Dialectical behavior therapy (DBT), developed by Marsha Linehan, PhD, at the University of Washington, is a type of psychotherapy (sometimes called "talking therapy") used to treat borderline personality disorder (BPD). DBT is a cognitive behavioral therapy, meaning it's a therapy that focuses on the role of cognition (e.g., thoughts and beliefs) and behaviors (e.g., actions) in the development and treatment of BPD. DBT includes some changes to the traditional cognitive behavioral elements of therapy; these changes are intended to specifically help reduce the symptoms of BPD.
Research Support for Dialectical Behavior Therapy
DBT was the first psychotherapy shown to be effective in treating BPD in controlled clinical trials -- the most rigorous type of clinical research. While DBT is no longer the only therapy to have shown effectiveness in controlled trials, it has grown a large evidence base and is considered one of the best treatments for BPD in terms of documented success rates.
Theoretical Basis for Dialectical Behavior Therapy
DBT is based on Dr. Linehan's theory that the core problem in BPD is emotion dysregulation, resulting from mixing biology (e.g., genetic and other biological risk factors) and an emotionally unstable childhood environment (e.g., where caregivers punish, trivialize or respond erratically to the child's expression of emotion) together. The focus of DBT is on helping the client learn and apply skills that will decrease emotion dysregulation and unhealthful attempts to cope with strong emotions.
What to Expect in Dialectical Behavior Therapy
Usually, DBT includes a combination of group skills training, individual psychotherapy and phone coaching, although there are exceptions. Patients in DBT are asked to monitor their symptoms and use of learned skills daily, while their progress is tracked throughout therapy.
There are four main types of skills that are covered in DBT skills training. These are:
- Mindfulness Meditation Skills. These skills center on learning to observe, describe and participate in all experiences (including thoughts, sensations, emotions and things happening externally in the environment) without judging these experiences as "good" or "bad." These are considered "core" skills that are necessary in order to implement the other DBT skills successfully.
- Interpersonal Effectiveness Skills. The focus of this skill module is on learning to successfully assert your needs and to manage conflict in relationships.
- Distress Tolerance Skills. The distress tolerance skills module promotes learning ways to accept and tolerate distress without doing anything that will make the distress worse in the long run (e.g., engaging in self-harm).
- Emotion Regulation Skills. In this module, patients learn to identify and manage emotional reactions.
Interested in Dialectical Behavior Therapy?
If you are interested in learning more about DBT, there are a number of resources available on the Behavioral Tech website. Visit the resources page to learn more about the basics of DBT and Dr. Linehan. The clinical resources directory can help you find DBT providers in your area.
Linehan, MM. "Skills Training Manual for Treating Borderline Personality Disorder." New York: Guilford Press, 1993.
Feigenbaum, J. "Dialectical Behaviour Therapy: An Increasing Evidence Base." Journal of Mental Health, 16:51-68, February 2007.