What is DBT?

Dialectical Behavior Therapy (DBT) is a type of cognitive-behavioral therapy. DBT was originally developed in the 1980s by Marsha Linehan, a psychologist at the University of Washington. Although initially intended to help chronically suicidal individuals diagnosed with borderline personality disorder (BPD; please refer to the accompanying fact sheet for information on BPD), DBT has since been adapted for and used to effectively treat a number of other psychological problems. The central dialectic within DBT is to balance acceptance of the person exactly as s/he is in this moment with intense efforts to change the person’s life to increase adaptive functioning and decrease maladaptive behavior. The overarching goal of treatment with DBT is to help individuals develop, as Dr. Linehan would say, “a life worth living.”

What Does DBT Involve?

Since DBT was developed for individuals with severe and persistent suicidality [for more information on suicide, see ABCT’s fact sheet on suicide], it tends to involve greater commitment on the part of therapists and clients alike to work towards developing a satisfying and meaningful life so suicide does not appear to be a good alternative to living.

In its standard, outpatient form, DBT has four major components:

1. Weekly individual (one-to-one) therapy

2. Weekly skills-training sessions, usually in the form of groups

3. As-needed consultation between client and therapist outside of sessions

4. Weekly therapist consultation meeting in which DBT therapists meet to discuss their DBT cases

Individual therapy occurs at least once a week. The content of the therapy session generally revolves around targeting a high-priority event that occurred within the past week, helping the individual identify all the factors that led up to and followed the event (via a process called “behavioral analysis”) and then determining and practicing new ways of responding in the similar situations. The skills-training component of DBT involves teaching the individual specific skills designed to help improve their life in four major areas: mindfulness, emotion regulation, interpersonal effectiveness, and distress tolerance. Therapists make themselves available between sessions for consultation to help the clients apply new skills to prevent the use of problematic behaviors. Finally, the weekly consultation team is designed to help therapists get the support they need for treating suicidal clients as well as increase their motivation and adherence to DBT principles.

It is important to note that any facility or clinician that does not offer all of these four major components, is not offering comprehensive DBT. Rather, they are providing an adaptation or modification of DBT. Although this type of adaptation is quite common in the community, unfortunately we do not yet know whether just one (or two or three) component of DBT is as effective as the whole package.

Psychotropic medications are also often used to treat symptoms of BPD and associated problems, in conjunction with DBT, though research on their effectiveness is limited and we really don’t know whether medication works. Although not opposed to the use of medications, the stance of a DBT therapist is generally to help the individual learn to “replace pills with skills.”

Who Is DBT for?

DBT was originally developed for individuals who suffered from borderline personality disorder, a psychological condition in which people have great difficulty managing their emotions. DBT has also been adapted to treat other psychological problems including: eating disorders (specifically bulimia nervosa and binge eating disorder), suicidal and self-injurious behavior in adolescents, treatment-resistant depression, and substance use problems that cooccur with BPD. It is important to note that the reason DBT has been adapted for those different disorders is because each of these conditions is theorized to be associated with problems that stem from maladaptive efforts to control intense, negative emotions.