What Is Dialectical Behavioral Therapy?

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Originally developed to treat borderline personality disorder, dialectical behavior therapy (DBT) is a type of cognitive-behavioral psychotherapy — or talk therapy — used to treat a range of mental health disorders. This treatment relies on the psychosocial aspects of therapy and tries to identify and change negative thinking patterns through a focus on building positive behavioral skills. Before considering dialectical behavior therapy, it is important to understand how it works and who can benefit from this treatment method, as it may not be the best option for everyone.

How Does Dialectical Behavioral Therapy Work?

This form of talk therapy is rooted in the idea that certain types of people are prone to react in a more intense and extreme manner in emotional situations, especially among interpersonal relationships. Dialectical behavioral therapy was developed in the 1980s by Dr. Marsha Linehan to help treat chronically suicidal individuals, and later, those with borderline personality disorder. Today, the dialectical behavioral therapy approach is recommended as a front-line treatment for personality disorder, a condition that impacts between 4 and 6 percent of the population.

DBT focuses on helping individuals with incredibly negative emotions that are difficult to manage, therefore therapists trained in dialectical behavioral therapy work to help their clients find and achieve emotional balance. Sessions are focused on helping a person develop an ability to hold multiple perspectives at once, helping to reduce the all-or-nothing styles of thinking that can lead to an extremely negative and hopeless outlook. The focus of this treatment remains on promoting acceptance and positive change through four main strategies:

  1. Distress tolerance
    Learning to accept oneself and the current situation by tolerating and surviving intense emotions like anger, as well as avoiding impulsive reactions or substance abuse to get through moments of distress.
  2. Mindfulness
    Various techniques to become more aware of self and more attentive to living in the present moment.
  3. Emotion regulation
    Recognizing negative emotions when they occur, labeling them, and adjusting unhealthy emotions whenever needed.
  4. Interpersonal effectiveness
    Becoming more assertive in relationships by navigating conflict and fostering more positive interactions.

Types of Dialectical Behavioral Therapy

There are two primary types of DBT: individual treatment and skills group.

Individual treatment

This form of treatment consists of one-on-one contact with a licensed and trained therapist and helps ensure that specific needs are being met over a set period of time. A therapist will help a patient stay motivated, apply dialectical behavioral therapy skills to situations happening in their daily life, and address issues that arise over the course of treatment. Individual treatment generally takes place over the course of a year.

Skills group treatment

In this context, skills group participants learn and practice skills alongside others who face similar challenges and are encouraged to share experiences and support one another. Like individual treatment, groups are led by a trained therapist who teaches skills, leads exercises, and assigns homework such as practicing mindfulness. Sessions generally last for about two hours every week over the course of six months to a year.

In either context, this form of therapy follows a consistent, four-stage approach to driving change. First, therapists zero in on the most self-destructive behavior, such as self-harm, while gradually addressing quality-of-life skills such as emotional regulation, distress tolerance, and interpersonal effectiveness. At this point, a focus on improved relationships and self-esteem is brought into view. The final stage of DBT centers on promoting joy and connection to cap off treatment phases.

Does Dialectical Behavioral Therapy Work?

DBT is proven to significantly decrease suicide-related outcomes, psychiatric hospitalizations, use of emergency services, treatment discontinuation, depression, and substance use, while increasing social functioning. Research also shows this form of treatment can successfully treat people experiencing depression, bulimia, binge-eating, bipolar disorder, and post-traumatic stress disorder.

Additionally, the American Psychiatric Association endorsed DBT as an effective treatment method, with those who seek treatment experiencing the following improvements:

  • Less frequent and less severe suicidal behavior
  • Shorter hospitalizations
  • Less anger
  • Less likely to drop out of treatment
  • Improved social functioning

Getting Started with Dialectical Behavioral Therapy

If you believe that you may benefit from dialectical behavioral therapy, it is important to seek guidance from a doctor or healthcare professional who understands this treatment approach. The core of the DBT method is to identify and change negative thought patterns by focusing on positive behavioral changes such as mindfulness and emotion regulation.

As such, it is important to find a therapist who has experience in each of the four stages of treatment because, when done properly, this treatment method is proven to have a lasting impact and decrease emotional distress. For many, dialectical behavioral therapy is a light at the end of the tunnel.

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