Dialectical Behavior Therapy (DBT)

What Is Dialectical Behavior Therapy?

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.