Dialectical behavioral therapy commonly referred to as DBT is an evidence-based form of psychotherapy used to treat people with multiple mental health conditions.1 Developed by psychologist Dr. Marsha Linehan and her colleagues in the 1980s, DBT, largely based on cognitive-behavioral therapy (CBT), was used to treat severe mental health conditions and high-risk behaviors, such as chronic suicidal ideation, specifically.2 The main difference between CBT and DBT is that the latter focuses on validating and accepting uncomfortable feelings rather than avoiding or working around them.2 Now, individual and group treatments commonly employ DBT for conditions such as borderline personality disorder (BPD), depression, anxiety disorders, and substance use disorders (SUD), a medical condition defined by uncontrollable use of substances despite the negative consequences.
The DBT Approach
The DBT approach is multidimensional and comprehensive and relies on learning skills to change unhelpful thoughts and behaviors.
Therapists using DBT teach critical behavioral skills by modeling, providing instructions, telling stories, practicing, giving feedback, and coaching.1 DBT uses a variety of strategies and techniques to do this including:1
- Mindfulness. Central to all other skills in DBT, mindfulness is at the core of treatment. Individuals learn about and practice bringing awareness into the moment. By mastering the observation of what’s happening inside—feelings, thoughts, sensations, and impulses—and tuning into their senses and the environment around them, individuals can effectively slow down and focus on healthy coping skills during pain.
- Interpersonal effectiveness. Since many participants in DBT struggle with challenges in their relationships, interpersonal effectiveness works to repair, maintain, and establish healthy relationship behaviors, which also include ending destructive ones. This strategy incorporates assertiveness training to help individuals create and enforce their boundaries with others and communicate effectively.
- Emotional regulation. This technique focuses on identifying, naming, and changing the negative effects of an emotional response. By helping an individual recognize and cope with intense negative emotions—and create an opposite action—therapists help them have more positive emotional experiences.
- Distress tolerance. This section of DBT discusses and teaches individuals to sit with discomfort and accept negative emotions. For individuals who experience distress or crisis, the implementation of learned techniques such as distraction and self-soothing skills empower them to cope with intense emotions with a more positive, long-term outlook.
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