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What is Dialectical Behavior Therapy (DBT)?

What is Dialectical Behavior Therapy (DBT)?

dbt therapy
Photo by Sven Kucinic on Unsplash

Dialectical Behavior Therapy or DBT is an evidence-based therapy that is effective in treating a wide range of disorders.

DBT is a recognized form of therapy that is accepted by the American Psychological Association (APA) and the National Institute of Mental Health (NIMH).

In this article, we explain what DBT is and take a look at the research behind it.

What is Dialectical Behavior Therapy?

Dialectical Behavior Therapy is based on the assumption that the problems exhibited by clients are caused by a deficit of skills.

DBT can be used as a treatment for many different things:

  • Individuals with Borderline Personality Disorder
  • Individuals with Eating Disorders
  • PTSD
  • Individuals with Substance-Abuse Disorders
  • Those at High-Risk of Suicide
  • For Adolescents
  • Treating Bipolar Disorder
  • ADHD
  • College Students with Emotional Dysregulation

According to John Grohol, Psy.D., DBT is a specific type of cognitive-behavioral psychotherapy that was originally developed to help better treat borderline personality disorder. (Grohol, 2018)

Since it’s conception, it has been used for many other types of mental health issues.

DBT is a type of psychotherapy or talk therapy that uses a cognitive-behavioral approach, which emphasizes the psychosocial aspects of treatment.

The theory behind the approach is based on the idea that some people are prone to react in a much more intense and out of the ordinary manner when it comes to certain emotional situations. This may be more likely in relationships that involve romance, family or friends.

This is based on the idea that some people’s level of arousal in such situations can increase much more quickly when compared to the average person.

These types of individuals seem to attain a higher level of emotional stimulation while taking a significant amount of time returning to baseline levels. This may also manifest as an extreme swing of emotions.

These kinds of personalities see things in black and white, as opposed to different shades of grey. This type of person may jump from one crisis to another because they lack the necessary coping skills. DBT teaches them the necessary skills to cope in a healthier manner.

There is a plethora of evidence supporting the effectiveness of DBT.

The first randomized controlled trial of DBT was published in 1991 by Dr. Marsha Linehan and her colleagues. (Linehan et al., 1991).

Linehan and her colleagues discovered that DBT showed vast improvements for women with BPD who were suicidal and also engaged in self-injuring behaviors. This clinical population was also previously a population that was viewed as untreatable. (Linehan et al., 1991).

The above treatment lasted for one year, with assessment every four months with the control treatment being treatment as usual.

The subjects who received dialectical behavior therapy had fewer incidences of parasuicide or attempts at suicide where death is not necessarily the desired outcome in most cases.

The test subjects also had less medically severe parasuicides, in most of the assessments.

The results of this study showed that subjects were more likely to stay in individual therapy. Subjects also experienced fewer inpatient psychiatric days. There were no between-group differences when it came to measuring depression, hopelessness, suicide ideation, or reasons for living although scores on all four measures tended to decrease throughout the year.

 

The Theory Explained

When cognitive-behavioral therapy was initially introduced, the basic approach worked well for treating clients who were depressed or anxious. However, it did not work as well for those with personality disorders and it was even more difficult for those with Borderline Personality Disorder.

As a result of this, psychologist Marsha Linehan, Ph.D. took it upon herself to enhance and build upon the basic cognitive-behavioral model. (Hoermann, Zupanik & Dombeck, n.d.).

Linehan’s enhancements were meant to manage the challenge of emotional dysregulation and of behaviors that are deemed self-destructive, which are associated with BPD.

The main issue she observed was the fact that those with BPD are extremely sensitive. These types of clients also react in a strong and intense way when they feel they have been invalidated.

Many with these types of disorders have often experienced difficult childhood histories, which certainly didn’t help matters. Because of their sensitivity and issues with caregivers, many children grew up in a poor emotional climate.

This type of emotional climate often resulted in children feeling invalidated or minimized.

This type of invalidation occurs whenever a caregiver punishes, shames, criticizes or negates the child’s responses.

Comments such as “big girls don’t cry” feel invalidating to a young child because the fact of the matter is they are crying.

These types of children with BPD often require a long period of time to cool down and recover from strong emotional highs.

These perceptions led Linehan to surmise that constantly challenging and trying to change behaviors only ended up with clients feeling invalidated. As a result, they needed a different kind of therapy.

In response to this observation, Linehan then introduced several unique variations to her therapeutic approach. (Hoermann, Zupanik & Dombeck, n.d.).

One of the most significant improvements was a new emphasis on acceptance and validation when it came to her client’s unique emotional needs.

This change was intended to act as a kind of counter-balance to the more traditional cognitive-behavioral emphasis on trying to change those states.

 

A Look at DBT Techniques

DBT is as an accepted form of therapy, which has been registered and reviewed by the Substance Abuse and Mental Health Services Administration as an evidence-based treatment.

In addition to the unique structure of therapy, DBT also recognizes the fact that most people are doing the best they can possibly do with the types of skills they have.

If someone is not doing well they may simply be missing the necessary skills.

Dr. Linehan determined what skills needed to be stronger and then set about a method of correcting that. (Hoermann, Zupanik & Dombeck, n.d.).

Four skills that DBT utilizes are:

  1. Mindfulness
  2. Interpersonal effectiveness
  3. Emotional regulation
  4. Distress tolerance

Mindfulness skills are all about developing self-awareness and living in the present moment. Mindfulness also teaches the reasonable mind, the emotional mind, and the wise mind.

  • The reasonable mind is logical and functions according to rules.
  • The emotional mind provides meaning to things and informs us about the importance of things such as the complexity of relationships.
  • The wise mind creates a sense of balance as clients are taught how to return to the wise mind when it is necessary.

Interpersonal effectiveness skills help clients become more skilled during interpersonal interactions, especially those involving conflict.

The client is taught a series of steps to follow, which allows them to function from the wise mind.

Emotional regulation skills help a client better understand and cope with intense emotions. Clients learn how emotions function, the relationship between an interpretation and the corresponding emotion, how the body responds and the resulting urges or impulses.

Distress tolerance skills are basically that ability someone has to move through a crisis without making things worse. This helps build resilience by both acceptance and a non-judgmental attitude when going through the crisis.

Those with BPD often have a very difficult time dealing with a crisis. Learning these skills helps them get through difficult times much more easily without engaging in behaviors that are self-destructive.

The ideas of acceptance and change are in a sense incompatible agendas. It is difficult to accept something and try and change it without invalidating someone’s experience.

Dr. Linehan’s solution to the problem of integrating these seemingly incompatible goals was to simply move back and forth between them during therapy. This is where the idea of the “dialectical” manner came into being.

The term dialectic refers to a sort of philosophical mode of argument, otherwise known as Dialectical Behavioral Therapy (DBT).

This back and forth mode is unique in the fact that the therapist will often accept and validate the client’s experiences and responses in one moment, and challenge them in another.

This then challenges the client to consider other alternatives. As the therapist moves between these two opposite modes and approaches, they can gauge the client’s ability to tolerate the requests for change.

This is essentially the core belief in Linehan’s Dialectical Behavioral Therapy.

The standard DBT model includes two main components of treatment:

  1. Individual weekly therapy sessions.
  2. Weekly group therapy sessions.

 

Examples of DBT in Use

There are multiple studies that show DBT’s effectiveness. DBT is especially effective in treating those with borderline personality disorder, post-traumatic stress, self-harm, and suicidality.

 

DBT and Community Health Centers

Community Mental Health Organizations or CMHO serve as a safe haven for those suffering from mental health disorders.

DBT has been used successfully in the public health sector for both self-harming and suicidal behaviors as well as for those with a broad range of disorders.

Trial results clearly demonstrate a reduction or elimination of behaviors that are deemed problematic. Results also indicate a high degree of satisfaction by staff who provide treatment resulting in overall cost saving in mental healthcare treatment costs.

DBT helps those who experience pervasive emotional dysregulation or those who experience intense emotional responses that are often difficult to change.

Clients in a community mental health center are likely to receive group skills training to learn mindfulness, emotional regulation, distress tolerance, and interpersonal effectiveness. Individual therapy may also be given to help one apply DBT skills. ((How DBT Helps, n.d.)

 

DBT and Eating Disorders

DBT can also be helpful for those clients in which emotional dysregulation plays a key role, such as those with eating disorders.

For clients whose primary issue is binge eating disorder or bulimia nervosa, DBT skills have been found to be more effective than control groups at reducing binge eating, or binging and purging behaviors as well as other types of eating-related problems.

For example, comprehensive DBT has been found to lead to high rates of diagnostic remission (64%) when it comes to eating disorders amongst suicidal and self-injuring women with Borderline Personality Disorder.

DBT can help those with eating disorders by helping sufferers cope more effectively with the challenging emotions that can lead to problematic behaviors.

DBT might also help someone better understand the patterns that typically lead them to engage in destructive eating behaviors.

They will also learn skills to increase their ability to tolerate and reduce difficult emotions without having to turn to food or behaviors related to food. (How DBT Helps, n.d.)

 

DBT and High-Risk Clients with PTSD

DBT can also be useful for those with PTSD. PTSD is a debilitating disorder, which is characterized by intrusive memories of past traumas, avoidance of traumatic situations and thoughts, emotional numbing as well as hyperarousal.

DBT uses a four-stage model of treatment for those with PTSD. The first stage of treatment is focused on using DBT to achieve a sense of control over suicidal, self-injurious, and other severe behaviors that require stabilization prior to initiating treatment.

The second stage of treatment utilizes the DBT Prolonged Exposure (DBT PE) protocol, which was developed by Dr. Melanie Harned.

Stages three and four are designed to help clients manage their day-to-day life as they work on feeling that sense of freedom and joy life can offer. (How DBT Helps, n.d.)

 

The DBT PE Protocol

This protocol is based on Prolonged Exposure Therapy, which is an evidence-based treatment for PTSD. It was adapted to fit the unique needs of high-risk and multi-problem clients.

DBT with the DBT PE protocol has been evaluated as a one-year outpatient treatment for suicidal and self-injuring women with PTSD and Borderline Personality Disorder.

This research has found that DBT with the DBT PE protocol leads to a much high rate of diagnostic remission for PTSD or 71-80%.

Research also found large improvements in suicidal and self-injurious behavior, dissociation, shame, depression, social adjustment, health-related quality of life, and global functioning.

Studies in community outpatient and residential settings with men and adolescents are also underway. (How DBT Helps, n.d.)

 

Commonly Asked Questions About DBT

 

How is DBT different from other forms of therapy?

DBT is a comprehensive type of cognitive behavioral therapy. Its aim is to treat people who see little or no improvement with other types of therapeutic models.

DBT focuses on problem-solving and acceptance-based strategies and it operates within a framework of dialectical methods. The term dialectical refers to the processes that are used to bring opposing concepts together.

The main difference between DBT and other therapeutic models is the fact that DBT often works with people who are difficult to treat.

 

What issues does DBT treat?

DBT is currently used to treat people with chronic or severe mental health issues. Therapists work with clients in helping them achieve goals, improve well-being and helping them effect lasting positive change.

Some common issues DBT treats are:

  • Self-harm.
  • Eating and issues with food.
  • Addictions.
  • Post-Traumatic stress.
  • Borderline Personality Disorder.

 

What was DBT originally designed for?

DBT was originally used to treat people with chronic suicidal thoughts, which were a symptom of Borderline Personality Disorder.

 

When was DBT first developed?

DBT was first developed in the 1970s by Marsha Linehan. Linehan developed DBT through her work with two mental health populations: those with chronic thoughts of suicide and those diagnosed with borderline personality disorder.

In 1993, Linehan published her first official treatment manual called the Cognitive-Behavioral Treatment of Borderline Personality Disorder.

 

How Does a DBT Intervention Work?

DBT utilizes four skills as previously discussed:

  1. Mindfulness
  2. Distress tolerance
  3. Interpersonal effectiveness
  4. Emotional regulation

Using these four skills, a DBT client will go through four stages of treatment. On a basic level, the therapist will work to move the client from where they are to where they want to be.

The four stages of DBT treatment are:

  • Stage One – Moving to gain control.
  • Stage Two – Moving to express emotions in an appropriate manner.
  • Stage Three – Learning to solve problems as a part of living a normal life.
  • Stage Four – Moving to feeling complete as a person.

In stage one, the client is attempting to regain that sense of control. Those using DBT may have a history of being somewhat reckless or even out of control. They may also be deemed as dangerous to themselves or others. DBT helps the client build positive relationships and it helps them better understand their emotions. DBT also helps the client build that sense of attention.

Stage two is all about expressing those emotions. DBT helps the client learn to express their feelings in an appropriate manner as opposed to shutting down to avoid feeling uncomfortable.

In stage three, the client learns how to solve problems as they learn to live a better life. In this stage, the client will also learn simple problem-solving techniques as they learn how to differentiate between serious situations and problems that occur from daily life.

In stage four, the client learns how to feel that sense of completeness. This stage is all about helping the client stay focused on finding that sense of well being and living a happy life.

 

What are the Benefits of Dialectical Behavior Therapy?

Over 30 years of research has demonstrated the effectiveness of Dialectical Behavior Therapy. Based on this extensive research, DBT has been recognized by the Cochrane Collaboration as the treatment with the strongest evidence of efficacy for BPD or Borderline Personality Disorder. (Behavioral Tech – Training, Continuing Education in Dialectical Behavior Therapy DBT, n.d.)

DBT also has the strongest research support for BPD by Division 12 of the American Psychological Association.

The benefits of DBT include:

  • Reduction of suicidal and self-harming behaviors.
  • Reduction of suicidal ideation and depression for adolescents exhibiting BPD traits.
  • Helpful in preventing at-risk individuals from progressing to meeting full diagnostic criteria for BPD.
  • Helping individuals with BPD learn more effective strategies for regulating emotions in order to achieve more balanced emotions, behaviors, and thoughts.

As a comprehensive treatment, DBT serves the following five functions according to Dimeff & Linehan (2001):

  1. Works to enhance behavioral capabilities.
  2. Improves the motivation to change by helping to modify inhibition and reinforcement contingencies.
  3. Provides assurance that new capabilities generalize to the natural environment.
  4. Structures the treatment environment in order to properly support both the client and the therapist.
  5. Enhances the capabilities of the therapist in terms of providing motivation to treat clients effectively.

 

Using DBT with Kids

According to Behavioral Tech, a Linehan Institute Training Company, DBT can also be used for adolescents.

Although it was originally developed for adults, DBT has since been adapted and found to be quite effective with adolescents ages 12-18.

Therapy for adolescents includes the same type of treatment strategy as well as the primary targets that adults would receive, however, this type of therapy includes the parents.

This helps to identify difficult behavior patterns common to adolescents and their families.

Utilizing DBT with this age group is typically a much briefer therapy when compared to adult therapy with sessions lasting approximately 16-24 weeks.

This type of treatment is found to last for at least one year after treatment has ended. DBT for adolescents includes four primary modes of treatment:

  1. Individual therapy.
  2. Periodic family sessions for adolescents and parents and/or caregivers.
  3. Multifamily group skills training to learn DBT skills such as mindfulness, distress tolerance, emotional regulation, and interpersonal effectiveness.
  4. Individual coaching where they receive help using DBT skills or for crisis situations.

DBT therapists also participate in therapist consultation teams focused on helping them treat patients effectively.

 

DBT Tests, Assessments and Questionnaires

 

1. Linehan Risk Assessment & Management Protocol (LRAMP)

The Linehan Risk Assessment & Management Protocol (LRAMP) is an empirically supported and comprehensive framework that is used to assess the risk of suicide and protective factors. It is a guide for the therapist to consider reasonable options for intervening in suicidal behavior.

This assessment includes a structured checklist for assessing, managing and documenting the risk of suicide.

It also provides a structure for documentation that allows for the therapist to clearly describe the presentation, the assessment as well as in-session interventions, which can help with follow-up as well as decision-making.

 

2. University of WA Risk Assessment Protocol (UWRAP)

UWRAP is another good tool for assessing suicide risk and distress protocols. UWRAP includes a Face Sheet to be used at the beginning of each assessment session as well as a Debrief Form, which is meant to gauge the subject’s mood and stress. A Mood Improvement Protocol is also included to help gauge the subject’s state of mind.

 

3. Borderline Symptom List (BSL)

The Borderline Symptom List or BSL-23 contains 23 questions that help the subject gauge their feelings. 11 additional questions are also provided in the BSL-Supplement: Items for Assessing Behavior.

Scoring instructions are also provided.

 

4. DBT-WCCL Scale and Scoring

The DBT-WCCL is a checklist designed to gauge ways of coping. As subjects go through the 59 questions, they can think about and evaluate different ways in which they may have coped with stressful events in life.

Scoring instructions are also provided.

 

4 Powerful Interventions

 

1. Opposite Action Skill

There are many powerful interventions within DBT. Some of the most powerful interventions are emotion regulation skills. When someone experiences an emotion, a behavior typically comes with it.

For example, if you are feeling anxious or upset, you probably feel inclined to argue. If you are feeling melancholy, you will probably want to retreat.

Doing the opposing action can help you change your emotional state. Instead of arguing, you can try talking quietly. Instead of retreating, you can try reaching out to a friend instead.

It’s a simple yet very effective skill.

 

2. P.L.E.A.S.E. Emotional Regulation Skill

The body and the mind are closely linked. The health of one impacts the other. An unhealthy body can make it difficult to manage healthy emotions.

The acronym P.L.E.A.S.E is a good one to practice for this type of thing.

PL – Remember to treat the physical illness.
E – Eat in a healthy manner.
A – Avoid mood-altering drugs.
S – Sleep well.
E – Remember to exercise.

These may seem like simple things, but they provide a great reminder.

 

3. Paying Attention to Positive Events

It’s only human to focus on the negative. Sometimes we have to remind ourselves to look on the bright side and think positive. For example, if you hear ten compliments, and one criticism, you will probably focus on the criticism!

This exercise can help someone focus on the positive by doing small positive activities every day. While adding one positive activity may not change your life, the effect is accumulative.

Some quick positive activities you can do to get started are:

  1. Have a relaxing meal that is not rushed.
  2. Watch a movie.
  3. Visit friends or family.
  4. Visit a local zoo or museum.
  5. Go for a nature walk.
  6. Treat yourself to a relaxing night in.
  7. Put on headphones and listen to music, and do nothing else.
  8. Try a new hobby.

 

4. Distress Tolerance Skills – Distraction

A.C.C.E.P.T.S is another great activity. Negative feelings will usually pass or lessen to some extent over time. If you distract yourself until the emotions subside, you may be able to better handle things.

A – Activities. Try engaging in activities that require thoughts and concentration. This might be doing a hobby, working on a project or doing something else.

C – Contributing. Focus on something other than yourself. For example, you can try volunteering or doing a good deed or anything else similar.

C- Comparisons. Compare your situation to someone else who may have it worse. You can also remember a time when you were in more pain or when someone else was going through a difficult time.

E – Emotions. Try an activity that creates a competing emotion like watching a funny movie, or listening to soothing music.

P – Pushing Away. Try writing down negative thoughts on a piece of paper and crumbling it up and throwing it away. Refuse to think about the situation until a better time.

T – Thoughts. Focus on your thoughts when emotions take over. Count to ten, write a poem or read a book.

S – Sensations. Distract yourself with physical sensations like wearing a rubber band and snapping it on your wrist or holding an ice cube in your hands. You can also try eating something sour like a lime.

 

10 DBT Exercises and Activities (PDF)

Here is a multitude of exercises and activities that can be done as part of a DBT practice including the practice of mindfulness.

 

1. What is Mindfulness?

Mindfulness is essentially a state of nonjudgmental awareness of what is happening in the present moment, including the awareness of your thoughts, feelings, and senses.

Mindfulness is all about being aware of thoughts, feelings, and sensations as they are happening. The goal is not to completely clear your mind or to stop thinking, but to focus 100% of your attention on the present moment and on the here and now.

The art of mindfulness allows you to become aware of your thoughts without getting caught up in them. Doing this in a non-judgmental manner, allows you to accept whatever feelings come up. If you are anxious, you can acknowledge you are anxious. If you are sad, you can recognize that as a valid feeling.

You can say for example, “I am feeling anxious, and that’s OK.” It’s not about trying to change the emotion or feeling but simply recognizing it.

A few benefits of mindfulness include:

See Also

  • Reduced anxiety and depression.
  • Improved memory and focus.
  • Less rumination or going over and over a problem again and again.
  • Better ability to manage emotions.
  • Better adaptability to stressful situations.
  • Greater satisfaction with relationships.
  • Mindfulness is more a state of awareness rather than an exercise.

This information is derived from the What is Mindfulness worksheet from therapistaid.com.

Activities like mindful walking and creating quiet time are a few mindfulness activities that may be helpful. Click on the links below to access these activities in our Positive Psychology Toolkit.

 

2. DBT Interpersonal Effectiveness Skills

Developing interpersonal skills helps one get along better with others. Some great ways to do this include the G.I.V.E. and F.A.S.T. exercise.

Relationship Effectiveness

The G.I.V.E exercise helps with relationship effectiveness. Relationships aren’t only about getting what we need, but about other’s needs as well.

G – Gentle. Being gentle means not attacking, threatening or expressing judgment during interactions. It’s about accepting the occasional NO for your requests.

I – Interested. This is about showing genuine interest to someone else without interrupting.

V – Validate. Validating means outwardly validating the other person’s thoughts and feelings. It’s also about acknowledging someone’s else’s feelings and recognizing when your requests are demanding and respecting others opinions.

E – Easy. This is about having an easy attitude and remembering to smile and act lighthearted.

Self-Respect Effectiveness

The F.A.S.T. exercise is about self-respect. Sometimes in relationships, we might find ourselves betraying our own beliefs in order to receive approval for what we want.

F – Be Fair. This is about being fair not only to yourself but to others.

A – Apologies. Don’t apologize unless it’s warranted. Don’t apologize for making a request, having an opinion or for disagreeing.

S – Stick to values. Don’t compromise your values just to be liked or to get what you want. Stand up for what you believe in.

T -Truthful. Avoid dishonesty such as exaggeration, acting helplessly as a form of manipulation or outright lying.

This information was derived from the Interpersonal Effectiveness Skills worksheet from therapistaid.com.

 

3. Distress Tolerance Skills

Radical acceptance is a distress tolerance skill. Sometimes we will run into a problem that is simply out of our control. It’s easy to think that it isn’t fair or we shouldn’t have this problem even though thinking in this manner only makes things worse.

Radical acceptance is a healthier way to think about something. Instead of focusing on how you would like something to be, you can recognize the problem or situation as it is.

Accepting something is not the same as liking or condoning something. Learning to accept the problems that are out of our control will lead to less anger, stress, and anxiety in the end.

For example, let’s say you were not chosen for a job when you really felt that you were the ideal candidate.

  • Typical thinking would lead us to believe that this situation wasn’t fair.
  • Radical acceptance, on the other hand, would help us realize that while it’s frustrating that we didn’t get the job, we can accept that they felt someone else would be a better fit.

This information was derived from the Distress Tolerance skills worksheet from therapistaid.com

 

4. Emotion Regulation Skills

Check the Facts Exercise

This exercise allows us to look back at our life and think of situations where we may have overreacted. This might also be something we thought was a big deal when it was really unimportant.

Checking the facts helps reduce the intensity of these extreme emotions.

Try having your clients ask themselves the following questions as they think about a situation.

  1. What event triggered my emotions?
  2. What interpretations or assumptions did I make about the event?
  3. Did my emotions and the intensity of the emotions, match the facts of the situation or did they match my assumptions of the situation?

This information was derived from the Emotion Regulation Skills worksheet from therapistaid.com.

The Wise Mind Exercise

The Wise Mind exercise is meant as a guide to help clients learn skills to use their wise mind so they can better manage their behavior. The activity includes recognizing the three minds: the emotional mind, the wise mind, and the reasonable mind.

The emotional mind is used when feelings control a person’s thoughts and behaviors. Someone might act impulsively as a result with little regard to the consequences.

The reasonable mind is when someone approaches a situation intellectually. They might plan and make decisions based off of fact.

The wise mind refers to that ideal balance between the emotional mind and the reasonable mind. This occurs when someone is able to recognize and respect their feelings while responding to them in a rational manner.

A great exercise to do for this is to try and have clients describe an experience they have had with each of the three states of mind, and describe the differences.

This information is derived from The Wise Mind worksheet from therapistaid.com.

 

5. Other Mindfulness Skills Helpful for DBT

There are many other Mindfulness Skills that can be used with DBT. The exercises below can be downloaded from our Positive Psychology Toolkit.

A few of these are:

 

4 Recommended Books

There are many excellent books for DBT. Check out these great selections below.

 

1. Cognitive-Behavioral Treatment of Borderline Personality Disorder (Marsha Linehan).

Written in 1993, this book by Dr. Linehan provides a wonderful overview for treating those with BPD and for helping clients who have complex issues.

Available on Amazon.

 

2. DBT® Skills Training Manual, Second Edition (Marsha Linehan)

Also a great reference guide providing a comprehensive resource for implementing DBT skills. The book, written in 2015 includes reproducible teaching notes, handouts and worksheets.

Available on Amazon.

 

3. DBT® Skills Training Handouts and Worksheets (Marsha Linehan)

Written in 2014, it features more than 225 user-friendly handouts and worksheets essential for helping provide resources for DBT.

Available on Amazon.

 

4. Building a Life Worth Living: A Memoir (Marsha Linehan)

This book tells Linehan’s personal story about her experience moving from a suicidal teenager to world-renowned therapist and doctor.

Available on Amazon.

 

10 Quotes on the Topic

The great thing about treating borderline patients is that it is like having a supervisor always in the room.

Marsha M. Linehan, Cognitive-Behavioral Treatment of Borderline Personality Disorder

The desire to commit suicide, however, has at its base a belief that life cannot or will not improve. Although that may be the case in some instances, it is not true in all instances. Death, however, rules out hope in all instances. We do not have any data indicating that people who are dead lead better lives.

Marsha M. Linehan, Cognitive-Behavioral Treatment of Borderline Personality Disorder

It’s important to keep in mind that most people have no idea how to respond effectively to someone who self-harms.

Kim L. Gratz, Freedom from Self-harm: Overcoming Self-Injury with Skills from DBT and Other Treatments

Compassion is a fundamental principle of meditation. Meditation is not a narcissistic, self-interested path. It provides the foundation for love, integrity, compassion, respect and sensitivity (Feldman, 1998, p.2).

Christina Feldman

This might surprise you, but one of the best ways to manage your emotions is simply to experience that emotion and let it run its course.

Kim L. Gratz, Freedom from Self-harm: Overcoming Self-Injury with Skills from DBT and Other Treatments

We want to be clear: The skills we [teach] you for managing your emotions and controlling your urges to self-harm will never be quite as effective or satisfying as self-harm in the short run.

Kim L. Gratz, Freedom from Self-harm: Overcoming Self-Injury with Skills from DBT and Other Treatments

A patient’s passivity must not be unilaterally interpreted as lack of motivation, resistance, lack of confidence, or the like. Many times, passivity is a function of inadequate knowledge and/or skills.

Marsha M. Linehan, Cognitive-Behavioral Treatment of Borderline Personality Disorder

Emotions are not good, bad, right, or wrong. The first step to changing our relationship to feelings is to be curious about them and the messages they send to us.

Lane Pederson, Dialectical Behavior Therapy Skills Training for Integrated Dual Disorder Treatment Settings

It is hard to be happy without a life worth living. This is a fundamental tenet of DBT. Of course, all lives are worth living in reality. No life is not worth living. But what is important is that you experience your life as worth living—one that is satisfying, and one that brings happiness.

Marsha M. Linehan, DBT Skills Training: Manual

The word dialectic (in dialectical behavior therapy) means to balance and compare two things that appear very different or even contradictory. In dialectical behavior therapy, the balance is between change and acceptance (Linehan, 1993a). You need to change the behaviors in your life that are creating more suffering for yourself and others while simultaneously also accepting yourself the way you are. This might sound contradictory, but it’s a key part of this treatment. Dialectical behavior therapy depends on acceptance and change, not acceptance or change.

Matthew McKay, The Dialectical Behavior Therapy Workbook: Practical DBT Exercises for Learning Mindfulness, Interpersonal Effectiveness, Emotion Regulation, And Distress Tolerance

 

A Take Home Message

As we have seen, Dialectical Behavior Therapy is a wonderful therapy for those who are prone to react in a much more intense and out-of-the-ordinary way toward certain emotional situations.

Although DBT was originally created for Borderline Personality Disorder, it can be used for many other mental health issues far beyond its original purpose.

 

  • Behavioral Tech – Training, Continuing Education in Dialectical Behavior Therapy (DBT). (n.d.). Retrieved June 12, 2019, from https://behavioraltech.org/
  • Bohus M., Limberger, M.F., Frank, U., Chapman, A.L., Kuhler, T., Stieglitz, R.D. (2007) Psychometric Properties of the Borderline Symptom List (BSL). Psychopathology, 40, 126-132.
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