Dialectical Behavior Therapy Explained | E-Counseling.com

Dialectical Behavior Therapy Explained

Emily Mendez M.S., Ed.S.
January 6, 2020

According to the Wall Street Journal, more and more Americans are seeking therapy. That is great, as therapy is an incredibly useful tool that can help with a range of issues. Almost anyone can benefit from therapy sessions. If you’ve started searching for a mental health professional, you might have noticed various acronyms listed under the types of services that they offer, such as EMDR, CBT, etc. So, what do these things stand for? They are used to designate different types of therapy. 

If you’re thinking of getting help from a therapist, it’s important to understand the differences between these various forms of therapy and what kinds of things they treat. In this article, I’ll be shedding the light on one particular type of therapy that has tons of scientific research to back its effectiveness  — dialectical behavioral therapy (DBT). 

What is Dialectical Behavioral Therapy? 

Dialectical behavioral therapy is a form of psychotherapy that was developed in the 1980s by Dr. Marsha Linehan. This therapy was initially designed to treat the symptoms of borderline personality disorder (BPD), which include unstable moods, intense emotions, explosive anger, suicidal ideation, self-destructive behaviors, and an unclear sense of self. Dr. Linehan told the New York Times that she’s suffered from the symptoms of this disorder since her teens. Linehan’s symptoms were so severe, that at the age of 17, she was placed in a facility for severely mentally ill children and teens. The facility indicated in 1963 discharge notes that Linehan was one of the most disturbed patients there. When she was in her early 20s, Linehan used the interventions that define DBT to recover from the disorder herself. She later went on to become a psychologist and develop DBT as a recognized intervention for treating BPD. 

What Is DBT Used To Treat? 

As mentioned above, this therapeutic method was initially developed to address the symptoms of borderline personality disorder. But, in my opinion, it has a far wider range of applications and can be used to help a variety of mental health disorders from relationship problems to social anxiety. Research backs that assertion up. Since its widespread use in the 1980s, scientists have discovered that DBT is incredibly helpful for treating depression, anxiety, eating disorders, and substance abuse disorders

Other research has found that DBT can even be used for things like trichotillomania — an impulse control disorder that involves an irresistible urge to pull one’s own hair, and post-traumatic stress disorder, a trauma-related disorder.

How Effective Is DBT? 

DBT is one of the most effective treatments for borderline personality disorder. Compared to other treatments for BPD, it has shown the most promise in both clinical and research settings. In one well-known study, German researchers examined the effectiveness of DBT on borderline personality disorder. It was found that this therapy significantly improved self-injurious behaviors, reduced the number of inpatient hospital stays, and decreased the severity of borderline symptoms. After 12 months of treatment, 77 percent of the patients no longer met the criteria for a diagnosis of borderline personality disorder.

Dialectical behavioral therapy is also quite effective for other mental health disorders, as well. A research study, published in the Journal of Psychology and Psychotherapy, examined the effectiveness of DBT on depression and anxiety in patients enrolled in a psychiatric partial hospitalization program. It was found that DBT was helpful in treating the symptoms of both of these disorders. 

How Does DBT Work? 

The term dialectical means “to bring opposites together” — and that it what DBT does. It balances opposites. One of the defining features of BPD is called “black and white thinking.” With this type of thinking, the person sees themselves, others, and situations as either all bad or all good. There is no middle ground. This type of thinking is a problem because it leads to strong emotional responses or serious reactions to minor things. Dialectical behavioral therapy addresses this type of thinking. DBT teaches you to identify and change “black and white” thinking patterns. Rather than either-or, you learn to accept that others and situations have both bad and good aspects. 

Dialectical behavioral therapy also helps you learn to better manage painful emotions and better tolerate distress. It is also effective at helping to eliminate unhealthy behaviors, such as impulsivity and substance abuse.  DBT is incredibly helpful in treating self-destructive and suicidal behaviors. This treatment teaches you to replace problematic behaviors with positive ones that help you build stronger interpersonal relations and experiences.

What to Expect 

Wondering what to expect in DBT? It is a bit different than other types of therapy. DBT consists of several different interventions that are used together to manage symptoms. These interventions include: 

DBT skills training groups 

These groups are led by a trained DBT therapist. They typically last about two hours. During these sessions, you learn and practice four key DBT skills alongside other group members. The skills that are taught include: 

  • Distress tolerance – Stress and negative emotions are an everyday part of life. However, people with BPD have a very difficult time tolerating even minor distress. They often resort to self-destructive or impulsive behaviors when under stress. Distress tolerance teaches one to cope with negative emotions, such as anger or sadness, in a healthier way. 
  • Interpersonal effectiveness – Borderline personality disorder is defined by unstable personal relationships. Interpersonal effectiveness helps people with borderline PD and other disorders improve interpersonal relationships. Communication, conflict resolution, and other important relationship skills and taught and practiced. 
  • Mindfulness –  Have you ever felt “stuck in negative emotion and not know how to get out of the emotion? Mindfulness is about staying in the present moment without judging the situation. This can help you move on or let go of difficult emotions rather than remaining “stuck.” 
  • Emotional regulation –  Emotional regulation is one of the most important skills taught during DBT groups. By learning to manage overwhelming and difficult emotions, you can ease emotional suffering and pain. 

Individual therapy

Individual therapy is a big part of DBT. During these 1:1 sessions, individual therapeutic needs are addressed. Common things worked on include unstable self-image, impulsivity, and suicidal behaviors. 

Phone coaching

Phone coaching is an important part of DBT. This is extra support that you can use between individual and group sessions. Phone support can be helpful to have during times of crisis or when you feel overwhelmed. Your therapist will guide you through how to use your DBT skills to overcome whatever challenge or crisis you are facing. 

Tips For Success 

Here are a couple of tips for success for anyone considering DBT. 

  • Be willing to practice – It is not enough to learn the DBT skills. Most people with borderline PD and other disorders already know how to manage emotions and cope in healthier ways. It’s implementing these skills that is a problem. For DBT to work, you have to be willing to practice the skills, so that you can use them when the time is right.
  • Be committed – Borderline personality disorder was often seen as one of the more difficult disorders to treat. But, newer research finds that people with the disorder do get better. One of the key aspects that determine the outcome of treatment is your commitment. It will be difficult at times. But, you must be willing to complete therapeutic “homework” on your own, attend sessions regularly, and so forth. This is true of depression, anxiety, and other disorders, as well. Getting better takes a lot of time outside of therapy sessions. 

How To Know If DBT Is Right For You

Dialectical behavioral therapy was created for people with borderline personality disorder, as mentioned above. However, it has shown promise at treating a range of conditions. This type of therapy can be applied to all ages, from adolescence through adulthood. With that being said, the very best way to know if DBT is the best treatment for your particular issue to talk with a mental health professional. 

What To Look For In A DBT Therapist 

For DBT to be effective, the therapist should be skilled at basic behavior therapy techniques and DBT treatment strategies. Look for a mental health professional with experience and specialized training in DBT. I would recommend choosing a clinician who has the DBT®-Linehan Certification. This ensures that they are skilled in DBT interventions and methods. 

In addition, it is important to find a therapist with whom you feel comfortable working. Look for someone who you find trustworthy and likable. DBT is a more intensive treatment, as it involves both groups and individual sessions, so make sure they have the availability to help you, as well. 

The Bottom Line 

Although dialectical behavioral therapy was developed to treat borderline personality disorder, it can help anyone who is struggling with emotional control, impulsive behaviors, self-harm, and interpersonal problems. The skills taught in DBT can help you learn to react to stressful emotions and events in a more positive, productive ways. Just remember that for DBT to be effective, you must be willing to commit to using the skills taught during sessions. 

Emily Mendez M.S., Ed.S.

Emily Mendez received an Ed.S and Masters degrees in counseling from Indiana University. She is a mental health writer and expert in the areas of mental health and substance abuse. As a former private practice psychotherapist, Emily specialized in treating adults and children suffering from depression, anxiety disorders, PTSD, and substance abuse.