Dialectical Behavioral Therapy (DBT) Overview
Dialectical Behavioral Therapy was developed by Marsha Linehan, PhD. It’s a well developed, complex, skill-based therapy designed for people who struggle with persistent mental health disorders. DBT is a synthesis of Eastern mindfulness skills with Western cognitive-behavioral skills. The overall goal is to teach people behaviors and attitudes – skills – that foster non-judgmental acceptance of the self and life events while, at the same time, striving for appropriate behavioral changes.
Linehan first developed the DBT skills set in the late 1980’s for those who suffered from Borderline Personality Disorder (BPD). For those of you in the know, you know that BPD, like other personality disorders, is a long-term illness whose symptoms are resistant to therapy and medication. The intractability of this disease causes much suffering and can even leave a person disabled and unable to productively work.
BPD is a devastating diagnosis. Persons with BPD suffer from chronic low self-esteem, broken relationships and para-suicidal and suicidal behaviors. BPD is characterized by extreme mood swings, persistent feelings of abandonment and hostility towards the self and others.
Linehan’s DBT program has been shown in research and clinically to reduce emotional pain and self-harming behaviors in those who suffer from BPD. Over several decades this work has gradually spread to include persons who suffer with other chronic and difficult to treat mental health disorders, such as obsessive-compulsive disorder, depression, anxiety and panic disorder.
Here is the Linehan Training Manual available on Amazon, where you can read about the concepts. Its a very dense book, though, meant for clinicians!
Overview of DBT
DBT is a skills-based, long-term therapy requiring a collaborative commitment between client and therapist. The DBT curriculum runs six months. A full cycle of DBT is considered a year long consisting of two six-month programs. The goal is for the individual to build a broad base of skills to choose from when swamped by negative thoughts and strong emotion. By spreading the training out over a year, people have time to acquire and reinforce the skills until they generalize and become part of their daily behavioral patterns.
DBT is taught in group format. The purpose of a DBT group is to learn and practice skills and to review skills homework. The DBT group is not a traditional therapy group where one processes emotion and events. The therapist running the group is a facilitator and supportive teacher and not an insight-oriented therapist. The facilitator enlists the cooperation of the group members in maintaining the group structure. Clients are encouraged to purse their own individual therapy to both reinforce the DBT skills and to process their emotions.
DBT is taught to the group in four modules. Each module teaches four large sets of skills and lasts approximately five weeks. Homework is assigned weekly and reviewed at the next class.
Here is the Linehan set of worksheets for homework. Sometimes clients like to buy this book so they have access to all of the homework sheets. There are a lot of homework exercises available. The facilitator picks and chooses from the available homework exercises as there is such a rich assortment.
DBT’s four modules are:
Mindfulness – Core mindfulness skills teach attunement to the present moment which helps calm the mind and physiology
Distress Tolerance – These skills are meant to help a person come to a place where one can tolerate and survive a crisis while accepting self and situation in a non-judgmental way
Emotional Regulation – These skills help a person build up a base of positive experiences and regulate emotion on a daily basis.
Interpersonal Effectiveness – These skills help teach interaction with others in such way that advocates for the self while positively respecting both the self and other.
The skills included in the four DBT modules will be discussed in future posts!
Kathy Morelli, LPC was trained in DBT by the Linehan Institute and was on the team that implemented DBT groups in the Outpatient and Intensive Outpatient Programs at a major hospital.