Understanding Dialectical Behavior Therapy: What You Should Know

“Dialectical” means trying to understand how two things that seem opposite could both be true. A great example of this is you can accept where you are in life and strive to grow. While these might feel contradictory, dialectical behavior therapy teaches you that you can achieve both of these goals together. Find out what DBT is and why it can be a useful approach to help people manage troubling thoughts and various mental health challenges.

What is Dialectical Behavioral Therapy?

Dialectical behavior therapy is based on cognitive behavioral therapy (CBT), but it’s specially adapted for people who feel emotions very intensely. First developed in the 1980s by psychologist Marsha Linehan, PhD, dialectical behavior therapy was intended to treat borderline personality disorder. But it has since been modified and now DBT can support individuals dealing with:

• Suicidal ideation
• Substance use disorder
• Eating disorder
• Post-traumatic stress disorder (PTSD)
• Borderline personality disorder
• Depression
• ADHD
• Anxiety

Many people with these mental health disorders have trouble expressing their emotions and rely on unhelpful coping mechanisms to block out intense, negative feelings. DBT is rooted in dialectics, the idea that two seemingly opposite things can be true at the same time. It emphasizes finding a balance between acceptance and change, validation and change strategies, and the dialectical tension between the therapist and client.

Unlike CBT, a DBT therapist will spend less time delving into your past and more time focusing on the present and how you can move forward with healthy behaviors.

What Happens During Dialectical Behavior Therapy?

Before attending your first DBT session it is important to understand that this therapeutic approach, like all other approaches, is not an overnight fix. It will take time and dedication to get from where you currently are to where you want to be.

DBT Group Skill Training

DBT therapists will work with you on four key skills – usually in a group setting – to help improve your quality of life, overall health, and relationships. You will learn about:

1. Mindfulness is one of the core aspects of DBT. Mindfulness involves cultivating awareness of the present moment without judgment. These valuable skills help individuals observe, describe, and be fully engaged in their experiences, which can be especially beneficial for becoming aware and managing your emotions. Becoming mindful helps to lower stress and anxiety and improve focus and concentration.
2. Emotion Regulation skills are taught to help individuals identify and manage intense emotions. This includes understanding the function of emotions, reducing emotional vulnerability, and learning to respond to emotions in a skillful way.
3. Interpersonal Effectiveness focuses on improving communication skills, setting boundaries, and balancing the needs of the individual with the needs of others. Interpersonal effectiveness skills aim to help individuals build and maintain healthy relationships.
4. Distress Tolerance skills are designed to help individuals cope with crises and tolerate distress without resorting to destructive behaviors. These skills include self-soothing techniques, distraction strategies, and ways to accept and tolerate difficult situations.

Individual DBT Sessions

You typically meet one-on-one with a DBT therapist once or twice a week. In the initial sessions, your therapist will ask questions to understand your background and mental health challenges.

A DBT session revolves around you and your therapist targeting a recent life event, helping you identify all the factors that led up to and followed the event, and then determining and practicing new ways of responding to similar situations. You may also be asked to keep a diary card which is a self-monitoring chart used to document urges, behaviors, emotions, and skills. Writing down your thoughts in a diary may sound silly, but it is a good tool to look for patterns in your life and check your progress.

One of the goals of dialectical behavior therapy is to help the client apply the tools learned in group therapy to current situations and challenges in daily life. Essentially, DBT is a training method for rewiring how you relate to your own emotions, which all take time to be effective.

How DBT Can Help Treat Addiction

If you are struggling with addiction, DBT may be an effective therapy approach for you. Healthcare providers may suggest pairing dialectical behavior therapy with prescription medications or wellness exercises for a more balanced recovery.

The opposing concepts in DBT — change and acceptance — can come into play when working to quit using alcohol or drugs. A DBT therapist can help you work toward stopping substances completely, which would be the change, while also acknowledging that setbacks and relapses occur, which would be acceptance. This creates a supportive environment conducive to healing.

Studies show how DBT is effective at reducing drug cravings, discouraging negative behaviors, and promoting healthy relationships.

Is Dialectical Behavior Therapy for You?

While many people have found success with this approach, it may not be the best fit for everyone. DBT requires a lot of commitment, openness to change, and work outside of therapy to see changes. Many people find this therapy rewarding as it pushes individuals to develop coping skills and enhance their overall well-being.

Ultimately, the decision should come from a discussion between you and a healthcare professional. Speaking with an expert can help you conclude whether DBT or another therapeutic intervention might be most effective for your mental health or recovery journey.