Dialectical Behavioral Therapy (DBT): A Practical Guide

What is DBT?

• DBT is an evidence-based form of cognitive behavioral therapy

• In DBT, ideas about the self, the world, emotional experiences, and coping mechanisms are identified and explored

• DBT provides psychoeducation and skills training for bringing about acceptance and change, as means to improve and maintain behavioral, emotional, cognitive, and interpersonal patterns

• DBT is intended to help understand distressing experiences and emotions, while developing healthy coping mechanisms, and altering ways of thinking and feeling about past lived experiences 

• It is helpful for stabilizing behaviors, mood, self-image, and self control, while moving towards a better quality of living

Who is involved in DBT?

• DBT utilizes a collaborative team of professionals, including an individual therapist, a group therapy leader and co-leader, and a medication provider and/or nutritionist if necessary

• DBT occurs in both individual and group sessions

• Used to treat several mental health conditions, such as borderline personality disorder, suicidal behavior, self-harm, substance use, post-traumatic stress disorder, depression, and eating disorders

How does DBT work?

• DBT works by identifying negative behavioral, emotional, cognitive, and interpersonal patterns that are causing distress, and developing the skills to accept and change these patterns

• There are four components to DBT: individual therapy, group therapy, peer consultation, and coaching

  • Individual therapy sessions are intended to enhance motivation for addressing maladaptive behaviors and learning acceptance and change skills

  • Group therapy is complementary to individual therapy, as it provides psychoeducation and skills training for acceptance and change. These skills are learned and practice to further enhance one’s capabilities to change maladaptive patterns of thinking, feeling, behaving, and relating to others

  • Brief phone coaching sessions are encouraged between DBT sessions, because it allows an individual to generalize their skills and use them to cope with challenges in their natural environment

  • Peer consultation is utilized by the DBT team to provide support and feedback for one another, while further enhancing the therapists skills and motivation

Skills for Acceptance and Change

• In DBT, strategies for experiencing both acceptance and change are learned

• Experiencing and maintaining positive change in DBT requires a skill set for managing emotions and moving forward, which are emotion regulation skills and interpersonal effectiveness skills

  • Emotion Regulation– the ability to manage emotions so that they do not control thoughts and behaviors

  • Interpersonal Effectiveness– the ability to ask for what a person needs and to say no when necessary, while still maintaining self-respect and healthy relationships with others

• Being able to accept reality and live in the moment in DBT requires a skill set for validating one’s own experiences and behaviors, which are mindfulness skills and distress tolerance skills

  • Mindfulness– the practice of being in the present and acknowledging thoughts, feelings and behaviors as they happen, without trying to control them

  • Distress Tolerance–  the process of learning how to cope during a crisis, especially when it is impossible to change, and accepting a situation as it is, rather than how it should be

• The separate components of DBT are working parts that seek to motivate clients, teach skills, learn how to generalize skills to natural environments, motivate and improve the skills of therapists, and structure a positive treatment environment

Source: Pesi Education

Overview

• DBT can be an effective way to reduce maladaptive patterns of thinking, feeling, and behaving that are causing distress in one’s life. Developing and applying skills for accepting reality and making positive changes are critical components to effective DBT. These skill sets allow an individual to learn how to live in the moment, change thoughts and behaviors, manage emotions, adopt healthy coping mechanisms, and set boundaries in relationships. By learning how to use these skill sets in times of distress, an individual can begin to experience a better quality of life and living.

Example: Using DBT Skills

• Joe identifies that he is in distress. Joe does not want to revert to harmful coping mechanisms. He recalls that he learned a set of distress tolerance skills. Joe is reminded of the acronym, ACCEPTS, that he learned in a DBT program:

  • Activities: engage in activities such as a hobby or schoolwork that require thought and concentration, to distract self from the distressing situation

  • Contributing: focus on something else by doing something that is helpful for another person

  • Comparison: think of a situation you’ve experienced that was more difficult and compare it to the current situation

  • Emotion: create a an emotion that competes with the negative emotion by watching a funny movie or listening to soothing music

  • Pushing Away: eliminate your negative thoughts by writing them on a piece of paper, crumpling it up, and throwing it away

  • Thoughts: focus on your thoughts to distract from negative emotions by counting to ten or reciting a poem 

  • Sensations: use safe physical sensations to distract and soothe the self from negative emotions, such as holding an ice cube in your hand

• By using this exercise in a time of distress, Joe was able to decrease the intensity of the emotion and identify healthier ways to cope.