What is DBT Therapy?
Dialectical behavior therapy (DBT) is a comprehensive, evidence-based treatment for borderline personality disorder (BPD). The patient populations for which DBT has the most empirical support include parasuicidal women with borderline personality disorder (BPD), but there have been promising findings for patients with BPD and substance use disorders (SUDs), persons who meet the criteria for binge-eating disorder, and depressed elderly patients.
Although DBT Therapy has many similarities with other cognitive-behavioral approaches, several critical and unique elements must be in place for the treatment to constitute DBT. Some of these elements include (a) serving the five functions of treatment, (b) the biosocial theory and focusing on emotions in treatment, (c) a consistent dialectical philosophy, and (d) mindfulness and acceptance-oriented interventions.
What Does DBT Treat?
Parasuicidal patients with BPD. For parasuicidal BPD patients, the most consistent finding is that DBT results in superior reductions in parasuicidal behavior compared with control conditions.
Women with BPD and substance use disorders. The second patient group for which DBT has demonstrated promising data consists of women with BPD and a substance use disorder (SUD).
The first study in this area for women who met criteria for BPD and SUD found that DBT patients showed greater reductions in drug use during the 12-month treatment and through the four-month follow-up period and had lower dropout rates during treatment. 
Other clinical populations and problems. Additionally, some research has examined DBT-oriented treatments for other clinical problems, including eating disorders and depression in elderly patients.
How Does DBT Work?
Dialectical behavior therapy (DBT) evolved from Marsha Linehan’s efforts to create a treatment for multiproblematic, suicidal women. Linehan combed through the literature on efficacious psychosocial treatments for other disorders, such as anxiety disorders, depression, and other emotion-related difficulties, and assembled a package of evidence-based, cognitive-behavioral interventions that directly targeted suicidal behavior. Initially, these interventions were so focused on changing cognitions and behaviors that many patients felt criticized, misunderstood, and invalidated, and consequently dropped out of treatment altogether.
Through an interplay of science and practice, clinical experiences with multiproblematic, suicidal patients sparked further research and treatment development. Most notably, Linehan weaved into the treatment interventions designed to convey acceptance of the patient and to help the patient accept herself, her emotions, thoughts, the world, and others. As such, DBT came to rest on a foundation of dialectical philosophy, whereby therapists strive to continually balance and synthesize acceptance and change-oriented strategies.
Ultimately, this work culminated in a comprehensive, evidence-based, cognitive-behavioral treatment for borderline personality disorder (BPD). The standard DBT treatment package consists of weekly individual therapy sessions (approximately 1 hour), a weekly group skills training session (approximately 1.5–2.5 hours), and a therapist consultation team meeting (approximately 1–2 hours). At present, eight published, well-controlled, randomized, clinical trials (RCTs) have demonstrated that DBT is an efficacious and specific treatment for BPD and related problems.
5 Benefits of DBT
Five functions of treatment. DBT is a comprehensive program of treatment consisting of individual therapy, group therapy, and a therapist consultation team. In this way, DBT is a program of treatment, rather than a single treatment method conducted by a practitioner in isolation. Often, clinicians are interested in applying DBT but find the prospect of implementing such a comprehensive treatment to be daunting.
In this case, it is important to remember that the most critical element of any DBT program has to do with whether it addresses five key functions of treatment. Although the standard package of DBT has the most empirical support, different settings and circumstances may necessitate innovative and creative applications of DBT. In all cases, however, it is critical that any adaptation of DBT fulfills the following five functions:
Function #1: Enhancing capabilities. Within DBT, the assumption is that patients with BPD either lack or need to improve several important life skills, including those that involve (a) regulating emotions (emotion regulation skills), (b) paying attention to the experience of the present moment, and regulating attention (mindfulness skills), (c) effectively navigating interpersonal situations (interpersonal effectiveness), and (d) tolerating distress and surviving crises without making situations worse (distress tolerance skills).
Function #2: Generalizing capabilities. If the skills learned in therapy sessions do not transfer to patients’ daily lives, then it would be difficult to say that therapy was successful. As a result, a second critical function of DBT involves generalizing treatment gains to the patient’s natural environment.
This function is accomplished in skills training by providing homework assignments to practice skills and troubleshooting regarding how to improve upon skills practice. In individual therapy sessions, therapists help patients apply new skills in their daily lives and often have patients practice or apply skillful behaviors in session. In addition, the therapist is available by phone between sessions to help the patient apply skills when they are most needed (e.g., in a crisis).
Function #3: Improving motivation and reducing dysfunctional behaviors. The third function of DBT involves improving patients’ motivation to change and reducing behaviors inconsistent with a life worth living. This function primarily is accomplished in individual therapy.
After prioritizing the behavioral targets for a given session, the therapist helps the patient figure out what led up to the behavior(s) in question and the consequences that may be reinforcing or maintaining the behavior(s). The therapist also helps the patient find ways to apply skillful, effective behavior, solve problems in life, or regulate emotions. In terms of enhancing motivation, the therapist actively works to get the patient to commit to behavior change, using a variety of “commitment” strategies.
Function #4: Enhancing and maintaining therapist capabilities and motivation. Another important function of DBT involves maintaining the motivation and skills of the therapists who treat patients with BPD. Although helping multiproblematic BPD patients can be stimulating and rewarding, these patients also engage in a potent mix of behaviors that can tax the coping resources, competencies, and resolve of their treatment providers (i.e., suicide attempts, repeated suicidal crises, behaviors that interfere with therapy). As a result, one essential ingredient of an effective treatment for BPD patients is a system of providing support, validation, continued training and skill-building, feedback, and encouragement to therapists.
To address this function, standard DBT includes a therapist consultation-team meeting, for which DBT therapists meet once per week for approximately 1 to 2 hours. The team helps therapists problem-solve ways to implement effective treatment in the face of specific clinical challenges (e.g., a suicidal patient, a patient who misses sessions).
Function #5: Structuring the environment. A fourth important function of DBT involves structuring the environment in a manner that reinforces effective behavior/progress and does not reinforce maladaptive or problematic behavior. Often, this involves structuring the treatment in a manner that most effectively promotes progress. Typically, in DBT, the individual therapist is the primary therapist and is “in charge” of the treatment team. He or she makes sure that all of the elements of effective treatment are in place, and that all of these functions are met.
Structuring the environment may also involve helping patients find ways to modify their environments. For instance, drug-using patients may need to learn how to modify or avoid social circles that promote drug use; patients who self-harm sometimes need to learn how to make sure that their partners or significant others do not reinforce self-harm (i.e., by being overly soothing, warm, or supportive). In DBT, the therapist normally has the patient modify his or her environment, but at times, may take an active role in changing patients’ environments for them (e.g., if the environment is overwhelming or too powerful for the patient to have a reasonable degree of influence).
How Can I Find a DBT Therapy Near Me?
DBT is a type of therapy that’s often used to reduce symptoms of BPD, but it has some other uses as well.
If you often find yourself in emotional distress and want to learn some new coping strategies, DBT Therapy may be a good fit for you.
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