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Dialectical Behavior Therapy (DBT)

Dialectical Behavior Therapy (DBT) is part of the cognitive-behavioral family of therapies. It was originally developed to treat seriously and chronically suicidal patients and has evolved to treat patients who meet criteria for borderline personality disorder and problems of emotional regulation. DBT combines principles of behavioral psychology, which are used to promote change, with mindfulness principles adapted from Buddhism, which are used to promote acceptance (Linehan, 1993). Read more

The Purpose of DBT

Linehan (2015a, 2015b) describes the purpose or functions of DBT as:

to enhance an individual’s capability by increasing skillful behavior;
to improve and maintain the client’s motivation to change and to engage with treatment;
to ensure that generalization of change occurs through treatment;
to enhance a therapist’s motivation to deliver effective treatment;
to assist the individual in restructuring or changing her environment in ways that support and maintain progress and movement toward goals.

DBT Skills Training

DBT teaches a balance of ‘acceptance skills’ and ‘change skills.’ These include:

Mindfulness skills (acceptance) including core mindfulness skills (nonjudgmental observation) and more complex mindfulness practice (wise mind, loving kindness, balancing ‘doing’ and ‘being’).
Distress tolerance skills (acceptance) including crisis survival skills, reality acceptance skills, and distress tolerance skills related to addiction.
Emotion regulation skills (change) including recognizing emotions, changing emotional responses (including cognitive restructuring), and reducing vulnerability to the emotional mind.
Interpersonal effectiveness skills (change) including objectives, relationship, and self-respect effectiveness skills.

Treatment Strategies in DBT

Treatment strategies in DBT include:

Dialectical strategies in which attention is paid toward balancing acceptance and change. Techniques include the use of metaphor and paradox, cognitive challenging, and restructuring.
Core strategies include problem solving and validation. Problem solving involves analysis and acceptance of a problem followed by an attempt to generate, evaluate, and implement adaptive solutions. Chain analysis is frequently used to analyze problem behaviors in the context of chains of actions, emotions, physiological responses, and cognitions. Skillful (wise) responses are generated and practiced.
Communication strategies are closely attended to in DBT. DBT therapists balance reciprocal communication that responds to the client’s agenda with an irreverent communication style intended to promote insight and change.
Case management strategies are used in DBT to guide the therapist’s interactions, including regular supervision and consultation on the grounds that complex clients should not be treated/‘held’ by a sole clinician.

References

Linehan, M. M. (1993). Cognitive–behavioral therapy of borderline personality disorder. New York: Guilford Press.

Linehan, M. M. (2015a). DBT skills training handouts and worksheets(2nd ed.). New York: Guilford Press.

Linehan, M. M. (2015b). DBT skills training manual(2nd ed.). New York: Guilford Press.

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Assessment

Reasons for Living Scale – Long download archived copy
Reasons for Living Scale – Short download archived copy
Reasons for Living Scale – scoring download archived copy
Borderline Symptom List download archived copy

Intervention

Treatment guides

Modified DBT group therapy manual for working with adolsecents experiencing substance misuse download archived copy
Dialectical Behavior Therapy – Youth & coaches workbook download archived copy
Self-validation skills for use in DBT group skills training download archived copy

Exercises, Worksheets & Workbooks

Dialectical Behaviour Therapy Skills Handbook download archived copy
DBT Training – Part 1 download archived copy
DBT Training – Part 2 (behavioral skills) download archived copy
DBT Training – Part 3 (core mindfulness) download archived copy
Worksheets at iLoveDBT download
Distress tolerance handouts download
Emotion regulation handouts download
Nightmare protocol download archived copy

Information Handouts

DBT skills quick reference sheet download archived copy
States of mind handout download archived copy
6 levels of validation handout & worksheets download archived copy
Reality acceptance skills overview download archived copy
DBT multi-purpose pros & cons worksheet download archived copy
DBT skills training pros & cons worksheet download archived copy
Guided mindfulness script for practicing mindfulness to emotion download archived copy
Distress tolerance worksheet download archived copy
Emotion myths worksheet download archived copy
Check the facts handout & worksheet download archived copy
Opposite action handout & worksheet download archived copy
Working with primary and secondary emotions worksheet and handout download archived copy
DBT target behavior chain analysis worksheet download archive.org
DBT behavior chain & solution analysis worksheet (fillable) download archived copy
DEAR MAN GIVE FAST handout & worksheet download archived copy

Self-Help Programmes

Overcoming distress intolerance (facing your feelings)

Understanding distress intolerance download
Accepting distress download
Improving distress download
Tolerating distress download

Improving your assertiveness

What is assertiveness? download
How to recognise assertive behaviour download
How to think more assertively download
How to behave more assertively download
Reducing physical tension download
How to say “no” assertively download
How to deal assertively with criticism download
How to deal with disappointment assertively download
How to give and receive compliments assertively download
Putting it all together download

Presentations

The chain analysis in dialectical behavior therapy | Henry Schmidt III | 2012 download archived copy