An Overview of Dialectical Behavioral Therapy (DBT)
Dialectical Behavioral Therapy (DBT) is a cognitive-behavioral treatment developed by Marsha Linehan, Ph.D., in the 1980s to help people who experience extremely intense emotions, catastrophic thinking, anxiety, stress, and "all or none" thinking (to name a few). These experiences are commonly, but not always, due to a history of trauma.
The “D” in DBT stands for “dialectical.” A dialectic is a synthesis or integration of opposites. A DBT-oriented therapist works with an individual to find ways to hold two seemingly opposite perspectives at once, promoting balance while challenging black and white (all-or-nothing) patterns of thinking. In service of this balance, DBT promotes a "both-and" rather than an "either-or" outlook. The dialectic at the heart of DBT is acceptance and change.
The Wise Mind
Dialectical strategies help us get unstuck from extreme positions. They help us stay "in-balance" so we can reach our goals as quickly as possible. The Wise Mind illustrates this point. The Wise Mind consists of a healthy balance of the reasonable and emotional parts of our brains (see below).
The reasonable parts of our brain use facts to plan, organize, and make decisions. These parts of our brain inhibit the impulsive emotional parts so we can make reasonable and rational decisions. Too much reasoning can cause us to overthink, to be indecisive, and to feel "stuck." Too much reasoning can also disconnect us from feeling our emotions, which leaves us feeling empty, "numb" or apathetic.
The emotional parts of our brain color our lives with emotions such as fear, anger, sadness, joy, and hope. The emotional parts of our brain color our worlds and make them interesting. These parts also serve an important evolutionary purpose. Our survival depends on our ability to act quickly in the face of danger. It would not behoove us to contemplate life as a lion chases us. However, when the emotional parts of our brain aren't in balance, we might overreact to a small threat. Overactive emotional parts can impair our ability to make rational decisions and can result in very toxic and unstable relationships.
Like the porridge in Goldilocks and the Three Bears, the goal is to be not too hot (emotional) and not too cold (reasonable). We want to be "just right".
The Four (4) Components of DBT
Dialectical behavior therapy (DBT) provides new skills to manage painful emotions and decrease conflict in relationships. DBT specifically focuses on providing skills in four key areas.
(1) Mindfulness: Mindfulness focuses on improving one's ability to accept the present moment without judgment.
(2) Distress Tolerance: Distress tolerance is geared toward increasing one's tolerance of negative emotions, rather than avoiding them.
(3) Emotion regulation: Emotion regulation covers strategies to manage and change intense emotions that are causing problems in one's life.
(4) Interpersonal effectiveness: Interpersonal effectiveness consists of techniques that allow one to communicate with others in a way that is assertive, maintains self-respect, and strengthens relationships.
Using a DBT approach, a therapist guides a client or patient through the process of acceptance and change by validating and accepting the individual as he or she is. A DBT therapist appreciates that too much focus on change results in the individual feeling misunderstood and invalidated. Working with people with extreme emotional sensitivity requires careful attention to the balance between acceptance and change. It also requires an assessment of personal boundaries.
DBT was originally developed to relieve the emotional sensitivity experienced by individuals with borderline personality disorder. However, research shows that DBT has also been used successfully to help people suffering from depression, bulimia, binge-eating, bipolar disorder, post-traumatic-stress disorder, abandonment/attachment problems, and substance abuse.
See Handout on Dialectical Statements
Recommended DBT Workbook
Click here for a recommended DBT Workbook
Related Links
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This post was reviewed by a licensed medical professional.