What is Dialectical Behavior Therapy?

Dialectical Behavior Therapy, which many people in mental health refer to as “DBT,” is a specialized type of cognitive behavioral therapy. DBT helps patients regulate their emotions and the actions that follow. While the specific goals vary among clients, DBT generally aims to elevate each of the following:

Some patients excel in one of the main DBT goals but struggle with one particular area, but others may need help in each area. A therapist can personalize DBT to fit an individual’s needs.

Philosophy and Dialectical Behavior Therapy

In the 1990s, Dr. Marsha Linehan and some of her colleagues noticed that while cognitive behavioral therapy helped many patients, it wasn’t enough for patients with borderline personality disorder. With careful research, they designed DBT to help these patients.

Dr. Linehan’s team based the approach on the philosophy of dialectics. Philosophers in this sect believe that change is inevitable, everything connects, and one can find the truth somewhere in the middle of two opposing ideas. With this in mind, they created a therapy that embraces the apparent contradiction between loving oneself as is and aspiring to change.

Dialectical Behavior Therapy Settings

Now, DBT is one of the standard kinds of cognitive behavioral therapy. Patients who undergo DBT attend three distinct types of therapy sessions, each with unique benefits. First is individual therapy, in which the patient works one-on-one with a therapy.

Secondly, individuals attend group sessions with classroom environments. Unlike most group therapy, these courses do not focus on individual patients telling their stories. Instead, the main focus is on the behavioral techniques that the therapist teaches. The clients then act out scenarios in which they use the methods they learned.

Even with these tools, it can be difficult to overcome negative feelings at the moment. Patients can forget what they learned in group and individual therapy. That’s why the final component is the in-the-moment phone consultations. When things get too stressful, patients can contact their therapists to get reminders and guidance.

What Does Dialectical Behavior Therapy Treat?

Although Dr. Linehan developed DBT for patients with borderline personality disorder, it has proven to be useful for people with other disorders as well. Generally, this therapy works well for patients who exhibit self-destructive behaviors. Below are just some of the problems that DBT can treat.

Borderline Personality Disorder

Since doctors specifically designed DBT for patients with this disorder, it stands to reason that it is particularly effective in these cases. Before DBT became a standard treatment, many people believed that borderline personality disorder was untreatable.

Now, DBT is often the first therapy that therapists recommend because of its efficacy. One study showed that 77 percent of patients who received DBT improved so much that they would not then meet the diagnostic criteria for borderline personality disorder.

Eating Disorders

People with disordered eating engage in destructive behaviors as part of their illnesses. As such, therapists can adapt DBT techniques to treat anorexia, bulimia, and binge eating disorder. One study found that 89 percent of women with binge eating disorder stopped binging after completing DBT therapy.

Substance Abuse and Other Addictions

DBT can be a productive part of treating disorders such as substance dependency and impulse control disorder. In some of these cases, DBT is a life-saving treatment. When adapted to substance abuse, DBT therapists apply the dialectical philosophy to the idea of abstinence.

Many patients with addictions also have borderline personality disorder, sometimes without the diagnosis yet. They can also have comorbid depression, anxiety, or other mood disorders.


One of the many obstacles that some patients with PTSD face is acceptance of themselves and the trauma they endured. The dialectical approach to therapy gives these individuals the space and reasoning they need to finally clear that hurdle.

It can also help patients learn to regulate their emotions, stop or reduce flashbacks, and repair personal relationships. Therapists must tailor DBT techniques to meet the unique needs of PTSD patients.

Who Benefits From Dialectical Behavior Therapy?

With complex illness such as borderline personality disorder or substance dependency, some patients struggle with other types of therapy. Different treatments, including other cognitive behavioral therapies and medication, may only address one of the symptoms. However, DBT provides a holistic approach.

For Patients Who Tried Everything

There’s no doubt that trying different therapies andmedicationwithout seeing results can be exhausting. Patients often come to LifeStance Health feeling defeated and barely able to try again. However, the revolutionary and whole-person approach that DBT provides can help patients when nothing else did.

For People with Two or More Disorders

It’s relatively common for a patient with one disorder that DBT treats to also have other comorbid (or co-existing) mental health troubles. While this may make some clients feel more overwhelmed, it can mean that DBT is the perfect treatment plan. In patients with two or more mental health disorders, CBT can be more effective than previous therapies they tried because it focuses on several sources of illnesses.

For example, someone with alcoholism may turn to alcohol as a means of emotional regulation, and DBT can teach healthy alternatives. If that same person also has borderline personality disorder, he or she may struggle with interpersonal communication, which another one of the tenants of DBT.

For Those Who Don’t Know Where to Start

One of the tricky things about having a mental illness is that the symptoms often keep you from seeking treatment. For example, someone with severe depression and low self-esteem may think, “I am not worthy of treatment. They would just be wasting their time.”

However, this is a symptom, not a fact. It would be like if your cough convinced you not to drink cough syrup. Some disorders can also leave individuals feeling helpless–like they don’t know where to start to get better.

DBT is an excellent starting point for people who feel this way. It provides a structured system in which patients can see the route to success. DBT also gives patients tools they can start using right away, so improvements begin slowly but surely.

How to Prepare for Your Therapy Appointment

It is entirely natural for patients who are about to start DBT to feel nervous about the process. It takes a significant commitment to oneself, a lot of work, and some faith in the process to even get started. If you feel this way about an upcoming appointment, try being as prepared as possible before you start.

Have an Open Mind

Patients who have tried several therapies may feel understandably skeptical about DBT. It’s important to know that this method is scientifically backed and has helped many people. Some of those have almost certainly been skeptical at first as well. However, approaching your first appointment with the idea that this might be the thing you need can help make it so.

Think of Questions You Have for Your Therapist

While you should have an open mind, there’s no harm in having questions–even skeptical ones. Your therapist can help you understand the DBT process, what to expect, and how to handle certain situations.

It can be hard to remember all of your questions once you’re in the office. So, write them down as they come to you before your appointment. You might ask things like:

  • How often will I need to see you?
  • What are group classes like?
  • What number do I call for emergency scenarios?

Commit to Being Yourself

Your therapist can only help you if he or she gets to know you at some level. They will ask questions about your behavior and symptoms that may be uncomfortable to answer. After all, people outside the therapy world may judge you for your honest answers.

However, your therapist knows that these symptoms are just that–symptoms. They do not define your value as a person. The therapist will give you respect, advice, and help. However, you must be honest for it to work.

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