Dialectical behavior therapy: What you need to know

by | Apr 25, 2011

Intense and scattered emotions, unbearable pain – you feel totally out of control. And you have no idea what to do about it. But you can learn. Really, it’s true. Let’s talk about dialectical behavior therapy.

DBT places emphasis on learning to bear pain skillfully. One may not like or approve of their circumstances, but they’re real and present.

Article reviewed and updated 5.5.23.

That’s a heck of a state to be in, isn’t it. Time was, therapeutic hope was tough to come by. Frankly, many therapists burned out over such cases and didn’t want to take them.

But times have changed thanks to dialectical behavior therapy.

Let’s see what we can see…

What is dialectical behavior therapy?

Dialectical behavior therapy (DBT) is considered a “third wave” cognitive behavioral therapy. Others include mindfulness-based cognitive therapy and acceptance and commitment therapy.

It was developed in the late-1970s by University of Washington professor and clinical psychologist Dr. Marsha Linehan. She was a suicide researcher at the time.

DBT evolved from the failure of standard cognitive behavioral therapy in the treatment of chronically suicidal clients.

What makes DBT unique is its combination of cognitive behavioral techniques – and the mastering of four core skills to aid in problem solving and coping with life’s challenges. They are…

  • Mindfulness
  • Distress tolerance
  • Emotion regulation
  • Interpersonal effectiveness

Simply, DBT is about teaching folks strategies to help them live their best and most productive lives.

What’s DBT used for?

Though it’s most often associated with borderline personality disorder, DBT – with customizations – can work well for a variety of conditions, including…

  • Depression
  • Anxiety
  • Addictions
  • Eating disorder
  • PTSD
  • Self-injury
  • Suicidal ideation and behavior

As you continue reading, I think you’ll see how DBT can be a fit for all of them.

Dialectical?

The best way to begin to understand DBT is to become comfortable with the meaning of dialectical.

Let’s run with this: A method of argument for resolving a disagreement. It’s a dialogue between two or more people who stand by different opinions on a particular subject. No one cares who’s wrong or right because it’s about establishing truth.

Why was it named dialectical behavior therapy?

Dr. Linehan recognized that chronically suicidal clients were typically raised in intensely dysfunctional and self-harmful environments.

She believed it made sense to approach and work with such clients in a spirit of unconditional acceptance – they of themselves and therapist of client.

That’s the foundation of a powerful therapeutic alliance.

How does dialectical behavior therapy work?

what is dialectical behavior therapy

“This isn’t easy for me, trust and all. But it feels like it’s working – so far.”

First and foremost, after the client accepts their emotional challenges, they make a commitment to themselves and to the therapeutic alliance.

The next order of business is the therapist earning the right to be perceived as an ally – not an opponent.

Toward that end, the therapist accepts and validates the client’s feelings; however, shoots straight by telling the client when their feelings aren’t working in their best interest.

Of course, it’s the therapist’s responsibility to provide quality alternatives.

Take another look at our definition of dialectical. We’re talking about an alliance of differing feelings and opinions formed to establish truth.

Individual work

In one-on-one sessions, client and therapist discuss issues that surfaced during the previous week. The client recorded them on diary cards. And then it’s on to working with the material in order of priority – suicidal and self-injurious thoughts and behaviors, specific quality of life issues, and working toward improving one’s overall life.

By the way, this work is done individually so suicidal urges or uncontrolled emotional issues don’t disrupt group work.

Group work

Typically once a week for some two hours, specific skills are taught and a practice forum is provided. It’s all about learning how to regulate emotions and behavior in a social context.

Four core skills

Here are the four core skills that are behind each and every bit of DBT work…

  • Mindfulness: The capacity to pay attention, non-judgmentally, to the present moment. Key is experiencing one’s emotions and senses fully, yet with perspective. Mindfulness helps individuals accept and tolerate the powerful emotions they may feel when taking on their habits or exposing themselves to upsetting situations.
  • Distress tolerance: This isn’t a matter of changing distressing events and situations. It’s accepting, finding meaning in, and tolerating distress. DBT places emphasis on learning to bear pain skillfully. One may not like or approve of their circumstances, but they’re real and present. The mission is to learn how to make prudent action decisions.
  • Emotion regulation: Identifying and labeling emotions and obstacles to change, reducing vulnerability, becoming aware and non-judgmental of self, and taking the opposite action of what first comes to mind.
  • Interpersonal effectiveness: The work here is grounded in assertiveness and interpersonal problem solving. It’s all about learning how to ask for what one needs, saying no, and coping with interpersonal conflicts. Simply, developing the skills to change or resist harmful change.

Can you see how each one of them can have a powerful immediate impact? I use all of them, most often distress tolerance.

That’s called hope

Intense and scattered emotions, unbearable pain, feeling out of control – and not having a clue what to do about it. Yes, one heck of a state to be in.

But with dialectical behavior therapy, you can learn how to protect yourself and function amid the storms. Really, it’s true.

And that’s called hope.

Keep in mind, a DBT provider has to be certified. Looking for one? Head to the source: DBT-LINEHAN

For all sorts of additional info, yep, head to the source: DBT: Dialectical Behavior Therapy

Feel like reading more Chipur mood and anxiety info and inspiration articles? I’d sure like you to.

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