Dialectical Behavioral Therapy

Dialectical Behavioral Therapy (DBT) is a cognitive-behavioral treatment developed by Marsha Linehan, Ph.D., in the 1980s to help people who experience extremely intense emotions, catastrophic thinking, anxiety, stress, and “all or none” thinking (to name a few). These experiences are commonly, but not always, due to a history of trauma.

The “D” means “dialectical.” A dialectic is a synthesis or integration of opposites. A DBT-oriented therapist consistently works with an individual to find ways to hold two seemingly opposite perspectives at once, promoting balance and avoiding black and white (all-or-nothing) styles of thinking. In service of this balance, DBT promotes a “both-and” rather than an “either-or” outlook. The dialectic at the heart of DBT is acceptance and change.

Dialectical strategies help us get unstuck from extreme positions. They help us stay “in-balance” so we can reach our ultimate goals as quickly as possible. The Wise Mind illustrates this point (see below).

Dialectical behavior therapy (DBT) provides new skills to manage painful emotions and decrease conflict in relationships. DBT specifically focuses on providing skills in four key areas.

1. Mindfulness: Mindfulness focuses on improving one’s ability to accept the present moment without judgment. 
2. Distress Tolerance: Distress tolerance is geared toward increasing one’s tolerance of negative emotions, rather than avoiding them.
3. Emotion regulation: Emotion regulation covers strategies to manage and change intense emotions that are causing problems in one’s life.
4. Interpersonal effectiveness: Interpersonal effectiveness consists of techniques that allow one to communicate with others in a way that is assertive, maintains self-respect, and strengthens relationships.

Using a DBT approach, a therapist guides a client or patient through the process of acceptance and change by validating and accepting the individual as he or she is.  A DBT therapist appreciates that too much focus on change results in the individual feeling misunderstood and invalidated. Working with people with extreme emotional sensitivity requires careful attention to the balance between acceptance and change. It also requires an assessment of personal boundaries. 

DBT was originally developed to relieve the emotional sensitivity experienced by individuals with borderline personality disorder. However, research shows that DBT has also been used successfully to help people suffering from depression, bulimia, binge-eating, bipolar disorder, post-traumatic-stress disorder, abandonment/attachment problems, and substance abuse.