Dialectical Behavior Therapy (DBT) was developed by Marsha Linehan (1987) for treating suicidal behavior and borderline personality disorder (BPD). BPD criteria includes trouble regulating emotions, engaging in impulsive behavior, having a distorted self-image, fearing abandonment, and encountering relationship distress (National Institute of Mental Health, 2022). DBT encompasses a multi-method approach of sessions including assessment, individual therapy, group skills training, and telephone crisis coaching (Rizvi, Steffel, & Carson-Wong, 2012; Cleveland Clinic, 2022). Noteworthy, Linehan identified acceptance and change as the essential features of DBT (Robins & Chapman, 2004). DBT includes four skills intended to improve an individual’s day-to-day functioning. The four skills DBT teaches include emotion regulation, distress tolerance, mindfulness, and interpersonal effectiveness skills (Cleveland Clinic, 2022).
Emotion regulation begins with psychoeducation on the general purpose of emotions. An individual learns how emotions function in a particular way and possible ways of over-reacting (Dimeff & Linehan, 2001). Skills include naming and understanding emotions, perspective-taking, challenging unhealthy viewpoints and beliefs, reframing situations, problem solving, and decreasing emotional suffering and frequency of unpleasant emotions (Fassbinder et al., 2016; Goldin, Jazairi, & Gross, 2014). Thus, these skills focus on improving one’s awareness and insight into the function of emotions as well as reducing emotional reactivity (Karrass, Walden, & Conture, et al., 2006).
Distress Tolerance skills involve understanding and managing emotions in troubling situations and reducing the urge to engage in unhealthy and potentially harmful coping skills (Cleveland Clinic, 2022; Dimeff & Linehan, 2001). Acceptance of pain and distress in particular moments is encouraged and emphasizing what one can control versus cannot control in their environment (Fassbinder et al., 2016; Lynch, Chapman, Rosenhal, Kuo, & Linehan, 2006). These skills aim at decreasing self-harm behaviors such as self-injury, substance use, and avoidant patterns. Overall, distress tolerance teaches crisis survival skills and ways to manage high levels of anguish (Karrass, et al., 2006; Rizvi, et al., 2012).
Mindfulness skills stress the importance of being in the present moment with full awareness as opposed to being stuck in the past or the future (Fassbinder et al., 2016; Lynch et al., 2006; Cleveland Clinic, 2022). Many people become entangled in worry of the future and/or regret of the past. Therefore, mindfulness demonstrates ways to immerse oneself in the here-and-now to experience emotions, thoughts, and body sensations without judgement and reaction (Karrass, et al., 2006; Rizvi, et al., 2012). A person is able to truly appreciate the moment by allowing cognitions and emotions to pass by instead of one’s attention being preoccupied with distress and worry (Lynch et al., 2006).
Interpersonal effectiveness skills improve a person’s ability to implement boundaries and asks for what they may need or want from others in a respectful way (Fassbinder et al., 2016; Cleveland Clinic, 2022). Avoidance of interpersonal matters is challenged by increasing assertiveness skills with others; resulting in being positively reinforced for asserting one’s needs and wants (Karrass et al., 2006; Lynch et al., 2006). In sum, interpersonal effectiveness skills include learning how to communicate and listen effectively, be patient, solve conflict, and improve self-awareness.
In summary, DBT is effective for treating several disorders including: BPD, suicidal behaviors, substance abuse, PTSD, eating disorders, depression, and ADHD (Rizvi, et al., 2012; NIMH, 2022). In terms of ages, DBT has found to be effective for children, adolescents, and adults and can be adapted for different populations (Fassbinder et al., 2016). Overall, DBT includes several benefits such as regulating extreme emotions, reducing problematic behaviors, and create a balance of acceptance and strategies to adapt to distress.
- Mary Rizzo, Psy.D., 847-413-9700, ext. 405
References Cleveland Clinic. (2022). Dialectical Behavior Therapy (DBT). Retrieved from: https://my.clevelandclinic.org/health/treatments/22838-dialectical-behavior-therapy-dbt Dimeff, L., & Linehan, M. M. (2001). Dialectical behavior therapy in a nutshell. The California Psychologist, 34(3), 10-13.Fassbinder, E., Schweiger, U., Martius, D., Brand-de Wilde, O., & Arntz, A.R. (2016). Emotion Regulation in Schema Therapy and Dialectical Behavior Therapy. Frontiers in Psychology, 7.Karrass, J., Walden, T. A., Conture, E. G., Graham, C. G., Arnold, H. S., Hartfield, K. N., & Schwenk, K. A. (2006). Relation of emotional reactivity and regulation to childhood stuttering. Journal of communication disorders, 39(6), 402-423.Lynch, T. R., Chapman, A. L., Rosenthal, M. Z., Kuo, J. R., & Linehan, M. M. (2006). Mechanisms of change in dialectical behavior therapy: Theoretical and empirical observations. Journal of clinical psychology, 62(4), 459-480.National Institute of Mental Health. (2022). Borderline Personality Disorder. Retrieved from: https://www.nimh.nih.gov/health/topics/borderline-personality-disorder#:~:text=Borderline%20personality%20disorder%20is%20a,impact%20their%20relationships%20with%20others. Rizvi, S. L., Steffel, L. M., & Carson-Wong, A. (2013). An overview of dialectical behavior therapy for professional psychologists. Professional Psychology: Research and Practice, 44(2), 73.