Dialectical Behavior Therapy (DBT) is Dr. Marsha Linehan’s adaptation of cognitive behavioral therapy (CBT) with the primary goal of providing individuals with relevant coping skills for their daily lives. With radical self-acceptance at the core of DBT work, all-or-nothing thinking patterns are discouraged. Instead a middle path of thinking patterns, behaviors, and approaches to life is fostered.  

As such, this modality has been very helpful in treatment with:

  • Suicidal and self-harming adolescents
  • Pre-adolescent children with severe emotional and behavioral dysregulation
  • Major depression
  • Posttraumatic stress disorder related to childhood sexual abuse
  • Borderline personality disorder/symptoms
  • Narcissistic/antisocial/histrionic personality disorders
  • Attention deficit hyperactivity disorder (ADHD)
  • Bipolar disorder
  • Transdiagnostic emotional dysregulation
  • Binge eating disorder
  • Bulimia nervosa

In DBT, clients learn:

  • Mindfulness
  • Interpersonal effectiveness
  • Emotional regulation
  • Distress tolerance

Comprehensive DBT is an in-depth, very intensive program. Sessions of comprehensive DBT are aimed at teaching mindfulness, interpersonal effectiveness, emotional regulation, and distress tolerance. In order to be considered comprehensive DBT a program must include four modes of treatment:

  1. Individual therapy to increase motivation
  2. Group sessions to enhance skill capabilities
  3. Phone coaching in order to make skills more applicable to one’s environment
  4. Therapist consultation meetings to enhance the therapist’s capability of being the best clinician possible. 
  5. (Optional) Usually, a fifth mode of family work or psychoeducation is added into the program to maximize its benefits. 

Clients move through 4 Stages of personal growth.

Stage 1 – moving beyond being out of control to achieving behavioral control

Stage 2 – moving toward being able to experience emotions fully

Stage 3 – becoming able to solve ordinary life problems

Stage 4 – moving toward completeness

DBT Informed Therapy, on the other hand, usually involves an individual therapist utilizing similar principles without the client undergoing all of the heavily structured modalities of a full program. The therapist used the methods deemed most beneficial for a client and may coordinate care with another family therapist or Couples Therapist or child therapist as appropriate. Individuals who demonstrate less severe symptoms will often benefit from this more flexible approach to DBT. 

DBT often works when other forms of psychotherapy or psychopharmacology have not been effective for clients. Research suggests there is a low level of “dropout” from DBT, and thus can be extremely advantageous for the treatment of individuals who could benefit from learning to recognize and manage their emotional states.

Research and writing credit: Ally Blue