What is Dialectal Behavior Therapy (DBT)?

Dialectal Behavior Therapy is a particular type of cognitive behavioral therapy (CBT) developed in the late 80s by Marsha M. Linehan as a better alternative to existing methods for treating borderline personality disorder. Since then, DBT has been used as a cognitive behavioral approach which emphasizes particular psycho-social aspects of treatment such as finding trigger mechanisms to specific behaviors and helping to correct them or minimize their impact.

The treatment itself is designed to provide people with a positive avenue of changing behavior patterns which are often detrimental, such as substance abuse, sex or gambling addiction, or suicidal thoughts or tendencies toward self harm. The approach works by working with someone with these behaviors to improve emotional and/or cognitive regulation to better identify triggers that cause these behaviors. After the triggers are identified, a therapist will work with the patient to sort through the events, thoughts and feelings that these triggers create in order to find healthier ways to channel them rather than repeating the same undesired behaviors. Dialectal behavior therapy operates under the assumption that most of us have flaws which we are trying to correct but are often lacking in certain skills or are easily influenced by positive or negative reinforcement which often interrupt our normal thought patterns or actions to bring forth undesirable behavior.

DBT & Psychotherapy

As mentioned previously, DBT was originally developed as an alternative to traditional psychotherapy methods used to treat Borderline Personality Disorder — a cluster-B personality disorder which is defined by impulsivity and instability of self image as well as interpersonal relationships — as well as those who had experienced suicidal thoughts or bouts with self harm.

Dialectal Behavior Therapy is now being used in conjunction with other psychotherapy treatments for everything from traumatic brain injuries to childhood trauma, and spectrum mood disorders. There has also been recent work to adapt the therapy for use in treatment for patients with eating disorders, a history of sexual or physical abuse, and substance abuse or chemical dependency.

The Four Modules

DBT combines standard CBT techniques – such as identification of emotional or physical triggers into a therapy that requires those with mental health disorders to find a heightened sense of self-awareness in order to correct problem behavior before it happens. The approach is based on four modules that are said to be largely derived from Buddhist meditative practices. These four modules are:

  1. Mindfulness
  2. Distress tolerance
  3. Emotion regulation
  4. Interpersonal effectiveness

DBT and Individual or Group Therapy

Using these four modules, patients are taught over time to change the way they react to certain environmental or interpersonal stimuli that trigger the negative behavior they intend to correct. None of the modules are said to be ultra effective on their own, but used in conjunction with a trained therapist, and a willing patient, the therapy is quite effective at helping to regulate emotions and behavior.

All Dialectal Behavior Therapy involves components that find the patient participating in both individual and group sessions. The individual sessions are held in the presence of a trained therapist and they focus on discussing issues that have occurred in the time since the last session, as well as how they were handled, and what could have been done differently. These sessions have a common theme that feature “therapy interfering behaviors” — which are patient behaviors that undermine the benefits of the therapy and how to correct those from session to session. Group therapy features other DBT patients and discussion surrounding the four modules of DBT and how each member is utilizing them, struggling to utilize them, or just listening to stories and advice from others undergoing the therapy.