What is Dialectical Behavior Therapy?
Dialectical behavior therapy (DBT) is an evidence-based treatment for borderline personality disorder and other psychiatric disorders. This intensive long-term program includes individual psychotherapy and group skills training sessions. DBT therapists utilize cognitive-behavioral techniques to teach clients mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness skills.
DBT has four primary goals: to alter unhealthy and unhelpful behaviors, promote self-acceptance, acquire new skills, and receive support from others. It is especially effective for high-risk patients with multiple diagnoses who face challenges that could threaten their safety, relationships, work opportunities or emotional wellbeing.
DBT consists of individual therapy, skills training, on-call telephone coaching and DBT team meetings. This modular and hierarchical approach was initially created for treating BPD but is now widely used to address other mental health problems as well.
DBT stands apart from other cognitive-behavioral approaches by emphasizing the treatment of emotions. DBT therapists are taught to focus on the connection between emotions and behavior through a consistent dialectical philosophy, along with adopting hierarchy-based treatment targets and strategies designed to increase motivation for change.
Function #1: Teaching Skills to Manage Emotions. DBT therapists use a variety of skills training techniques to teach and practice these abilities, such as behavioral analyses (chain analyses and solution analyses), contingency management, and behavioural rehearsal. Clients learn these essential abilities in group settings by two skilled DBT trainers who reinforce them throughout sessions.
DBT therapists also offer structured exercises to their clients in order to help them become better at monitoring and managing their emotions and urges. These tasks may include filling out a diary card, tracking target emotions, and completing specific tasks.
The effects on mood and behavior can be profound. These adjustments often coincide with an enhanced sense of control, enabling patients to take more proactive measures for managing their symptoms.
In a first randomized controlled trial of DBT, parasuicidal women with BPD experienced significantly greater reductions in self-harm and other negative behaviors after DBT than they did when treated by treatment-by-community-experts (TBCE) for six months. At that time, more DBT patients achieved clinical significance than IGST patients had at six months, and at 12 months more DBT patients were free from self-harming behaviors.
Studies have demonstrated the efficacy of DBT in treating a range of mental health disorders, such as major depressive disorder, bipolar disorder, borderline personality disorder, substance use disorder and impulsive, violent or aggressive behavior. Additionally, this therapeutic model has been adapted for individuals suffering from eating disorders or elderly individuals with personality disorders.
DBT therapists are increasingly relying on technological supports such as mHealth apps to deliver treatment, but there are few guidelines about how this can be done effectively and without compromising patient quality of care. These technologies could be an invaluable addition to therapists’ toolboxes and may allow for faster adaptation of DBT for those living in remote or culturally diverse settings.