatment.

DBT is most likely to be effective for you if you are committed to:

  • Making positive changes in yourself
  • Working hard and progressing in therapy
  • Focusing on your present and your future instead of the past
  • Working with others in group sessions

Group processing is an important element of DBT. Since everyone experiences situations, thoughts, and ideas differently, group feedback and validation are important as you try out new skills and behaviors as a way to “check in” with how they are working. Your group members may notice things about you that neither you nor your therapist had even considered.

Thousands of people the world over have been able to make use of the skills learned in Dialectical Behavioral Therapy to live fuller, more integrated, more satisfying lives. DBT skills can help individuals be less emotionally reactive, less impulsive, less self-destructive, and less isolated. DBT skills can help individuals more effectively navigate the challenges of life and attain the goal of community acceptance and belonging which is common to all humans. While DBT may not be the answer for everyone, it can be highly effective for those who choose to learn and utilize the skills and integrate them into their daily lives.