Dialectical Behavioral Therapy (DBT)

DBT is considered a subtype of cognitive behavioral therapy (CBT), but there’s a lot of overlap between the two. Both involve talk therapy to help better understand and manage your thoughts and behaviors.

However, DBT puts a little more emphasis on managing emotions and interpersonal relationships. This is largely because it was originally developed as a treatment for BPD, which is often marked by dramatic swings in mood and behavior that can make having relationships with others difficult.

With DBT, you’ll learn to use four core skills, sometimes called modules, to cope with emotional distress in positive, productive ways. Linehan refers to these four skills as the “active ingredients” of DBT.

Mindfulness and distress tolerance skills help you work toward acceptance of your thoughts and behaviors. Emotion regulation and interpersonal effectiveness skills help you work toward changing your thoughts and behaviors.

Here’s a closer look at the four skills.

Mindfulness

Mindfulness is about being aware of and accepting what’s happening in the present moment. This can help you learn to notice and accept your thoughts and feelings without judgement.

In the context of DBT, mindfulness is broken down into “what” skills and “how” skills.

“What” skills teach you what you’re focusing on, which might be:

• the present
• your awareness in the present
• your emotions, thoughts, and sensations
• separating emotions and sensations from thoughts

“How” skills teach you how to be more mindful by:

• balancing rational thoughts with emotions
• using radical acceptance to learn to tolerate aspects of yourself (as long as they aren’t hurting you or others)
• taking effective action
• using mindfulness skills regularly
• overcoming things that make mindfulness difficult, such as sleepiness, restlessness, and doubt

Distress tolerance

Mindfulness can go a long way, but it isn’t always enough, especially in moments of crisis. That’s where distress tolerance comes in.

Distress tolerance skills help you get through rough patches without turning to potentially destructive coping techniques.

In times of crisis, you might use certain coping strategies to help you deal with your emotions. Some of these, like self-isolating or avoidance, don’t do much help, though they may help you temporarily feel better. Others, like self-harm, substance use, or angry outbursts, might even cause harm.

Distress tolerance skills can help you:

• distract yourself until you’re calm enough to deal with the situation or emotion
• self-soothe by relaxing and using your senses to feel more at peace
• find ways to improve the moment despite pain or difficulty
• compare coping strategies by listing pros and cons

Interpersonal effectiveness

Intense emotions and rapid mood changes can make it hard to relate to others. Knowing how you feel and what you want is an important part of building fulfilling connections.

Interpersonal effectiveness skills can help you be clear about these things. These skills combine listening skills, social skills, and assertiveness training to help you learn how to change situations while remaining true to your values.

These skills include:

• objective effectiveness, or learning how to ask for what you want and take steps to get it
• interpersonal effectiveness, or learning how to work through conflict and challenges in relationships
• self-respect effectiveness, or building greater respect for yourself

Emotion regulation

Sometimes you may feel like there’s no escape from your emotions. But as difficult as it might sound, it’s possible to manage them with a little help.

Emotion regulation skills help you learn to deal with primary emotional reactions before they lead to a chain of distressing secondary reactions. For example, a primary emotion of anger might lead to guilt, worthlessness, shame, and even depression.

Emotion regulation skills teach you to:

• recognize emotions
• overcome barriers to emotions that have positive effects
• reduce vulnerability
• increase emotions that have positive effects
• be more mindful of emotions without judging them
• expose yourself to your emotions
• avoid giving into emotional urges
• solve problems in helpful ways

DBT uses three types of therapy approaches to teach the four core skills discussed above. Some believe this combination of techniques is part of what makes DBT so effective.

One-on-one therapy

DBT usually involves an hour of one-on-one therapy each week. In these sessions, you’ll talk with your therapist about whatever you’re working on or trying to manage.

Your therapist will also use this time to build up your skills and help you navigate specific challenges.

Skills training

DBT involves a skills training group, which is similar to a group therapy session.

Skills groups usually meet once a week for two to three hours. The meetings generally last for 24 weeks, but many DBT programs repeat the skills training so the program lasts a full year.

During skills group, you’ll learn about and practice each skill, talking through scenarios with other people in your group. This is one of the key components of DBT.

Phone coaching

Some therapists also offer phone coaching for extra support between your one-on-one appointments. This might be a good thing to have in your back pocket if you often find yourself feeling overwhelmed or just need a bit of extra support.

Over the phone, your therapist will guide you through how to use your DBT skills to tackle the challenge at hand.

DBT was initially developed to help improve symptoms of BPD and persistent thoughts of suicide. Today, it’s considered one of the most effective treatments for BPD.

For example, a 2014 study looked at how 47 people with BPD responded to DBT. After a year of treatment, 77 percent no longer met the diagnostic criteria for BPD.

DBT may also help with a range of other conditions, including:

• Substance use disorders. DBT can help reduce urges to use and shorten relapses.
• Depression. A small 2003 study found a combination of antidepressants and DBT was more effective for treating depression in older adults than antidepressants alone.
• Eating disorders. An older study from 2001 looked at how DBT helped a small group of women with binge eating disorder. Of those who participated in DBT, 89 percent had stopped binge eating completely after treatment.

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 may be a good fit for you.