What is Comprehensive Dialectical Behavioral Therapy (DBT)?

1. ​Biosocial theory: an origin theory about the fit between people and their environment. Biosocial theory posits that each person is innately predisposed to a certain baseline emotional temperament ("bio-"), and that they also must interact within families, social spaces, communities, and other social structures that may not match their temperament ("-social"). Mismatches tend to give rise to constant feedback that the individual's emotions don't fit the facts, which leads to the individual mistrusting their own emotions.

2. Behaviorism: the backbone of modern psychological research and therapy. As the name suggests, behaviorism focuses on behaviors as evidence of psychological well-being, as well as the tools to treat psychological distress. In the context of DBT, behaviorism is the foundation of treating emotional distress by teaching skills and habits for managing complex and powerful feeling-states.

3. Dialectics: this term has a complex history, giving rise to many meanings. It comes from the Ancient Greek dialektikḗ technḗ, from diá (through) + légein (to speak), which, in its original usage in the writings of Socrates and Plato, referred to the discovery of complex truths through the dialogue of other, seemingly contradictory, component truths. Dialectical Behavioral Therapy is founded on the same principle that finding the syntheses of seemingly opposite but equally true statements can lead us to greater understandings about ourselves and the social worlds we're embedded within. In other words, DBT constantly asks, "What is being left out?" while acknowledging that many true things can coexist in the same person, relationship, or social structure, even if they seem contradictory at first glance.​​

• Mindfulness skills help people focus on and accept the present moment without judgment. Mindfulness in DBT involves three “what” skills (observing, describing, and participating in the present moment) and three “how” skills (nonjudgmental state of mind, paying attention to one thing at a time, and doing what is needed in the present moment).

• Distress tolerance skills help people better tolerate and accept distress and pain. In DBT, people are taught that distress and pain cannot be entirely avoided in life, but by using certain strategies, they can be tolerated.

• Interpersonal effectiveness skills include strategies people can use to assert themselves in social situations, including saying no, asking for what they want, and dealing with conflict in relationships. Additionally, these skills also emphasize building new and maintaining existing relationships, as well as maintaining self-respect in them.

• Emotion regulation skills help people better understand and control their emotions. In DBT, people learn several strategies to improve their emotion regulation, including identifying and labeling their current emotions, identifying obstacles that prevent them from changing their emotions, and engaging in positive events and experiences, among others.

In Dialectical Behavioral Therapy, there are four modes of treatment:

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• Individual sessions with a primary DBT therapist, usually once per week.

• A DBT skills group that meets for two hours, once per week.

• Telephone coaching with the primary therapist, available 24/7, for crisis situations and guided skills practice.

• A DBT consultation team that acts as "therapy for the therapist," to ensure that providers always deliver the highest quality of care. Clients do not attend consultation team meetings.

Pretreatment

We call the first four sessions of dialectical behavioral therapy “pretreatment.” During this stage, the DBT therapist assesses the new client to determine if they are likely to benefit from DBT. We also orient the individual to how the treatment works and ask them to commit to the full program (1 year for adults, 6 months for adolescents). People do not “officially” join the DBT program until they have signed their commitment.

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Stage One

In Stage One of DBT, the therapist helps the client to get their behaviors under control. We prioritize life threatening behaviors first, like suicidal ideation and self-harm. We also work on any behaviors that interfere with therapy, like not showing up for sessions, and behaviors that interfere with the client’s quality of life, like using drugs or fighting with loved ones. 
Stage One is also when the individual joins their skills group. This is where they learn the skills they need to avoid those destructive behaviors. The skills are taught in 4 modules:

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• Core mindfulness

• Distress tolerance

• Emotion regulation

• Interpersonal effectiveness

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DBT groups are an effective, evidence-based way for people to learn these necessary skills without taking attention away from their individual work on specific problems they face in their lives.

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Stage Two

Once the individual has gained some behavioral control, they are ready to move onto Stage Two. During this stage of treatment, people work on experiencing their emotions in a healthier way, without avoiding them. This is also when people can work on trauma therapy if they have PTSD. The goal is to reduce suffering and restructure those thoughts and beliefs that are causing painful emotions.

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Stage Three

In Stage Three, people work on “ordinary” happiness and unhappiness, and set out to accomplish life goals. This is also a time for increasing self respect and maintaining the progress of the previous two stages.

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Stage Four

Stage 4 DBT is something that just about anyone could strive to achieve. In this stage, people have resolved most of their larger problems and are now working towards spiritual fulfillment and expanded awareness.

One of the most common questions we receive from new clients is about the difference between DBT and CBT therapy. They sound so similar. Are they?

CBT stands for cognitive behavior therapy. It is based on the idea that our thoughts, emotions, and behaviors are all connected. Therefore, if you change the way you think, you can also change how you feel and behave.  The focus of CBT is mainly on challenging irrational thoughts and beliefs. For example, people with social anxiety might walk into their doctor’s waiting room and automatically think that everyone else is looking at them and judging them. A CBT therapist would challenge those thoughts and help the individual to understand that, most likely, the other people in the room aren’t thinking about them at all.

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In DBT, there is some focus on challenging thoughts. However, DBT techniques put a lot more emphasis on helping people to regulate emotions, change behaviors, and learn new skills. It is especially important for DBT clients to learn mindfulness and acceptance.

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In addition, CBT is typically only conducted in individual therapy sessions. This is in contrast to DBT's four modes of comprehensive treatment.

As mentioned above, dialectical behavioral therapy has been proven effective in treating a number of mental health conditions. If you often find emotions overwhelming and intense, struggle to maintain relationships, and wish you could stop engaging in destructive behaviors, DBT can help.

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Some of the issues DBT can treat include:

• Suicidal thoughts and attempts

• Self-harm

• Frequent psychiatric hospitalizations

• Intense emotional expression

• Rapid mood swings

• Low tolerance for distress

• Addiction

• Emotional dysregulation

• Intense anger

• Binge eating

• Overspending

• Avoiding responsibilities, people, or events

• Numbing or "shutting down" in response to fear, anger, or pain

• Trauma and PTSD

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Working with a DBT therapist can help you to integrate the skills into every area of your life and empower you to build a life worth living.