When we try to navigate the world of mental health treatment, we get accosted by acronyms.  CBT, DBT, EMDR, TF-CBT…OMG!  Often we hear someone talking about a great new treatment (insert your acronym of choice here), and we think it might help us.  Here are the basics on one of those bits of alphabet soup: DBT.

What is DBT?

Dialectical Behavior Therapy, or DBT was originally developed by Marsha Linehan1 in the late 1980s as a way to treat and help manage the symptoms of Borderline Personality Disorder. The therapy was featured in TIME’s 100 New Scientific Discoveries book in 2016.

The Dialectical part, or the “D” in DBT, is a Buddhist concept of opposing forces. For example, someone who was sexually abused by a parent might feel both love and hate for that parent at the same time. That is a hard dichotomy to experience, and the dialectical part teaches us to sit calmly with those warring forces inside of our brains.

Article continues below

Concerned about Borderline Personality Disorder?

Take our 2-minute quiz to see if you may benefit from further diagnosis and treatment.

Take BPD Quiz

The Behavior Therapy (“BT”) refers to the use of principles of Cognitive Behavioral Therapy, or CBT, such as the idea that we all have thoughts that cause us to have emotions, which then cause us to act on those emotions. Take, for instance, when someone cuts you off in traffic and you think, “That person put me in danger (and other expletives)!” That thought causes you to be angry and scared, which then causes you to honk your horn or show that driver one of your fingers.

What Does DBT Involve?

This is the part where things get a bit controversial. True DBT (or DBT the way Marsha Linehan designed it)2 involves group and individual therapy every week, as well as 24-hour phone coaching. The group provides a place where participants learn DBT skills, which teach different ways of coping with emotions and complicated life situations.

In individual therapy, a therapist reviews something called a Diary Card with the client. The Diary Card is a means to track your emotions throughout the week, identify what DBT skills you used, and determine if they worked. The therapist will then work with you to determine how you might have struggled in using your skills and help you figure out how to avoid those pitfalls in the future. The phone coaching is offered as a relatively short phone call with a therapist, if you need it, to coach you though using your skills in a given situation.

For example, let’s say you were attending a family event, and your family is one that puts the “fun” in dysfunctional.  You are chatting with your relative, who is telling you how great it would’ve been if you had been put up for adoption.  You stand there, fighting the urge to punch your relative in the throat.  Instead, you call the phone coaching hotline. The therapist suggests splashing your face with some icy cold water (a skill called TIP).  You hang up and go try it. It is not individualized phone therapy, but rather, a tool to coach you through the skills you are already learning. True DBT offers phone coaching 24 hours per day, 7 days a week.

What Should I Expect if I Agree to Try DBT?

This is your opportunity to be an informed consumer!  If you are looking into a DBT program, make sure it has all of the True DBT components noted above. Many therapy groups and mental health clinics say they are offering DBT, but do not offer individual therapy. Others include individual therapy, but it is only offered once per month. If you are seeking DBT, it should include individual therapy weekly, group therapy weekly, and phone coaching.

The phone coaching may not necessarily be with your individual therapist, but it should be available from someone who is trained in DBT. If an agency is telling you that you can call the crisis line instead of getting phone coaching, you are not getting comprehensive DBT. Many facilities do not offer comprehensive DBT, because it requires a great deal of time on behalf of the therapists.  Also, the training is expensive.  Often facilities cut corners and do not put therapists through the proper training.  Crisis workers generally are not trained to coach you through DBT skills.

It usually takes about six months to get through all the modules, which are described below, and most organizations will ask you to commit to participating in the full program for a year before they will accept you. One year of DBT will get you through all of the modules twice, and you should be very secure in your skills at the end of that year.

It is not necessary for you to go through all the skills twice, but doing so helps you to make sure you understand them fully and are able to use them in all kinds of situations without coaching.  Many agencies will also have you start completing diary cards before you start the group so that they can see that you are committed to the treatment. You may also have to sign an agreement that says you will complete one year of treatment before you can start the group. All of these expectations are normal parts of a DBT program, so do not be surprised if you see them.

There are also usually attendance requirements for therapy, and you will be removed from DBT if you miss too many sessions.  Agencies require attendance in group therapy, because it is in the group that you learn the skills.  Insurance nearly always covers both group and individual therapy as part of this program, but many insurers will require that you have group and individual therapy on different days. If you miss group, you miss the information just as if you missed a class in school.  Too many missed groups will leave you unable to catch up with the material.  Also, as with any type of therapy, it is only effective if you show up.

Make sure your therapist has been through a DBT training provided through Behavioral Tech, which is the company founded by DBT’s developer. (You can access a partial list of DBT-trained therapists here.) Or visit Psychology Today to research therapists. Be sure to inquire how potential therapists were trained in DBT. Some places provide certification in DBT, but certification is not necessary to be a qualified therapist. The most important thing for you to find is someone trained directly from the source and not taught second-hand.

What Will I Learn?

DBT has four modules: Mindfulness, Interpersonal Effectiveness, Emotion Regulation, and Distress Tolerance.  Mindfulness is the core of everything else in DBT. You will learn how to practice mindfulness, which is really just about being focused on the present rather than lost in your head about what might happen in the future or what has happened in the past.  Sometimes, mindfulness practice includes meditation, but there are lots of ways to practice, which you will learn about in your group. The goal is to gain control over your mind and not have it run off without you. In between each of the other modules, you will complete another mindfulness module.

Interpersonal Effectiveness skills teach you to navigate difficult interpersonal situations. You will also learn how to modulate the intensity with which you assert yourself based on a given situation. For example, you might learn to be very assertive when returning a defective item to a store but less assertive in saying no to a friend asking for help, because preserving the friendship is more important to you than achieving a goal. You will also learn how to have a difficult conversation with someone without damaging the relationship and how to assert yourself in situations involving your self-respect.

The Emotion Regulation module teaches you ways to manage your emotions in different types of situations. You will learn how to identify what you are feeling, how to determine if your emotions align appropriately with the current situation, and what to do if your emotions do not align appropriately. In addition, you will discover ways to better manage your emotions on a regular basis.

In Distress Tolerance, you will learn how to handle stressful situations. The tools you gain in this module include how to calm yourself down when you feel like your emotions are overwhelming you, techniques to manage ongoing stressful situations, and when to try to use problem-solving skills.

Is DBT Right for Me?

DBT is an ideal treatment for those with Borderline Personality Disorder and even for those with other mental health problems. If you are struggling to keep your emotions in check, then DBT is a great tool to teach you how. It is also beneficial for people who struggle with addictions and need some tools to manage cravings or those who have experienced trauma and do not feel as though they have the coping skills to handle processing the trauma.  DBT is not a stand-alone treatment for trauma, however, because it does not involve any type of trauma processing. (For more information on evidence-based trauma treatments, visit the United States Veterans’ Administration.) DBT is not recommended for individuals with intellectual disabilities or uncontrolled schizophrenia. A therapist who is trained in DBT can help you determine if DBT is an appropriate treatment for you.

Article Sources
Last Updated: May 28, 2019