What is Dialectical Behavior Therapy (DBT) and how does it work?

Here are the facts and statistics about one of the most common approaches to therapy.

Get a clear picture of what DBT is, and how it can help you transform your life. 

Table of Contents

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What is Dialectical Behavioral Therapy (DBT)?
What does it mean to think Dialectically?
What are DBT skills?
What are target behaviors in DBT?
What are the stages of DBT?
How long is DBT?
Is DBT Good for Depression?
Can DBT help with Anxiety?
What is the difference between CBT and DBT?

What is Dialectical Behavior Therapy (DBT)?

Dialectical behavior therapy (DBT) is a therapy approach that teaches skills to individuals who struggle with experiencing intense and painful emotions. DBT was originally created for chronically suicidal individuals and Borderline Personality Disorder (BPD) or were developing BPD. Since then, DBT has been applied to various types of clients, not just people with Borderline Personality.

DBT can be used by a mental health professional to treat a range of mental health concerns, impulsive behaviors, and unstable relationships. 

DBT involves a blend of Cognitive Behavioral Therapy, Zen practice and Behaviorism. 

DBT has four distinct areas of focus: emotion regulation, interpersonal effectiveness, distress tolerance and mindfulness. 

DBT includes a skills group, individual psychotherapy and coaching calls. It is used to treat children, adolescents, early adulthood, adults and relationships.

What does it mean to think Dialectically?

Thinking dialectically means finding the balance between two opposing beliefs and knowing that both can be true. For example, someone can love and dislike their partner or someone can be doing their best and do better. 

Thinking dialectically deters people from engaging in “black and white thinking” so they can find solutions to their problems and live a more balanced life. According to the American Psychological Association, this type of thinking is a crucial component of DBT.

What are DBT skills?

A key component to the DBT to treating mental illness, according to the journal Psychiatry, is the teaching of concrete skills that assist individuals in being more effective in various areas of their life. These skills include: mindfulness  skills,  interpersonal  effectiveness  skills,  distress  tolerance  skills,  and  emotion  regulation  skills.  

Mindfulness skills Mindfulness is the “core” skill in DBT. Mindfulness involves observing, describing, and allowing emotions to occur, without judging them or trying to ignore  them. Mindfulness allows individuals to enjoy the present moment.

Distress tolerance skills: The Center for Clinical Interventions defines distress tolerance as one’s ability to to experience painful emotions without acting on them through suicide, self-harm or lashing out. 

Emotion regulation skills help one identify and understand their feelings so they are not as overwhelmed by intense emotions or mood swings. Individuals have to understand their emotions before changing them.

Interpersonal effectiveness skills: These skills assist individuals in being more assertive and effective when expressing one’s beliefs, needs and setting limits. These skills focus on how to get needs met while also maintaining healthy relationships with others and feeling good about oneself. 

What are target behaviors in DBT?

DBT involves identifying target behaviors, which are harmful behaviors that people seek to eliminate from their lives.  Primary target behaviors include suicide attempts, plans, threats and self-harm behaviors. 

Target behaviors can also include: substance use, homelessness, binge eating, unemployment, self-judgments (such as Imposter Syndrome), etc. The client and their clinician identify and work on target behaviors together. 

What are the stages of DBT?

According to the University of Washington there are four stages in DBT.  

Stage one the primary focus is on assisting individuals to feel safe and secure. also decreases behaviors that get in the way of receiving effective therapy, such as missing or coming late to therapy sessions. In addition, stage one attempts to  decrease patterns of behavior serious enough to interfere with chances of success including substance use, self-harm, etc. 

Stage two includes treatment goals to achieve “ordinary” happiness  and reduce ongoing disorders and problems in living. 

Stage three is designed to resolve a sense of incompleteness and achieve joy. 

Stage four  is to assist people in feeling better and to resolve problems in living. 

How long is DBT?

In inpatient programs, clients typically attend a 2.5 hour skills group and one hour of individual therapy each week. In some cases, such as in inpatient settings, groups may be shorter and more frequent. Adult DBT programs are typically one year in length.  

In outpatient clinics, such as ALL IN, the client will meet with an individual therapist typically one hour a week. This could change according to the client’s preferences and goals. The length of treatment depends on the number of goals the client has.

Adolescent DBT programs also typically involve 2.5 hours of skills group and one hour of individual therapy. Parents may also participate in the group and the program is usually six months in length. 

Is DBT Good for Depression?

Studies in the journal Procedia and Behavior Research and Therapy have found that participating in DBT-based skills training may help individuals with Major Depressive Disorder. This is because about DBT’s approach to helping clients develop skills that reduce their depression symptoms. 

Depression is one of the risk factors that can lead to suicidal ideation or urges to self-harm. Studies have concluded that DBT can also drastically reduce both suicidality and self-harm behaviors.

Can DBT help with Anxiety?

There are studies that suggest DBT’s mindfulness and acceptance-based treatments have been successful in the treatment of anxiety disorders, including this study in Acceptance and Mindfulness-Based Approaches to Therapy. Attending a DBT skills group is also a helpful way to learn about and integrate DBT.

What is the difference between CBT and DBT?

Both Dialectical Behavior Therapy (DBT) and Cognitive Behavioral Therapy (CBT) affirm that thoughts, feelings and behaviors are connected and influence each other.