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What is Dialectical Behavioral Therapy?

Updated: Nov 16

What is dialectical behavior therapy?

Dialectical behavioral therapy (DBT) is an evidence-based psychotherapy, developed in the 1970s by American psychologist Marsha Linehan. Through dialectical behavioral therapy, you learn two opposing strategies - the ability to accept your thoughts, feelings, and behaviors, and how to change them in a way that enables you to wholly live the life you desire. It has roots in cognitive behavioral therapy (CBT). However, while cognitive behavioral therapy focuses on learning how to change thoughts and behaviors an individual finds unhelpful, dialectical behavior therapy simultaneously focuses on accepting your thoughts, feelings, and behaviors and techniques to change them.


The Four Stages of Dialectical Behavioral Therapy

DBT has four stages of treatment, which are defined by how severe your symptoms are. In stage one, you may frequently feel miserable and find your behavior uncontrollable. The goal of stage one is for you to come to a place where you feel you are in control of your behavior. In stage two, you may find that though you have control over your behavior, you are continuing to suffer emotionally. The goal is for you to move from a place of hopelessness and distress to emotional healing. In stage three, you will learn to live life on your terms by defining your goals, growing your self-confidence and self-respect, and finding peace. The goal is for you to live a life of ordinary happiness and unhappiness. Some people, but not all, will go through stage four, in which you will discover a deeper meaning for your life through your spiritual existence.


The Four Skills of Dialectical Behavioural Therapy

The four core skills taught in dialectical behavioral therapy are distress tolerance, mindfulness, emotional regulation, and interpersonal effectiveness. Distress tolerance refers to the process of learning how to cope with a crisis and accepting a situation as it is, particularly when you may be unable to change it. Mindfulness refers to the process of being fully present in the moment, acknowledging your thoughts and feelings without judgment. Emotional regulation is the ability to effectively process your emotions so that they do not gain control over your thoughts and behaviors. Interpersonal effectiveness refers to your ability to build and maintain healthy relationships, including boundary-setting and effectively communicating your needs.


How is Dialectical Behavioural Therapy Delivered?

Dialectical behavioral therapy is commonly delivered in four ways: individual therapy, group therapy, in-the-moment coaching, and consultation teams. Individual therapy sessions typically occur weekly, with the clinician collaborating with you to learn and apply dialectical behavior therapy skills to the challenges you are facing. When available, individual therapy sessions run concurrently with group therapy sessions. In group therapy, the four skills are taught (distress tolerance, mindfulness, emotional regulation, interpersonal effectiveness), generally over a span of twenty-four weeks. Group leaders will assign homework for you to practice throughout the week. Some clinicians may offer in-the-moment coaching, where the therapist will meet with you over the telephone or virtually to actively offer support as you apply dialectical behavioral therapy skills to cope with a challenging event or situation. Consultation teams offer support to clinicians as they work to monitor the effectiveness of their treatment and develop and improve their professional skills.


Who Could Benefit from DBT?

Dialectical behavioral therapy was originally developed for individuals with borderline personality disorder. Since its development, it has also been proven to be effective in treating a number of other concerns, including suicidal ideation, self-harm, substance use, eating disorders, posttraumatic stress disorder (PTSD), depression, attention deficit hyperactivity disorder (ADHD), and bipolar disorder. Additionally, research has proven it to be beneficial to individuals from diverse backgrounds regarding age, gender, sexual orientation, race, and ethnicity.


References

Chapman, A. L. (2006). Dialectical behavior therapy: current indications and unique elements. Psychiatry (Edgmont), 3(9), 62–68.

Core Evidence and Research. (2022). Core Evidence and Research. Behavioural Tech. https://behavioraltech.org/research/evidence/

Dialectical Behavioural Therapy (DBT). (2022). Dialectical Behavioural Therapy (DBT). CAMH. https://www.camh.ca/en/health-info/mental-illness-and-addiction-index/dialectical-behaviour-therapy

What is Dialectical Behaviour Therapy (DBT)? (2022). What is Dialectical Behaviour Therapy (DBT)? Behavioral Tech. https://behavioraltech.org/resources/faqs/dialectical-behavior-therapy-dbt/

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