DBT: What is Dialectical Behavior Therapy?

Aug 20, 2020 | Stone House Spotlight

by Danielle Seymour, M.A., LCMHC

What is DBT? 

Dialectical Behavior Therapy (DBT) is an evidence-based treatment protocol developed by Dr. Marsha Linehan during the 1980’s. It was initially created to treat those suffering from characteristics most commonly associated with Borderline Personality Disorder, including chronic suicidality and self-injurious behavior. Since Dr. Linehan’s initial application of DBT, it has been extensively researched and proven to have positive outcomes when applied to numerous other diagnoses, including depression, PTSD, anxiety, addiction, bulimia nervous, and impulse control disorders. DBT has been continually adapted to different treatment settings (in-patient, residential, intensive outpatient, rehabilitation centers, schools)  and remains one of the most respected and researched modalities in the field.

DBT is a type of cognitive behavioral therapy, however, there is more to it than that. While traditional CBT focuses on how thoughts and beliefs influence how we feel and act, DBT also teaches clients how to identify, accept, self-validate, experience, regulate, and tolerate emotional experiences. DBT is based on the theory that, in the absence of adaptive coping skills, and in the context of an invalidating environment, human beings can develop a dysfunctional pattern of alternating between emotional inhibition and denial, with dysregulated, frequently extreme feeling states wherein the individual “escapes” by engaging in a problematic behavior. These reactive, impulsive behaviors alleviate emotional pain in the short term, while escalating long term suffering by creating even more problems and distress. As this cycle continues, individuals feel less and less in control of their lives. Relationships deteriorate. A sense of self, if it was ever had, is sometimes thoroughly unknown. The behaviors which once provided a solution to emotional distress now create it. DBT aims to target these destructive patterns with the ultimate goal being obtainment of each individual’s Life Worth Living. 

In addition to individual therapy, standard DBT requires participants to engage in a weekly skills group, for as long as it takes to achieve behavioral control. DBT skills come in 4 “flavors” which Dr. Linehan refers to as modules (Core Mindfulness, Interpersonal Effectiveness, Emotion Regulation, Distress Tolerance). In my experience, it takes about 9 months of weekly skills group attendance to be taught, and assigned homework to practice, the entirety of the current DBT Skills Manual (Linehan, 2015). However, I have found that most successful clients I have worked with have dedicated themselves to more than 1 full round of formal skills training, coupled with diligent attention to homework completion and practice. As has been shown in the research, new skills need to be be practiced in all relevant contexts for them to be effective. 

DBT Assumptions (Linehan 1993, 2015) 

1. People are doing the best they can.  All people, at any given point in time, are doing the best they can. 

2. People want to improve.  The common characteristic of all people is that they want to improve their lives and be happy. 

3. People need to do better, try harder, and be more motivated to change.    The fact that people are doing the best they can, and want to do even better, does not mean that these things are enough to solve the problem. 

4. People may not have caused all of their own problems, but they have to solve them anyway.  People have to change their own behavioral responses to alter their environment for their life to change.

5. New behavior has to be learned in all relevant contexts.  New behavioral skills have to be practiced in the situations where the skills are needed, not just in the situation where the skills are first learned. 

6. All behaviors (actions, thoughts, emotions) are caused. There is always a cause, or set of causes, for our actions, thoughts, and emotions, even if we do not know what the causes are. 

7. Figuring out and changing the causes of behavior work better than judging and blaming. Judging and blaming are easier, but if we want to create change in the world, we have to change the chain of events that cause unwanted behaviors and events. 

Interested in learning more?

Contact : DSeymour@StoneHouseAssociates.com

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