What the heck is DBT?

If you've heard of Dialectical Behavior Therapy (DBT) but aren't quite sure what it entails, you're not alone, and you’re in the right place!

DBT is a specialized type of therapy that has gained recognition for its effectiveness in treating a variety of mental health challenges, particularly borderline personality disorder (BPD) but also anxiety, depression, eating disorders, and substance use disorders. DBT has become very popular, so some people have vaguely heard of it but don’t really understand its ins and outs.

This blog post is the first in a series of blogs that will aim to demystify DBT and make its concepts easier to understand for individuals seeking information about it. In this first blog post, we'll explore what DBT is all about, its origins, core principles, and how it differs from other therapeutic approaches.

Origins of DBT

DBT was developed by psychologist Dr. Marsha M. Linehan in the late 1980s. Initially, Linehan created DBT as a treatment for individuals struggling with chronic suicidal thoughts and behaviors associated with BPD. DBT was designed to help these hurting individuals to “find a path out of hell.” She aimed to integrate the seemingly opposite concepts of acceptance and change into one comprehensive therapy approach that balanced the two.

Drawing from cognitive-behavioral therapy (CBT), mindfulness practices, and dialectical philosophy, Linehan developed DBT to help individuals build skills for managing intense emotions, improving interpersonal relationships, and developing a sense of balance and well-being. DBT is considered part of the “third-wave” of cognitive behavior therapies.

Instead of just trying to stop unhelpful, harmful behaviors, DBT also emphasizes the importance of building a Life Worth Living. This means actively and intentionally working on building a life that feels meaningful and fulfilling for each individual. It looks different for everyone, but it’s something we want to flesh out at the start of someone’s DBT journey so they can keep it in mind as they work toward it.

Core Principles of DBT

DBT is grounded in several core principles that guide its therapeutic approach:

1. Dialectics: The term "dialectical" refers to the integration of opposing viewpoints. In DBT, this in particular means balancing acceptance and change. Clients are encouraged to accept themselves and their current circumstances while also working towards change and personal growth. But we also emphasize other dialectics, or opposites that can co-exist, which is very helpful for getting out of all-or-nothing thinking that can be a typical unhelpful mindset for people struggling with different mental health disorders.

2. Mindfulness: Central to DBT is the practice of mindfulness. Mindfulness involves paying attention to the present moment without judgment. Clients learn to observe their thoughts, emotions, and sensations with curiosity and openness. This helps them learn to be more intentional and responsive, rather than reactive and impulsive. It is also critical to intentionally moving toward and building a life worth living.

3. Skill Building: DBT is a skills-based therapy. Clients are taught specific skills in four key areas: mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness. These skills empower individuals to cope with stress, manage emotions, and navigate relationships more effectively.

4. Validation: Validation is a crucial component of DBT. Therapists validate clients' experiences, emotions, and struggles, fostering a sense of understanding and empathy. This validation helps build trust and strengthens the therapeutic relationship. Many clients who come to DBT have a history of being invalidated by people close to them. Through the therapist’s validation, clients also learn to self-validate and honor their own experiences to help minimize their self-doubt and shame.

5. Collaboration: DBT is a collaborative effort between therapist and client. Therapists work with clients to set goals, develop treatment plans, and continuously assess progress. Clients are encouraged to take an active role in their recovery. After all, you are the only one who can do the work and build your life worth living, and you know yourself best!

How DBT Differs from Other Therapeutic Approaches

DBT stands out from other therapeutic approaches in several ways:

• Emphasis on Skills Training: Unlike traditional talk therapy, DBT focuses heavily on teaching practical skills that clients can apply in their daily lives. This emphasis on skill building makes DBT highly actionable and empowering. You can start to practice the skills almost right away!

• Integration of Acceptance and Change: DBT integrates principles of acceptance and change, providing a balanced approach to personal growth. Clients learn to accept themselves while also working towards behavioral change. “The curious paradox is that when I accept myself just as I am, then I can change. People are just as wonderful as sunsets if you let them be.” - Carl Rogers

• Structured and Systematic: DBT is structured and follows a specific treatment protocol. Sessions are organized around skill acquisition, problem-solving, and addressing therapeutic targets. This structured format provides clarity and direction in therapy. Most DBT programs include a group skills training, individual therapy, and regular skills coaching.

• Adaptability: While initially developed for BPD, DBT has proven effective for various mental health conditions, including depression, anxiety disorders, eating disorders, and substance use disorders. It can be adapted to meet the unique needs of different populations. And it many clinicians have found it can help their clients whether it is in a fully immersive program, an outpatient group, or even just occassionally training their individual clients on some of the skills. DBT can be applied so many ways.

So to wrap up this first installment, Dialectical Behavior Therapy (DBT) is a comprehensive and evidence-based therapy approach developed to help individuals effectively manage intense emotions, improve relationships, and achieve a balanced life. Grounded in dialectics, mindfulness, and skill building, DBT offers a unique blend of acceptance and change and balancing the paradoxes of being human. If you're considering therapy or seeking support for mental health challenges, DBT may be a valuable option to explore with a qualified therapist.

If you have any questions about DBT or would like to learn more about how it can benefit you, feel free to reach out. Seeking help is a courageous step towards your commitment to your own personal well-being and mental health.

Thanks for reading!

Your friendly DBT Therapist, Maggie