Dialectical Behavior Therapy (DBT)
When you combine the principles of mindful living with the evidence-based structure of cognitive behavioral therapy, you get dialectical behavior therapy (DBT). DBT helps you live in the present moment.
It discourages forecasting and mind-reading, which can often lead to negative consequences. In the case of DBT participants, these consequences can range from drug abuse to suicide attempts. According to the National Institute of Mental Health (NIMH), suicidal thoughts and behaviors are a major public concern and the 12th leading cause of death in the United States.
Because DBT participants are equipped with essential skills to control their emotions and their reactions to these emotions, they benefit from a reduction in self-harm. This allows the person to move forward into a happier state of being.
Learn about dialectical behavior therapy and how it can help you move forward.
Find the location that works for you.
If you feel DBT could benefit your mental health, call Zinnia Health at (855) 430-9439. Our fully accredited facilities offer inpatient and outpatient treatments that help individuals struggling with mental health conditions and addiction.
What Is Dialectical Behavior Therapy?
Dialectical behavior therapy was developed in the 1980s by Marsha Linehan, Ph.D., to treat women with severe emotional dysregulation and suicidal ideations.
The term “dialectical” refers to joining two opposite ideas. In dialectical behavior therapy, they are acceptance and change. On the surface, the two terms are indeed opposite. However, by accepting a situation for exactly what it is, you can learn how to change it instead of avoiding it. This discourages the development of negative habits used for coping.
Dialectical behavior therapy (DBT) is an emotion-focused, evidence-based form of talk therapy (psychotherapy) that stems from the basic principles of cognitive behavioral therapy (CBT).
Although CBT works well for people with mild to moderate emotional dysfunction, it isn’t as helpful to those suffering from severe emotional dysregulation, such as those with borderline personality disorder (BPD).
This form of therapy works best for people who experience strong emotional responses to events they consider to be negative.
For example, these individuals may respond to a traumatic experience by overeating, starving, self-harming, hurting others, using harmful substances, or attempting suicide.
What Is the Aim of Dialectical Behavior Therapy?
DBT aims to strike a balance between acceptance of a situation and the benefits of changing it. To do this, the patient learns to remain in the moment without judging. They are encouraged to accept their feelings about a situation without catastrophizing or ruminating. This method is called mindfulness.
In addition, DBT patients learn to tolerate uncomfortable feelings, such as sadness or anger. This is called distress tolerance.
By teaching the individual new skills to replace unhelpful habits that led to past destructive behaviors, one can expect to achieve emotional regulation.
People who have completed DBT experience the following benefits:
- A lower tendency to self-harm
- Fewer days in inpatient hospitalization
- A lower risk of drug and alcohol misuse
- Improved depression symptoms
How Is Dialectical Behavior Therapy Structured?
DBT is a structured form of therapy. The way it is implemented may differ from therapist to therapist, but the basic structure contains the following key components:
- Pre-assessment
- Individual therapy sessions
- Skills training group sessions
- Telephone crisis coaching
1. Pre-Assessment
Before beginning a DBT program, the therapist goes through a pre-assessment to determine the patient’s suitability for the program. DBT is only suitable for certain conditions.
Some people will have a more successful outcome with cognitive behavioral therapy, a mixture of medication and talk therapy, or inpatient treatment.
At the end of this assessment, the therapist provides you with a program outline and an estimated length of treatment.
2. Individual Therapy Sessions
An average individual DBT session lasts 40 to 60 minutes. Patients attend this session once weekly for the entirety of their treatment.
The goal of individual therapy is to:
- Reduce destructive behaviors, such as suicidal behavior and self-injury
- Limit behaviors that stifle productivity
- Improve quality of life by discovering what’s blocking progress
- Learn new skills to replace bad habits
- Discover triggers by using a diary
3. Group Skills Training Sessions
DBT group sessions differ from traditional group therapy sessions, like those provided in cognitive behavior therapy.
A DBT group session is not an open forum for bouncing ideas off other attendees.
Instead, people learn the key principles of DBT in a classroom setting. During this 1.5 to 2.5-hour session, attendees will learn the following:
- Mindfulness — how to stay in the present moment
- Distress tolerance — how to manage emotions without responding to them in a destructive way
- Interpersonal effectiveness — how to be assertive and set healthy boundaries
- Emotional regulation — how to have more control over emotions
4. Phone Coaching
In between sessions, attendees are encouraged to use the crisis hotline for immediate assistance in difficult situations.
If a person feels they may hurt themselves, they may not remember how to implement the tools gathered from their DBT sessions. The DBT therapist will help them through the crisis and remind them how to use their new skills. This phone call is usually brief.
What Are the Treatment Stages of Dialectical Behavior Therapy?
There are three stages of dialectical behavior therapy treatment. What stage the patient is in is determined by their progress and behavior.
1. Feeling Out of Control
During the first stage, patients display unhealthy and harmful behaviors such as suicide attempts, drug abuse, and self-harm. Patients in stage one often describe themselves as feeling out of control and miserable.
The goal of this stage is to help them transition from being out of control to being in control.
2. Quiet Desperation
In stage two, the person has regained some control over their behavior, though the emotions of trauma and invalidation remain. This stage is called quiet desperation.
The goal is to move them out of this stage and into better emotional experiences.
3. Learning to Live With New Terms
Stage three challenges the patient to incorporate new terms into their daily life.
The goals of stage three are to set healthy boundaries, develop new self-respect, and find happiness in new endeavors.
Sometimes, an additional stage is necessary to help participants achieve their goals.
In this fourth stage, a person who feels unfulfilled is encouraged to achieve a sense of connectedness through additional goals. Both the patient and the therapist set these goals.
No matter what mental health challenge you struggle with, Zinnia Health can help you address it. Call us at (855) 430-9439, and let us hear your story. We can help you determine if dialectical behavior therapy is right for you; or if another therapy is more suitable.
Our lines are open 24/7, and your call is completely confidential.
What Are the Conditions That Dialectical Behavior Therapy Treats?
Dialectical behavior therapy best suits people with conditions that stem from or promote destructive behaviors.
These conditions include the following:
- Bipolar disorder (BD): BD is a condition that causes extreme shifts in mood, usually from hypomania to depression.
- Borderline personality disorder (BPD): This condition causes a person to have a distorted view of themselves and others, leading to emotional instability.
- Post-traumatic stress disorder (PTSD): A person with PTSD will continue to relive a traumatic event long after it has ended. Certain triggers cause them to have flashbacks, nightmares, and panic attacks.
- Substance use disorder (SUD): This condition occurs when a person abuses a substance to the point of damaging their health and cognition.
- Eating disorders (including anorexia and bulimia): A person with an eating disorder may compulsively binge eat, undereat, or purge after eating as a response to intense emotion.
- Self-harm tendencies: A person with this condition intentionally injures themselves to avoid feeling a negative emotion.
- Anxiety disorder: Everyone experiences anxiety from time to time, but a person with an anxiety disorder may experience it nearly every day.
- Major depressive disorder (depression): MDD is a mood disorder characterized by intense sadness and the inability to participate in meaningful activities.
People with the above conditions have unhealthy ways of dealing with traumas. Over time, they develop problematic patterns to soothe themselves and control their intense, negative emotions.
Even though they are aware that their actions are destructive, they describe being “stuck” in a pattern of negative thinking that encourages them to continue. Dialectical behavior therapy provides them with emotion regulation skills to exit this negative thinking loop.
What to Consider Before Signing Up for Dialectical Behavior Therapy
Dialectical behavior therapy isn’t for everyone. There are a few things you should consider before signing up for a DBT program.
1. You Have to Put in the Work
For this therapy to work, you must be willing to put in the work. This includes showing up to group therapy sessions and doing homework the therapist provides. If you can follow through with your obligations, it will be easier to reach the goals that you set with your therapist.
2. You Have to Stay the Course
The average dialectical behavior therapy program lasts anywhere from six months to one year. After this time, some people still experience symptoms and may require a longer treatment. Certain conditions, like borderline personality disorder, take years to treat with dialectical behavior therapy.
3. DBT Doesn’t Replace Medication Given for Mental Health Disorders
Dialectical behavior therapy is not a replacement for antidepressants or psychotropic medications. If you need to take medications to treat your condition, you will take these medications while undergoing DBT. The therapist will work closely with psychiatry to determine if your healthcare provider should change these medications or adjust the dose as you progress.
4. Contact With Your Therapist Will Be Restricted
Your therapist may provide you with an emergency number to call if there is a crisis. However, there are rules regarding when you can call and how long the phone call will last. You must respect these rules and not abuse them.
Dialectical behavior therapy provides you with valuable tools to use throughout every stage of your life. At the end of your journey with DBT, you’ll be able to cope with life’s ups and downs without spiraling into self-destructive behaviors — but you have to put in the work.
Key Differences Between Cognitive Behavioral Therapy and Dialectical Behavior Therapy
Cognitive behavioral therapy helps people understand how their thoughts drive behavioral responses. In a CBT session, patients are encouraged to express their feelings without judgment. This allows the patient to discover unhealthy thought patterns on their own. Then, the CBT therapist will give the patient helpful tools to retrain their thinking.
Dialectical behavior therapy helps patients accept themselves and their situation and manage how they feel about it.
DBT also helps regulate thought patterns that can lead to destructive behaviors. It achieves these goals by focusing on the five functions of DBT treatment.
They are:
- Enhancing capabilities: This involves teaching the patient life skills to regain their ability to carry on with daily responsibilities, such as going to work or school and completing goal-oriented daily tasks.
- Generalizing capabilities: The therapist gives the patient homework that helps them learn and develop new skills to replace destructive habits.
- Improving motivation and reducing dysfunctional behaviors: In this function, patients are motivated to change and reduce behaviors that are out of alignment with their goals.
- Enhancing and maintaining therapist capabilities and motivations: This involves a system of support for therapists using DBT to help individuals with severe emotional dysregulation.
- Structuring the environment: This function is one of the most important. It involves creating an environment that facilitates change.
Key Differences Between Dialectical Behavior Therapy and Mindfulness-Based Cognitive Therapy
Mindfulness-based cognitive therapy (MBCT) is an eight-week course incorporating mindful living principles and thought/behavior awareness. In this therapeutic practice, the participant utilizes a daily mindfulness exercise such as meditation to develop the habit of staying in the moment.
The purpose of a mindfulness exercise in MBCT is to keep the participant aware of how their anxious thoughts affect their behaviors. Cognitive behavior therapy provides the tools of reframing to help this person break the connection between negative thinking and unhealthy habits.
On the surface, DBT and MBCT seem indistinguishable; however, there is one significant difference.
MBCT isn’t proven to work for individuals with severe emotional dysregulation. The positive benefits of MBCT, such as better eating habits, better sleep, and fewer depression episodes, are proven to work for people with mild to moderate anxiety and depression. Those who self-harm or need crisis intervention are better suited for DBT.
How to Find a Therapist Trained in Dialectical Behavioral Therapy
If you believe that Dialectical Behavioral Therapy could be helpful for you, it is essential to find a therapist who is trained in this approach.
At Zinnia Health, we provide inpatient and outpatient programs for people with mental health disorders, drug addiction, substance abuse disorders and alcoholism.
We offer these treatments at our fully accredited locations throughout the United States.
Call Zinnia Health at (855) 430-9439 to find out whether dialectical behavior therapy, or any of our additional evidence-based therapies are suitable for you. We have operators standing by 24 hours a day to take your call.
More Psychotherapy Options
These are other types of psychotherapies available: