Dialectical Behavioral therapy (DBT) is an evidence-based therapy that has its origins in cognitive behavioral therapy (CBT). The primary goal of DBT is to help patients build mentally healthy lives by improving their ability to manage their emotions.
Learn more about Dialectical Behavior Therapy, how it works, when to use it, and its core skills.
What is Dialectical Behavior Therapy?
In the 1980s, psychologist Dr. Marsha Linehan noticed that CBT was not suitable for patients who had experienced suicidal behavior, self-harm tendencies, or borderline personality disorder. CBT’s focus on improving feelings by changing thoughts and behaviors overwhelms them. Patients feel ineffective, misunderstood, and criticized, which leads many to drop out of treatment.
Recognizing that some patients require different types of emotional support and skills training, Linehan created Dialectical Behavior Therapy.
If you are having suicidal thoughts, please contact the National Suicide Prevention Lifeline at 1-800-273-8255 for support and assistance from a trained counselor. If you or a loved one are in immediate danger, call 911. For more mental health resources, see our national helpline database.
What does dialectics mean?
In DBT, dialectics means that two opposing views are simultaneously true. Patients with an all-or-nothing or black-and-white attitude are sometimes unable to think otherwise.
DBT emphasizes the dialectics of acceptance and change.
How does it work?
DBT requires a fundamental shift in thinking. DBT therapists work to teach patients necessary skills, such as mindfulness and pain tolerance, to balance their emotions and change their thinking.
DBT changes the way of thinking by teaching people to accept the moment and acknowledge how a person may be feeling at the moment, while still working towards the changes needed to improve their lives.
Here are some examples of DBT thinking:
- Instead: I can’t get out of bed. I’m so tired. I can’t go to work today. On DBT: I don’t want to get up (accepted). Or: I can still get up and go to work. My thoughts won’t control my life – I will (change).
- Instead: I’m a loser. I am worthless. I will never succeed. On DBT: Sometimes I may fail (accept). Or: Sometimes I succeed and I’m sure I’ll do better (change) next time.
- Instead: I’m an idiot. I’ve never done anything right. In DBT: I made a mistake (accepted). Or: I can learn from my mistakes and do better next time. This error does not define me as a person. No one is perfect (change).
DBT core skills
DBT has four main core skills. These include pain tolerance, mindfulness, emotion regulation, and interpersonal efficiency.
Distress tolerance skills
Often, when people are overwhelmed with emotions, they may deal with distressing feelings in a way that helps them feel better in the moment. This may include abusing the drug to numb the feeling or some kind of immediate self-destructive behavior.
But in the long run, these methods can lead to deeper emotional pain. Coping with stress is about learning to manage those overwhelming emotions in a healthier way.
DBT skills to improve pain tolerance include:
- Distraction: Distracting yourself from unhelpful thoughts and emotions
- Total acceptance: accept what you can’t change, focus on what you can change
- Self-Soothing Strategies: Using the Five Senses to Relax and Soothe Yourself
- Safe place visualization: imagine a safe, peaceful place such as a beach or a mountain
- Spirituality: Empowering Yourself with Your Spirituality
The practice of mindfulness is to be aware and focus on the present rather than the past.
Some DBT skills for practicing mindfulness include:
- Focus more fully on the moment.
- Observe your thoughts, emotions, and bodily sensations without judgment.
- Mindful breathing exercises can bring you into the present moment.
- Be kind and compassionate to yourself in mindfulness meditation.
Emotion Regulation Skills
Some people experience extreme emotions that they cannot regulate, usually when there is a history of trauma or when they feel threatened or abandoned.this is called emotional out of balance.
When they are triggered or emotionally overwhelmed, they can become hyperreactive and self-destructive. Using magnetic resonance imaging (MRI), brain researchers have found that people with emotional dysregulation may have the following problems: neural circuit Regulate emotions in the brain.
Some DBT emotion regulation techniques include:
- recognize your emotions
- Recognize how your thoughts and actions affect your emotions
- Identify self-destructive behavior
- increase positive emotions
manage extreme emotions
Emotions are chemical and physical signals in the body that communicate how you’re feeling and what’s going on. Extremely reactive emotions are very effective when a person faces an imminent threat or danger, but not so much in relationships or work. DBT was developed in large part to help people experiencing extreme emotions gain the necessary skills to manage them and improve their lives.
Interpersonal Effectiveness Skills
Interpersonal effectiveness is about improving interpersonal skills. Managing emotions and emotional responses in interpersonal relationships requires setting limits and managing conflict, while also being respectful of others.
Some DBT interpersonal effectiveness skills include:
- Mindful attention to others to understand their thoughts and feelings
- Use assertive behavior instead of passive aggressive behavior
- Make simple requests for what you want while protecting your relationships
- Active listening instead of passive listening
How does a Dialectical Behavior Therapy course work?
Traditional forms of DBT are intensive, requiring patients to work between treatments. The four main components of a DBT session include:
- Individualized treatment once a week.
- Skills training sessions, usually in the form of one to two hours of group therapy per week.
- Consultation check-ins between patients and therapists, outside of weekly meetings, as needed.
- Therapists meet weekly with other DBT-trained therapists for clinical case supervision. They discuss DBT cases for one to two hours a week and get guidance, which also helps clients.
When to use DBT?
DBT was originally created for borderline personality disorder (BPD) and people with suicidal behavior and non-suicidal self-harm who may experience extreme emotions. But it has also been found to be an effective treatment for other mental health problems, including:
- Post Traumatic Stress Disorder (PTSD)
- bipolar disorder
- Attention deficit hyperactivity disorder (ADHD)
- eating disorders such as binge eating and bulimia
- Major Depressive Disorder (MDD)
- substance use disorder
How can DBT help?
In a DBT study, as participants developed more effective emotion management skills, their substance use also decreased. The researchers believe this is because their emotional coping skills improved and they no longer needed to use substances to numb their emotions.
In another study, after the first year of DBT treatment, 77% of patients no longer met the criteria for a borderline personality diagnosis.
Dialectical behavior therapy is a therapy developed from cognitive behavioral therapy. It involves pain tolerance, mindfulness, emotion regulation, and interpersonal skills. Although it is designed for people with suicidal behavior, self-harm and borderline personality disorder, it is an effective treatment for many other mental health disorders.
If you have suicidal thoughts, self-harm or other mental health conditions, you are not alone. Resources can help. If you are interested in exploring or think you could benefit from Dialectical Behavior Therapy, talk with your healthcare provider or mental health professional about referring you to a DBT therapist in your area.