Dialectical Behavior Therapy: Who is it For?

Developed in the late 1980s by psychologist Marsha M. Linehan, dialectical behavior therapy (DBT) is a type of cognitive behavioral psychotherapy that has proven to be beneficial in the treatment of borderline personality disorder (BPD).

Some people have a tendency to react more intensely than others in response to certain emotional situations, especially those involving interpersonal relationships, including individuals with BPD. People with BPD experience extreme swings in their emotions and often seem to jump from one crisis to another. Because they react in out-of-the-ordinary ways, and their family members and friends do not understand their emotions, BPD sufferers often do not have adequate methods for coping with their intense emotions. Dialectical behavior therapy (DBT) aims to teach these skills to people who need them.
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How Does DBT Work?

“Dialectical” means acting through opposite forces. In DBT, therapists bring together two strategies that seem to be opposing, to treat their clients. First, DBT therapists focus on stressing that they accept their clients regardless of their struggles. Secondly, therapists who practice DBT stress that change must take place in order for their clients to live fully functional lives. Through this approach, clients are taught how to better tolerate their stressors and to accept them. They are also taught how to identify the emotions that cause them difficulty and how to work on them.

Dialectical behavior therapy seeks to help people with disorders like BPD to identify their strengths and build from them in an attempt to help them feel better about their lives. It helps identify negative thoughts and assumptions that make sufferers’ lives more difficult, such as “I have to do everything perfectly,” and teaches them different ways of thinking that will make their lives easier, like, “I do not have to be perfect at everything to be accepted by others.”

DBT also requires a close relationship, with interactions between clients and therapists more than just once a week in therapy sessions. For example, clients often see their therapists in weekly skills training groups and also have access to them for skills coaching over the phone when needed.

DBT sessions focus on teaching skills in four areas: mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness.

• Mindfulness focuses on acceptance and being present in the moment.
• Distress tolerance encourages a person to learn to tolerate negative emotions rather than trying to escape from them.
• Emotion regulation offers strategies to manage intense emotions and how to change them over time.
• Interpersonal effectiveness encourages patients by teaching them how to communicate with others in a way that maintains self-respect, is assertive and strengthens relationships.

Who Can Benefit from DBT?

Although DBT was developed as a means of treatment for borderline personality disorder, it has been successfully used in the treatment of other disorders, including depression, eating disorders, and substance use disorders. This form of cognitive behavioral therapy is ideal for many people who have complex disorders that are difficult to treat due to issues regulating their thoughts and emotions.

People with BPD and other specific disorders who are candidates for DBT may be suicidal and are typically emotionally intense, often battling feelings of extreme anger, frustration, anxiety and depression. Their emotional issues are deeply integrated into their personalities. People who have issues with impulsive and/or reckless behavior, along with unstable relationships, may be good candidates for DBT.

“I’ve Already Tried DBT”

If you have tried DBT in the past with little success, do not write it off as an option. It is possible that you were not yet ready or able to do the work required in order for DBT to be successful. According to the Stages of Change Model (also known as the Transtheoretical Model), each individual goes through specific stages of readiness and ability in the process of changing their behavior. These stages include:

• Pre-contemplation
• Contemplation
• Preparation
• Action
• Maintenance
• Termination

For example, you may have been in the contemplation stage where you recognized the benefits of making change but were still working through internal conflict about giving up your destructive behaviors, rather than the preparation or action stage where you are ready to take steps toward accomplishing your goals. You may find great success in trying DBT again.

It is important to note that there are alternatives to DBT, including general psychiatric management, transference-focused psychotherapy (TFP), mentalization-based therapy (MBT), schema-focused therapy and systems training for emotional predictability and problem-solving (STEPPS). It is best to discuss the options with a therapist to determine the best fit for you.