What is DBT (Dialectical Behavior Therapy)?
Dialectical Behavior Therapy (DBT) is a form of psychotherapy or talk therapy designed for individuals who experience intense and distressing emotions. DBT is evidence-based, meaning there has been a significant amount of research supporting its benefit for individuals with certain mental health concerns. Dialectical behavior therapy is considered the primary treatment for people with Borderline Personality Disorder, also known as BPD. This type of talk therapy can also be beneficial for people with substance use disorders, eating disorders, anxiety disorders, depression, and Post-Traumatic Stress Disorder (PTSD).
The core purpose of DBT involves effectively managing uncomfortable emotions, engaging in fewer harmful or self-destructive habits, enhancing communication with others, and generally improving relationships. Individuals who participate in DBT build and practice four main skills, which we will cover in this article. We will also discuss what DBT sessions often look like, how long they take, and what age groups are most appropriate for this treatment.
Core skills
The first skill addressed as part of DBT is mindfulness. This involves guiding individuals in bringing their mind to the present moment, then acknowledging and accepting any thoughts they have. People who practice these habits regularly will gain the ability to remain level-headed in the face of difficult emotions, negative thoughts, and trying situations.
Mindfulness relates to the next DBT skill: distress tolerance. Mindfulness is one way people can practice this second skill, but distress tolerance is much broader and involves finding what works for you. Some individuals may choose distraction techniques such as watching a funny TV show or spending time with friends, while others may use more direct self-soothing such as deep breathing or Progressive Muscle Relaxation.
Next is emotion regulation, a more education-based skill. Providers begin this part of DBT by teaching individuals how to identify and understand the full range of their emotions, which is key in knowing how to best respond to them. Emotion regulation training also involves learning how to seek out tasks that build positive emotions, making negative emotions feel less intense, shifting perspective to prevent emotions from impacting your life in a bad way, and using positive coping strategies.
Last is interpersonal effectiveness, which involves managing the effects of emotions on interactions with others. As part of DBT, individuals will practice assertively expressing their wants and needs, setting healthy boundaries with those around them, and communicating their emotions in a positive way. This will not only help individuals with intense emotions connect with others, but can also improve their ability to navigate difficult social situations.
Therapy format
As with many types of talk therapy, a large portion of Dialectical Behavior Therapy is provided through individual sessions. However, a core component of DBT is practicing interpersonal effectiveness. This means group therapy sessions are also important in helping someone achieve the proper outcomes from this modality. You can expect individual DBT sessions to take place once each week and last between 45 and 60 minutes. These sessions incorporate training and education related to the core skills with a focus on addressing personal safety and managing unsafe behaviors that may impact a person’s well-being.
DBT group therapy involves sessions with individuals who have similar difficulties. This may mean that your therapy group consists of people of various backgrounds, ages, and mental health diagnoses. But therapists intentionally design these groups so that all individuals can benefit from working together with peers. Group sessions traditionally take place once per week, but are often a bit longer (between 1 and 3 hours) to help individuals work toward a common goal. DBT programs may last between 12 and 24 weeks, depending on how long each group session is and the specific clinic protocols.
Individuals participating in talk therapy using DBT may also have the option of virtual consultations with their provider throughout the program. This allows someone to informally check in with their mental health professional – usually over the phone or via video call – outside of individual and group sessions to see how they are feeling, discuss homework, and answer any questions they may have. This type of brief visit is intended to ensure someone is still committed to the program, making progress, and feels supported in their efforts.
Homework
Homework is an important part of success with DBT. Homework may involve completing worksheets, making lists of uncomfortable thoughts or difficulties, journaling, or other practice of skills taught during sessions. Specific homework assignments will depend on the provider as well as each person’s needs, goals, and areas of focus. Most often, homework is given after each individual therapy session. Those participating in DBT may be asked to do some of the following for homework:
Keep an emotion diary
Practice the concept of radical acceptance in response to unchangeable situations
Use urge surfing techniques to avoid harmful behaviors
Go through the DEARMAN steps when communicating with others
Use TIPP strategies for distress tolerance
Populations
While DBT is helpful for many mental health concerns, there are some individuals who are not a good fit for this program. Since DBT is a talk therapy modality, individuals should be able to follow basic directions and participate in discussions with their provider in order for sessions to go smoothly. In order for DBT to work as intended, individuals should also be aware of their strengths as well as what areas they can improve upon. Therefore, DBT is not recommended for individuals with cognitive conditions that prevent them from following along. People with psychotic disorders (or other conditions that cause a disconnect from reality) will also likely have difficulty with many of DBT’s core skills.
Age ranges
Traditional Dialectical Behavior Therapy is a good fit for adults over the age of 18. Experts have recently adapted the program to develop new versions that are more suitable for younger individuals. Dialectical Behavior Therapy for Adolescents (DBT-A) is designed for teens between 13 and 18 years of age, while Dialectical Behavior Therapy for Children (also called DBT-C) is ideal for children as young as 6 years. These modified versions allow more individuals to benefit from DBT and learn how to manage uncomfortable emotions that many people may experience.
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References:
Chapman A. L. (2006). Dialectical behavior therapy: Current indications and unique elements. Psychiatry (Edgmont (Pa.:Township)), 3(9), 62–68.
Gillespie, C., Murphy, M., Kells, M., & Flynn, D. (2022). Individuals who report having benefitted from dialectical behaviour therapy (DBT): A qualitative exploration of processes and experiences at long-term follow-up. Borderline Personality Disorder and Emotion Dysregulation, 9(1), 8. https://doi.org/10.1186/s40479-022-00179-9
May, J. M., Richardi, T. M., & Barth, K. S. (2016). Dialectical behavior therapy as treatment for borderline personality disorder. The Mental Health Clinician, 6(2), 62–67. https://doi.org/10.9740/mhc.2016.03.62
Therapist Aid. (n.d.) DBT Worksheets. Retrieved from https://www.therapistaid.com/therapy-worksheets/dbt/none?page=1
