Dialectical Behavior Therapy (DBT)

Dialectical Behavior Therapy (DBT) is a cognitive behavioral treatment that was originally developed to treat chronically suicidal individuals diagnosed with borderline personality disorder (BPD) and it is now recognized as the gold standard psychological treatment for this population. In addition, research has shown that it is effective in treating a wide range of other disorders such as substance dependence, depression, post-traumatic stress disorder (PTSD), and eating disorders.

Four Components of DBT

DBT Skills Training Group

DBT skills training enhances clients' capabilities by teaching behavioral skills in a class-like setting. The leader instructs and assigns homework for real-world practice. Weekly 2.5-hour sessions span 24 weeks, often repeated for a 1-year program. Condensed schedules for specific populations are also available.

DBT Phone Coaching

DBT phone coaching is focused on providing clients with in-the-moment coaching on how to use skills to effectively cope with difficult situations that arise in their everyday lives. Clients can call their individual therapist between sessions to receive coaching at the times when they need help the most.

DBT Individual Therapy

DBT individual therapy is focused on enhancing client motivation and helping clients to apply the skills to specific challenges and events in their lives. In the standard DBT model, individual therapy takes place once a week for as long as the client is in therapy and runs concurrently with skills groups.

Therapist Consultation Team

DBT therapist consultation teams provide support and therapy for therapists working with complex cases. These teams, consisting of individual therapists and group leaders, aim to maintain therapists' motivation and competence. Meetings are weekly, ensuring collaborative care for each client.

Stages of Treatment in DBT

DBT is divided into four stages of treatment. Stages are defined by the severity of the client's behaviors, and therapists work with their clients to reach the goals of each stage in their progress toward having a life that they experience as worth living.
  • Stage 1
  • Stage 2
  • Stage 3
  • Stage 4

Stage 1

Stage 1

The client is miserable and their behavior is out of control: they may be trying to kill themselves, self-harming, using drugs and alcohol, and/or engaging in other types of self-destructive behaviors. When clients first start DBT treatment, they often describe their experience of their mental illness as “being in hell.” The goal of Stage 1 is for the client to move from being out of control to achieving behavioral control.

Stage 2

Stage 2

In Stage 2, they’re living a life of quiet desperation: their behavior is under control but they continue to suffer, often due to past trauma and invalidation. Their emotional experience is inhibited. The goal of Stage 2 is to help the client move from a state of quiet desperation to one of full emotional experiencing. This is the stage in which post-traumatic stress disorder (PTSD) would be treated.

Stage 3

Stage 3

In Stage 3, the challenge is to learn to live: to define life goals, build self-respect, and find peace and happiness. The goal is that the client leads a life of ordinary happiness and unhappiness.

Stage 4

Stage 4

For some people, a fourth stage is needed: finding a deeper meaning through a spiritual existence. Linehan has posited a Stage 4 specifically for those clients for whom a life of ordinary happiness and unhappiness fails to meet a further goal of spiritual fulfillment or a sense of connectedness of a greater whole. In this stage, the goal of treatment is for the client to move from a sense of incompleteness towards a life that involves an ongoing capacity for experiences of joy and freedom

Skills Taught in DBT

Dialectical Behavior Therapy (DBT) includes four sets of behavioral skills.

Mindfulness
Practice

The practice of being fully aware and present in this one moment

Distress
Tolerance

How to tolerate pain in difficult situations, not change it

Interpersonal
Effectiveness

Assertively expressing needs and setting boundaries with self-respect

Emotion
Regulation

How to change emotions that you want to change