Overview of Dialectical Behavior Therapy

Dialectical behavior therapy (DBT) is a type of cognitive behavioral therapy. Its main goals are to teach people how to live in the moment, cope healthily with stress, regulate emotions, and improve relationships with others.

It was originally intended for people with borderline personality disorder but has since been adapted for other conditions where the patient exhibits self-destructive behavior, such as eating disorders and substance abuse. It is also sometimes used to treat post-traumatic stress disorder.

DBT was developed in the late 1980s by Dr. Marsha Linehan and colleagues when they discovered that cognitive behavioral therapy alone did not work as well as expected in patients with borderline personality disorder. Dr. Linehan and her team added techniques and developed a treatment which would meet the unique needs of these patients.

DBT is derived from a philosophical process called dialectics. Dialectics is based on the concept that everything is composed of opposites and that change occurs when one opposing force is stronger than the other, or in more academic terms—thesis, antithesis, and synthesis. 

More specifically, dialectics makes three basic assumptions:

• All things are interconnected.
• Change is constant and inevitable.
• Opposites can be integrated to form a closer approximation of the truth.

Thus in DBT, the patient and therapist are working to resolve the seeming contradiction between self-acceptance and change in order to bring about positive changes in the patient.

Another technique offered by Linehan and her colleagues was validation. Linehan and her team found that with validation, along with the push for change, patients were more likely to cooperate and less likely to suffer distress at the idea of change. The therapist validates that the person's actions "make sense" within the context of his personal experiences without necessarily agreeing that they are the best approach to solving the problem.

DBT has now evolved into a standard type of cognitive behavioral therapy. When a person is undergoing DBT, they can expect to participate in three therapeutic settings: 

• A classroom where a person is taught behavioral skills by doing homework assignments and role playing new ways of interacting with people
• Individual therapy with a trained professional where those learned behavioral skills are adapted to a person's personal life challenges
• Phone coaching in which a person can call their therapist to receive guidance on coping with a difficult at-the-moment situation

In DBT, individual therapists also meet with a consultation team to help them stay motivated in treating their patients and help them navigate difficult and complex issues.

People undergoing DBT are taught how to effectively change their behavior using four main strategies:

• Mindfulness—focusing on the present ("living in the moment").
• Distress Tolerance—learning to accept oneself and the current situation. More specifically, people learn how to tolerate or survive crises using these four techniques: distraction, self-soothing, improving the movement, and thinking of pros and cons. 
• Interpersonal Effectiveness—how to be assertive in a relationship (for example, expressing needs and saying "no") but still keeping that relationship positive and healthy.
• Emotion Regulation—recognizing and coping with negative emotions (for example, anger) and reducing one's emotional vulnerability by increasing positive emotional experiences.

If you believe that you or a loved one may benefit from DBT, please seek guidance from a doctor or healthcare professional trained in this treatment approach.