Dialectical Behavioral Therapy, or DBT, is a type of therapy developed in the late 1980s by Dr. Marsha Linehan, a psychologist who struggled herself with extreme emotional distress in her youth. It was originally developed out of necessity for helping individuals in their diagnosis of Borderline Personality Disorder (BPD). Researchers were noticing that individuals diagnosed with BPD struggled greatly with emotional vulnerability and dysregulation. Dr. Linehan initially started to develop DBT as a modification to other types of therapies, but she realized that the techniques of other therapies, such as Cognitive Behavioral Therapy (CBT), alone were not enough to treat the complex symptoms of BPD.
She also studied mindfulness traditions and integrated these principles into designing DBT, creating an approach that focuses on mindfulness and acceptance as key components of emotional regulation. Further, Dr. Linehan recognized how individuals struggling with BPD often had low distress-tolerance skills, which often lead to severe mood swings and impulsive behaviors. To help individuals manage these symptoms better, she included distress-tolerance skills in DBT, such as self-soothing techniques and behavioral strategies to cope with triggers. In addition to these core components, Dr. Linehan also added interpersonal effectiveness skills to DBT. She saw how many people with BPD struggle with interpersonal relationships and this can be a significant factor in their emotional distress. Through DBT, individuals learn communication skills, assertiveness techniques, and how to express their needs and boundaries in healthy ways.
Over the past few decades, DBT has since proven to be useful for a wide range of diagnoses not limited to borderline personality disorder. For example, DBT has been shown to be effective for bipolar disorder, substance use disorders, eating disorders, depression, and anxiety. DBT may be delivered in individual or group settings, and it typically consists of a combination of weekly therapy sessions, group sessions, homework assignments, and skills training. Although DBT is now widely used across multiple populations, it still remains as the highest recommended therapy for individuals diagnosed with BPD.
Bringing all of her ideas together, Dr. Linehan structured DBT as a therapy based on 4 key sub-parts: mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness. In the context of therapy, mindfulness refers to the practice of being present in the moment and observing one’s experiences without judgment. This skill is often taught through various exercises such as guided meditations or body scans. Distress tolerance involves learning to tolerate intense emotions and situations without engaging in harmful or negative coping mechanisms. This skill may be taught through strategies such as self-soothing or imagery.
Emotion regulation focuses on improving an individual’s ability to manage their emotions effectively. This may be achieved through techniques such as identifying and labeling emotional states, figuring out the functions of emotions, or developing a regulation plan. Finally, interpersonal effectiveness involves honing one’s social skills, including the ability to communicate effectively, establish boundaries, and resolve conflicts.
One of the primary reasons why DBT is so helpful for individuals with BPD is because it places a strong emphasis on skill-building. In DBT, individuals learn a variety of skills that can help them manage their symptoms more effectively. By learning and applying these skills, individuals with BPD can better cope with their emotions and reduce the risk of engaging in self-destructive behaviors. Another reason why DBT is so effective for individuals with BPD is because it is a highly comprehensive form of therapy. Unlike traditional talk therapy, which primarily focuses on talking about emotions and experiences, DBT is more action-focused. In DBT, individuals actively work on developing and practicing new skills, rather than just talking about them. This can help to create a greater sense of self-efficacy and empowerment, which can be critical for individuals struggling with BPD.
DBT is also backed by evidence-based research. Numerous studies have shown that DBT can help to reduce symptoms of BPD, including self-harm and suicide attempts. This therapy has been shown to be highly effective, even for individuals who have not responded well to other forms of treatment. This gives individuals with BPD hope that they can improve their quality of life, even in the face of a challenging mental health condition. Because DBT provides a set of strategies and skills to help individuals address specific difficulties and improve their quality of life, it should be strongly considered as a treatment option for those diagnosed with BPD.
We want people to know that there is always hope, no matter what they are facing. Living with borderline personality disorder can be an emotional roller coaster with enormous turbulence, particularly in relationships. You don’t have to struggle alone. We can help you navigate through your life more smoothly and more effectively. We would be honored to meet you and talk about whether DBT might be a good treatment option for you or a loved one struggling with mental health.
Written by Lauren Presutti