In some cases, people with challenging mental health disorders need specialized support beyond standard forms of psychotherapy. This is especially true for people with disorders characterized by high emotional reactivity and symptoms that increase dramatically in response to stressful or distressing situations.
Dialectical behavior therapy (DBT) is a subtype of cognitive behavioral therapy (CBT) developed by Dr. Marsha Linehan to support people with those types of disorders, specifically people with severe borderline personality disorder (BPD). Other approaches were ineffective in helping patients manage extreme, disruptive emotions, out-of-control behaviors, and volatile patterns of thought.
What Type of Patients Do Best With DBT?
Four decades of research on DBT show it’s an effective therapeutic approach for people diagnosed with the following mental health challenges, conditions, and/or disorders:
- Borderline personality disorder (BPD)
- Major depression (MDD)
- Bipolar disorder (BD)
- Posttraumatic stress disorder (PTSD)
- Suicidal ideation (SI)
- Non-suicidal self-injury (NSSI)/Self-harm
- Adverse childhood experiences (ACEs)
The addition of DBT to the therapeutic toolbox for mental health professionals was a significant event in mental health treatment. Before DBT, many providers refused to accept or treat patients with volatile or severe emotional and behavioral symptoms, and instead refer them to inpatient hospitalization programs. Those programs are effective in stabilizing people with extreme symptoms, but are not designed for long-term care, sustained recovery, or helping patients develop effective tools to manage day-to-day life.
That’s why DBT is important: it helps patients with extreme symptoms learn to manage them and teaches highly reactive patients an array or practical tools to tolerate distress and find balance.
DBT: How it Works
Information from the Behavioral Tech Knowledge Center, published by the Behavioral Tech Institute, founded by Dr. Linehan, identifies three primary modes of treatment in DBT:
- Psychotherapy
- Skills Training
- Personal coaching
Here’s an explanation of these three modes of treatment.
DBT MODE ONE: One-on-one, Individual Psychotherapy
Most patients engage in highly structured, organized, individual DBT therapy once a week or more, depending on the patient, provider, and diagnosis, in conjunction with DBT skills training.
DBT MODE TWO: Skills Training
DBT is distinct from other forms of psychotherapy in its focus on practical skills patients can learn quickly and apply immediately in order to manage severe and extreme symptoms.
DBT skills include, but are not limited to:
Mindfulness
The foundation of mindfulness training, or the DBT skill we call mindfulness, is developing the ability to experience our thoughts and emotions without judgment and without allowing them to take over and dominate how we think and feel. In DBT mindfulness training, patients learn that automatically identifying an emotion as good or bad is not helpful, because that judgment influences how they react to that emotion. Instead, a DBT therapist helps patients allow their emotions to be what they are, and allow them to run their course without automatically responding or reacting to them.
When a patient learns to use mindfulness to let go of their immediate, unconscious reactions to various stimuli – including emotions, the actions of others, and stressful life events – a skilled DBT therapist can help them modulate the behavior associated with that emotion. In most cases, patients can apply these skills successfully almost immediately, and experience significant improvement.
Emotion Regulation
The core skill of mindfulness dovetails perfectly with the next core DBT skill, emotion regulation. An individual with a disorder associated with high levels of emotional reactivity, volatile behavior, and/or feelings that are extremely powerful needs to learn how to bring those emotions, behaviors, and feelings into balance. A skilled DBT therapist can help patients learn – sometimes for the first time in their lives – how to manage these emotions without being driven by them. Learning the skill of emotion regulation in DBT helps patients experience and process their emotions, no matter how severe, in a healthy and balanced manner.
Distress Tolerance
There are times in life when we experience serious difficulties and challenges that can seem overwhelming. No one is immune from ups and downs, and we all experience crises at some point, whether they’re psychological, emotional, or physical. DBT therapists work with patients to prepare for moments of daily stress, moments of significant distress, and the periods of elevated stress and distress, or crisis. These skills take work to learn and apply, but it pays off: a patient who learns DBT distress tolerance skills can make safe and healthy choices during crisis moments, which is essential for len-term health and well-being.
Interpersonal Effectiveness
Interpersonal effectiveness means the ability to form healthy, enriching, beneficial relationships with other people. Skills that help patients enhance interpersonal effectiveness include:
- Recognizing personal needs
- Clearly defining those needs
- Effectively communicating those needs to others in the moment
- Setting healthy boundaries, i.e. learning when to say yes and no
Patients can apply these skills to rediscover equilibrium and restore primary relationships disrupted by the extreme emotion and atypical behaviors associated with some mental health disorders.
DBT MODE THREE: Personalized Skills Coaching
Trained DBT therapists often allow patients to contact them outside of standard therapy sessions – typically by phone or text – for individual coaching during challenging or stressful moments. DBT therapists help by providing step-by-step support to help patients manage these moments in a healthy and productive manner. Then, in the next session, patient and therapist review what happened, identify the trigger, match the appropriate coping skill, then practice that skill until the patient is ready to apply it independently, the next time they experience a similar situation.
The Benefits of Dialectical Behavior Therapy (DBT)
Patients with mental health or behavioral disorders defined by extreme emotion and disruptive behavior can learn and apply DBT skills relatively quickly. That’s one thing that separates DBT from other forms of therapy, and that’s the primary benefit of DBT:
Effective skills that work in the moment.
Most of us develop basic stress tolerance and emotion regulation skills over time, throughout childhood, adolescence, and early adulthood. But for some people, the presence of a mental health disorder prevents the development or those skills, which can cause real problems across almost all domains of life. For people born with what DBT therapists call a skills deficit, whereby a lack of emotion regulation, distress tolerance, and interpersonal skills can lead to maladaptive patterns of thought and behavior, DBT treatment can make all the difference, and help them learn to manage their disruptive symptoms, and live the life they choose, rather than one dominated by the symptoms of their disorder.
Learn More Today
If you or a loved one has a mental health disorder defined by high emotional reactivity, volatile behavior, and/or low stress/distress tolerance, dialectical behavior therapy (DBT) may be an effective treatment modality that helps them achieve their treatment and recovery goals.
Gianna Melendez
Jodie Dahl, CpHT