By: Stephen Scherer, Ph.D.
Licensed Clinical Psychologist
All about Dialectical Behavior Therapy: Navigating the Balance of Life
Dialectical behavior therapy (DBT) is a form of psychotherapy that was originally developed to help people with borderline personality disorder (BPD). DBT was developed from Cognitive behavioral therapy (CBT) and Eastern philosophy (hence the Dialectic part). DBT offers practical skills and encourages people receiving the treatment to consider “dialectics” in life, that is, how two seemingly opposite things can be true at the same time. A unique aspect of DBT is that each DBT therapist who practices “adherent DBT” fully integrates all of the components of the treatment in their daily lives. This means that DBT therapists “practice what they preach” and can understand how challenging it is to make major life changes. DBT has been found to be effective in treating a wide range of mental health conditions, including:
Depression
Anxiety
Post-traumatic stress disorder (PTSD)
Eating Disorders
Substance abuse
It's important to note that DBT isn't a one-size-fits-all treatment for any specific diagnosis. DBT has a strong skills-based component to therapy, which means that it teaches you practical tools that you can use to manage your emotions, improve your relationships, and cope with difficult situations. These skills are grouped into four modules:
Mindfulness: Mindfulness is the practice of paying attention to the present moment without judgment. It can help you to become more aware of your thoughts, feelings, and bodily sensations, and to accept them without trying to change them. This causes an inherent change in how you relate to the world and can have a profound impact on your overall well-being.
Interpersonal effectiveness: This module teaches you how to communicate effectively with others, set boundaries, and assert yourself in a healthy way that aligns with your personal values and maintains your self-respect.
Emotion regulation: This module delves the function of emotions and how they can build on one another (called secondary emotions). By understanding this process, you can gain deeper self-awareness, prepare for emotionally charged situations, and change your relationship with your emotions, even reducing the likelihood of unwanted emotions lingering longer than necessary.
Distress tolerance: This module teaches you how to cope with extreme levels of emotion and near-crisis situations without engaging in unhealthy behaviors, such as self-harm or substance abuse. Distress tolerance also includes a sub-module called Reality Acceptance. This is similar to mindfulness in that it’s designed to help you shift your perspective toward painful life circumstances in a way that builds your resilience, is empowering, and helps you live a fulfilling life despite harsh circumstances.
How DBT Can Help Different Mental Illnesses
DBT can be helpful for people with a wide range of mental health conditions. Here are some specific examples of how it can help:
Depression: DBT can help individuals with depression develop present-moment awareness without judgment. This includes identifying negative thought spirals, becoming more attuned to emotional triggers, and observing them neutrally. It can also improve relationships and combat feelings of isolation that often accompany depression.
Anxiety: Mindfulness skills learned in DBT help people with anxiety step back from overwhelming thoughts and observe them without getting stuck in the thought (like watching an avalanche happen vs being stuck in it). It also provides practical skills that work on the human body’s natural regulation system which can bring down stress levels incredibly quickly when the skills are used correctly and for a long enough period of time.
PTSD: DBT can help people with PTSD to process their trauma by giving them skills needed to manage intense emotions such as fear, shame, guilt, and anger. Additionally, you can develop grounding skills for overcoming the paralyzing nature of flashbacks and nightmares.
Eating disorders: DBT can help individuals with eating disorders to develop balanced eating habits, challenge negative body image thoughts, and improve their relationships. It can help boost a person’s self-esteem, identify what’s important in life, and find a new way to manage the challenges that drive unbalanced eating.
Substance abuse: The concept of "Dialectical Abstinence" within DBT encourages individuals to strive for abstinence while acknowledging that overcoming substance use is a lifelong process with ups and downs. DBT helps prepare for both successes and setbacks, fostering acceptance of the process. It can also help uncover underlying issues driving addiction and develop coping mechanisms for cravings.
Self-harm: Even though this isn’t a “diagnosis” on its own, self-harm, or Non-suicidal self-injurious behavior (NSSI) is a form of harmful coping that a person can develop in response to extreme distress. DBT can help people with NSSI to develop healthier ways of coping with difficult emotions, feel less triggered by the experience of emotion, change their relationship with emotions, and build their self-confidence.
What to Expect When Starting DBT:
Individual therapy: You'll meet with a therapist regularly, typically once a week (potentially more depending on your situation). Individual therapy involves learning about DBT, setting expectations for your therapist and yourself, and understanding what to expect in each session. While focusing on applying skills in real-world situations, individual therapy also provides an opportunity to explore your emotions, values, and identify ways to approach life's challenges dialectically.
Group therapy: You may also participate in a group therapy session in addition to individual therapy. Group therapy can be a helpful way to learn from others who are also struggling with mental health challenges and to practice your DBT skills. The main point of DBT skills group is to learn the DBT skills, so in a sense it may feel like being part of a class. In skills groups I’ve run I like to keep group predictable: Practice mindfulness, discuss skills homework from last week, then jump into the skill or skills to cover this week. Depending on the skills group leader you may have a slightly different experience.
Phone coaching: If you are involved in comprehensive DBT, you may also have access to phone coaching from your therapist. Phone coaching can be a helpful way to get support and guidance between sessions and is designed to help you avoid behavior that makes life harder for you, such as isolating, NSSI, substance use, or anything that may damage your relationships. Phone coaching is usually discussed during individual therapy.
DBT is certainly a commitment to your well being. I like to tell people who I work with is that in order for DBT to work, you have to live it. Just like every DBT therapist does!
If you are struggling with your mental health, I encourage you to learn more about DBT and see if it might be right for you. Please don’t hesitate to if you have any questions!
*The information in this blog post is intended for general informational purposes only and does not constitute medical advice. Please consult with a qualified mental health professional before making any changes to your lifestyle to make sure they are right for you.
Additional Resources
Behavioral Tech, Home of DBT: https://behavioraltech.org/
University of Washington: https://depts.washington.edu/uwbrtc/about-us/dialectical-behavior-therapy/
The National Alliance on Mental Illness (NAMI): https://www.nami.org/Home
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