Dialectical Behavior Therapy (DBT), developed by Marsha Linehan, Ph.D., ABPP, at the University of Washington, was originally developed as a comprehensive cognitive-behavioral treatment for borderline personality disorder (BPD). DBT was found to be especially effective for those with chronic suicidal or other severe, dysfunctional behaviors related to emotional dysregulation. As a result of DBT’s success in treating adults with BPD, it has been adapted for other populations including adolescents struggling with severe emotional turmoil and intensely problematic ways of dealing with their distress. At DBT has also been modified so that it can be used with other difficulties such as eating disorders, substance use, anxiety, treatment-resistant depression and anger management.
Core Components of Full, Adherent DBT include:
- Individual DBT Therapy
- DBT Skills Group
- Telephone Skills Coaching
- Consultation Team (for therapists)
- Collaboration with other Health Professionals (for therapists)
DBT Skills
DBT clients are taught more skillful ways to regulate their emotions, deal with the distressing situations in their lives, and improve relationships with the people around them. These skills are taught in caring treatment relationships that appreciate the clients’ strengths, acknowledge their emotional sensitivity, and offer powerful, pragmatic methods for creating a “life worth living”.
Mindfulness Skills
Mindfulness is one of the core concepts behind all elements of DBT. Mindfulness is the capacity to pay attention, non-judgmentally, to the present moment. Mindfulness is all about living in the moment, experiencing one's emotions and senses fully, yet with perspective. It is considered a foundation for the other skills taught in DBT, because it helps individuals accept and tolerate the powerful emotions they may feel when challenging their habits, patterns of behaviors, or exposing themselves to upsetting situations. This module assists one in learning how to be in control of your own mind, instead of letting your mind be in control of you; it is learning to go within to find oneself and learning to observe oneself. This module assists one in experiencing and identifying a self; decreases a sense of emptiness; and teaches one how to maintain one's own feelings, opinions, and decisions when around others.
Distress Tolerance Skills
Distress tolerance skills constitute a natural development from DBT Mindfulness Skills. They have to do with the ability to accept, in a non-evaluative and nonjudgmental fashion, both oneself and the current situation. Although, this is a nonjudgmental stance, that does not mean it is one of approval, liking it, or resignation. The goal is to become capable of calmly recognizing negative situations and their impact, rather than becoming overwhelmed or hiding from them. This allows individuals to make wise decisions about whether and how to take action, rather than falling into intense, desperate, and often destructive emotional reactions. This module assists one in learning how to tolerate and accept distress; thereby, decreasing impulsive behaviors, such as alcohol, drugs, eating, spending, sex, fast driving, and other self-injurious behaviors.
Interpersonal Effectiveness Skills
Interpersonal response patterns taught in DBT skills training are very similar to those taught in many assertiveness and interpersonal problem-solving classes. They include effective strategies for asking for what one needs, saying no, and coping with interpersonal conflict.
The interpersonal effectiveness module focuses on situations where the objective is to change something (e.g., requesting that someone do something) or to resist changes someone else is trying to make (e.g., saying no). One learns how to cope with conflictual situations; to get what one wants and needs; to say no to unwanted requests and demands, while maintaining a sense of self-respect and others' liking and respecting you. The skills taught are intended to maximize the chances that a person’s goals in a specific situation will be met, while at the same time not damaging either the relationship or the person’s self-respect. This module assists one in decreasing intense, unstable relationships, and assists with skills that help in maintaining relationships.
Emotional Regulation Skills
This module assists one in learning to understand your own emotions, reduce emotional vulnerability, and decrease emotional suffering. This module assists one in learning how to modulate some emotions; thereby, enhancing emotional regulation and decreasing extreme emotional sensitivity, ups and downs, moodiness, intense emotional reactions, chronic depression, and problems with anger. This module recognizes that having ineffective health habits can make one vulnerable to high intensity emotions and assists with skills that maintain a healthy body so one is more likely to regulate one's emotions.
Walking the Middle Path
A fifth skills module, unique to DBT for adolescents, focuses on teaching adolescents and their parents the concepts of dialectics, validation, and reinforcement, with specific emphasis on the relationship between parents and teens. The concepts and skills taught in this module help teens and parents improve communications and overcome power struggles.
First four skills descriptions Adapted from Marsha M. Linehan's Skills Training Manual for Treating Borderline Personality Disorder, 1993. Fifth skills description adapted from Alec L. Miller’s “DBT Dialectical behavior therapy with suicidal adolescents, 2007.
