What is Dialectical Behavior Therapy (DBT)

At Columbus Therapy and Hypnosis we often use dialectical behavior therapy (DBT) to work with clients. Sometimes it is the primary method used. At other times we just use some of the skills with clients to help them with a particular situation such as self soothing during couple therapy. Our owner Yvonne Judge is DBT certified and provides guidance to the therapists in the practice on when and how DBT should be used.

The 4 pillars of Dialectical Behavior Therapy

Dialectical Behavior Therapy (DBT) is structured around four pillars or modules, which provide a comprehensive framework for addressing the challenges faced by individuals with emotional dysregulation and difficulties in interpersonal relationships. The four pillars (various skills modules) of DBT are:

Mindfulness skills

Mindfulness skills are the foundation of DBT. The reason for this is mindfulness increases awareness of what is going on with your emotions, with your body and around you.

For instance, if you don’t know what your emotions are and what is triggering them, it is difficult to regulate them. For this reason, dialectical behavior therapy often starts out with mindfulness skills training.

Distress tolerance skills

Dialectical Behavior Therapy (DBT) incorporates distress tolerance skills to help individuals manage and tolerate upsetting emotions, crises, and overwhelming situations. These behavioral skills are designed to prevent impulsive and self-destructive behaviors, providing healthier alternatives for coping with distress.

Emotion regulation skills

Dialectical Behavior Therapy includes a set of various emotion regulation strategies and skills designed to help individuals effectively manage and regulate their emotions on a day-to-day basis. These skills provide practical strategies for understanding, tolerating, and modulating emotions in a healthy manner.

Interpersonal effectiveness skills

Dialectical Behavior Therapy emphasizes the development of interpersonal effectiveness skills (people skills) to improve communication, assertiveness, and the ability to build and maintain healthy boundaries and relationships. These skills are particularly helpful for individuals who struggle with interpersonal challenges, difficulty using new skills, setting boundaries, and navigating conflicts.

What can you treat with DBT therapy?

Dialectical Behavior Therapy (DBT) is a comprehensive therapeutic approach that has been shown in clinical trials to be effective in treating a range of mental health conditions and difficulties. Some of the main conditions and concerns that DBT can address include:

1. Borderline Personality Disorder (BPD): DBT was initially developed specifically for treating borderline personality disorder. It is considered the gold standard treatment for this condition and has been shown to reduce self-destructive behaviors, suicidal ideation, and improve overall functioning and quality of life. Dialectical behavior therapy skills have since been used for other personality disorders and many other diagnoses.
2. Self-Harm and Suicidal Behaviors: DBT has been proven effective in reducing self-harm behaviors, suicidal ideation, and suicide attempts. It provides individuals with alternative coping strategies and skills to manage distress and regulate emotions without resorting to self-destructive behaviors.
3. Eating Disorders: DBT can be used as part of the treatment for individuals with eating disorders, such as binge eating disorder, bulimia nervosa, or other disordered eating patterns. It focuses on emotional regulation, distress tolerance, and developing healthier coping mechanisms to manage the complex emotions and behaviors associated with eating disorders.
4. Mood Disorders: DBT can be effective in treating individuals with depression, bipolar disorder, and other mood disorders. It helps individuals regulate emotions, manage distress, and develop skills to challenge negative thought patterns and improve overall mood.
5. Post-Traumatic Stress Disorder (PTSD): DBT can be utilized as part of the treatment for individuals with PTSD. It focuses on managing emotional dysregulation, developing skills for distress tolerance, and processing traumatic experiences in a safe and structured manner.
6. Anxiety Disorders: DBT can provide individuals with anxiety disorders, such as generalized anxiety disorder or social anxiety disorder, with tools to manage anxiety, challenge irrational thoughts, and cope with distressing situations effectively.
7. Interpersonal Difficulties: DBT emphasizes interpersonal effectiveness skills, helping individuals improve communication, set boundaries, and navigate conflicts in relationships with romantic partners,  family, friends, coworkers and others. It can be beneficial for those struggling with difficulties in relationships, including difficulties maintaining relationships or engaging in assertive communication.

It’s important to note that while DBT has shown effectiveness in treating these conditions, it is typically implemented as part of a comprehensive treatment plan tailored to the individual’s specific needs. A qualified DBT therapist can assess whether DBT is appropriate to treat patients and develop a personalized treatment approach based on the individual’s unique circumstances.

What does DBT therapy look like?

What DBT a therapy session looks like depends on if you are doing full DBT, or only individual therapy sessions that use DBT.

Full DBT

Full DBT is meant for clients who are at high risk of suicidality and self harm such as those with borderline personality disorder. Full dialectical behaviour therapy is more than just individual therapy. It includes individual therapy sessions, group skills training, phone coaching and a consultation team. I will explain each of these separately.

1. Individual therapy:

   The therapist and the client work together one-on-one to set treatment goals, discuss specific issues, and develop skills to cope with challenges. The therapist provides guidance and support while helping the client apply DBT techniques to manage emotions, improve relationships, and increase overall life satisfaction.

2. Group skills training:

   Clients participate in group sessions where they learn specific skills related to four main modules: mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness. These skills are designed to help individuals regulate their emotions, navigate interpersonal conflicts, cope with distressing situations, and increase their self-awareness.

3. Phone coaching:

   DBT often includes the option for clients to contact their therapists between sessions for brief phone consultations. This is intended to provide support and guidance during challenging or crisis situations, helping clients apply the skills they have learned in therapy to real-life scenarios.

4. Consultation team:

   Therapists who provide DBT often participate in consultation teams with other professionals. These teams serve to support the therapists in their work, ensure adherence to the principles of DBT, and address any challenges that arise during treatment.

DBT individual Sessions

Clients who are not high risk, often choose to do only some DBT sessions or individual therapy sessions. During these sessions clients may be taught specific DBT skills, receive support and learn how to apply DBT skills to their own particular challenges in life.

What is the difference between Dialectical Behavioral Therapy and CBT?

DBT (Dialectical Behavior Therapy) and CBT (Cognitive Behavioral Therapy) are both evidence-based therapeutic approaches but have distinct differences in their focus and application. Here are some key differences between DBT and CBT:

1. Focus and Target Population:

   • DBT was initially developed to specifically target individuals with borderline personality disorder (BPD) and chronic suicidality. However, it is not just for chronically suicidal borderline patients, it has since been adapted to address a wider range of conditions characterized by emotional dysregulation, self-destructive behaviors, and difficulties in interpersonal relationships.
   • CBT is a more general therapeutic approach that can be applied to various mental health conditions, including anxiety disorders, depression, phobias, and obsessive-compulsive disorder (OCD), among others. It focuses on the relationship between thoughts, emotions, and behaviors.

2. Emotional Regulation Skills:

   • DBT places a strong emphasis on teaching individuals skills to regulate and tolerate intense emotions effectively. It helps individuals identify and label their emotions, develop distress tolerance techniques, and learn adaptive ways to manage emotional dysregulation.
   • While CBT also addresses emotions, it typically focuses more on cognitive restructuring and challenging maladaptive thoughts and beliefs that contribute to emotional distress. The emphasis is on identifying and modifying unhelpful thinking patterns.

3. Mindfulness:

   • Mindfulness is a core component of DBT and is taught and practiced throughout the therapy. Mindfulness skills help individuals cultivate present-moment awareness, non-judgmental observation of thoughts and emotions, and acceptance of oneself and the current experience.
   • While mindfulness can be incorporated into CBT, it is not as central to the approach as it is in DBT. CBT primarily focuses on identifying and challenging cognitive distortions and replacing them with more realistic and adaptive thoughts.

4. Dialectics and Validation:

   • DBT incorporates dialectics, which involves recognizing and reconciling opposing perspectives or truths. It encourages finding the middle ground between acceptance and change. For instance, “I am a good person” and “I need to improve my coping skills”. DBT also places a strong emphasis on validation, helping individuals feel understood and acknowledged.
   • CBT typically focuses on identifying and challenging cognitive distortions without the same emphasis on dialectics or validation.

5. Treatment Structure:

   • Comprehensive DBT typically includes individual therapy, group skills training, phone coaching, and therapist consultation meetings. It provides a comprehensive treatment approach that combines individualized therapy with skills development and support between sessions. This is often used for high-risk or chronically suicidal borderline patents. Partial DBT is often used for those who are not in danger of self harm.
   • CBT can be delivered in individual or group therapy formats, with a primary focus on individual sessions. It usually follows a structured and goal-oriented approach to address specific symptoms or problems.

It’s important to note that DBT incorporates some cognitive-behavioral techniques within its framework. Both DBT and CBT share the goal of helping individuals develop healthier coping strategies, improve functioning, and achieve better overall well-being. The choice between DBT and CBT depends on the individual’s specific needs, diagnosis, and treatment goals. A qualified mental health professional can assess and determine if dialectical behavior therapy or a cognitive behavioral treatment approach may be most suitable for an individual’s particular circumstances. A good DBT therapist will be able to determine if a client needs comprehensive dialectical behavior therapy, cognitive behavioral treatment, or individual DBT therapy.

The Benefits of DBT

Dialectical Behavior Therapy (DBT) offers several benefits for individuals struggling with emotional dysregulation, self-destructive behaviors, and difficulties in interpersonal relationships. Here are some of the key benefits of DBT:

1. Improved Emotional Regulation:

   DBT provides individuals with skills to better understand, manage, and regulate their emotions. It helps individuals identify and label emotions, tolerate distressing emotions without resorting to impulsive or self-destructive behaviors, and develop healthier ways of coping with intense emotions.

2. Reduction in Self-Destructive Behaviors:

   DBT has been proven effective in reducing self-harm behaviors, suicidal ideation, and suicide attempts. It provides individuals with alternative coping strategies and skills to manage distress and prevent impulsive actions, thus promoting a safer and more stable life.

3. Enhanced Interpersonal Skills:

   DBT places a strong emphasis on developing interpersonal effectiveness skills. Individuals learn effective communication, assertiveness, setting boundaries, and navigating conflicts in relationships. These skills can improve relationships, enhance social functioning, and increase satisfaction in interactions with others.

4. Increased Distress Tolerance:

   DBT equips individuals with skills to tolerate distressing situations and emotions without resorting to maladaptive behaviors. This helps individuals build resilience, withstand challenging circumstances, and maintain stability during difficult times.

5. Improved Mindfulness:

   DBT incorporates mindfulness practices to cultivate present-moment awareness, non-judgmental observation of thoughts and emotions, and acceptance of oneself and the current experience. Practicing mindfulness can help individuals reduce rumination, increase self-awareness, and promote overall well-being.

6. Coping Skills for Crises and Triggers:

   DBT provides individuals with specific coping skills to manage crises and navigate triggers effectively. This can prevent impulsive or self-destructive reactions and help individuals respond in a more adaptive and skillful manner during challenging situations.

7. Increased Self-Acceptance and Self-Compassion:

   DBT encourages individuals to cultivate self-acceptance and self-compassion, recognizing that everyone has strengths and limitations. This promotes a more positive and non-judgmental relationship with oneself, leading to improved self-esteem and overall self-worth.

8. Enhanced Quality of Life:

   By addressing emotional dysregulation, self-destructive behaviors, and interpersonal difficulties, DBT can lead to a significant improvement in an individual’s overall quality of life. It helps individuals build a life worth living, with increased emotional well-being, better relationships, and a greater sense of fulfillment.

It’s important to note that the benefits of DBT are typically achieved through a structured and comprehensive treatment approach that involves individual therapy, group skills training, phone coaching, and therapist consultation meetings. The duration and effectiveness of therapy can vary depending on the individual’s needs, commitment to practicing skills, and engagement in treatment. A qualified mental health professional experienced in DBT can guide individuals through the process and help them experience the benefits of this therapeutic approach.

Next Steps

If you would like to start DBT or have questions we can answer about how we do DBT, contact us.