Dialectical Behavior Therapy (DBT)

DBT is incredibly powerful, validating and life changing.

Dialectical Behavior Therapy (DBT) is a evidence-based mental health treatment developed by Dr. Marsha M. Linehan and her colleagues at the University of WA, which combines principles and practices of Behaviorism, Cognitive-Behavioral Therapy (CBT), Eastern Mindfulness, Biosocial Theory and Dialectics. DBT was originally designed to treat borderline personality disorder (BPD) , which is characterized by symptoms of emotional dysregulation (extreme sensitivity), "black and white" thinking, chronic feelings of emptiness, thoughts or attempts of suicide or self harm, inappropriate outbursts of anger, impulsivity, and a chronic instability in mood, behavior, sense of identity and relationships. Over the past several years, the DBT model of therapy has been adapted to treat a broader range of mental health disorders, including: mood disorders (depression & bipolar), anxiety disorders (posttraumatic stress, generalized anxiety, panic disorder, and social anxiety disorder), eating disorders, substance abuse, self-harm in teens, and couples and relationship conflict.

DBT therapy is organized into a hierarchy of four stages of treatment (some of the symtoms or behaviors may not apply to you):

Stage One - Out of Control Behavior to Feeling Competent and In Control Stage one focuses on:

1) reducing and eliminating any life threatening behaviors (suicide attempts, suicidal thinking, self-injury, homicidal and aggressive behaviors), then

2) therapy interfering behaviors (missing sessions, low commitment, not doing homework, behaviors that cause therapist or client burn out), and

3) quality of life threatening behaviors (depression, anxiety, eating issues, missing work or school, addictions), and

4) increasing coping skills and effective behaviors in every day life. You move from feeling overwhelmed and out of control to experiencing greater comfort in your ability to alter and shape the course of your life.

Stage Two - Quiet Desperation to Experiencing Emotions Fully

Stage two focuses on inhibited emotional range and experience. In this stage, you move from a state of silence or "quiet desperation" to a space where you are able to fully experience and express your thoughts and emotions in a safe and meaningful way. PTSD is treated in stage two.

Stage Three - Building an Ordinary Life and Managing Ordinary Troubles

Stage three focuses on identifying and working through more ordinary problems and stressors that continue to arise in life, while practicing skills to increase awareness, acceptance, compassion, tolerance and confidence in your ability to experience and express a greater range of thoughts and feelings in your life.

Stage Four - Expanding Your Experience of Freedom and Joy

Stage four focuses on increasing your spiritual awareness, overall sense of well-being and connectedness to a greater whole.

DBT treatment consists of three essential components:

1. Weekly individual therapy - where problematic behaviors or events from the past week are explored in detail, beginning with the chain of events leading up to it, going through alternative solutions and skills which might have been used, and problem-solving and practicing effective ways to manage stressful moments and situations in the foreseeable future.

2. Weekly DBT Skills Group ( or individual skills coaching session) - is where you learn and practice the following core DBT modules:

• Mindfulness - you learn the art of focusing your attention on one thing at a time, and how to be fully present in the moment. There is a peaceful and wise place within called "wisemind"... you learn to BE in this place where thoughts and feelings come and go like waves.

• Emotional regulation - you learn how to experience and express your emotions in a safe and meaningful way. Reducing emotional vulnerability along with increasing your awareness of the value, function and role of emotions is learned and further explored in this module.

• Distress Tolerance - you learn how to tolerate and manage distressing emotions and situations by practicing new skills and behaviors including self-soothing, distracting, problem-solving and improving the moment.

• Interpersonal Effectiveness - you learn how to build and maintain healthy relationships, how to balance priorities vs. demands, wants vs. shoulds, and how to achieve a greater sense of mastery, self respect and self regard in life. *Self Management - you learn how to check in with your self, validate, correct or reinforce your own thoughts, emotions and actions.

• Walking the Middle Path: Learn how to see a situation dialectically, from different angles and perspectives, how to validate without invalidating self and how to communicate, collaborate and negotiate effectively.

3. Coaching calls - scheduled in between sessions to help validate and reinforce your efforts to practice newly learned DBT skills and make more adaptive choices in problematic situations and during stressful events.

DBT Therapists are required to consult regularly with a DBT Consult Team to ensure that they are providing the most effective and compassionate treatment.


For more information, see the following links:

BEHAVIORAL TECH, LLC (founded by Dr. Linehan) - http://www.behavioraltech.com

Tools for Consumers - http://behavioraltech.com/resources/tools_consumers.cfm

San Francisco DBT Center www.sanfranciscodbt.com/

DBT Center of Marin  www.dbtmarin.com

UCSF DBT/DBT Program:  http://psych.ucsf.edu/cbtdbt-program

Samantha Fordwood, Phd  DBT Skills Groups  http://www.samanthafordwoodphd.com/DBT_Skills_Groups.html

Oakland DBT Center  www.oaklanddbtcenter.com

Wikibooks DBT https://en.wikibooks.org/wiki/Dialectical_Behavioral_Therapy