A comprehensive resource for therapists on Dialectical Behavior Therapy: understanding the theory, core principles, skills modules, and practical applications in clinical practice.
Dialectical Behavior Therapy (DBT) is a comprehensive, evidence-based treatment originally developed by Marsha Linehan in the 1980s to treat individuals with Borderline Personality Disorder (BPD). DBT has since been adapted and proven effective for a wide range of conditions involving emotion dysregulation.
DBT combines cognitive-behavioral techniques with concepts from Eastern mindfulness practices. The "dialectical" aspect refers to the balance between acceptance and change—accepting clients as they are while simultaneously working toward change.
DBT is structured as a comprehensive program typically lasting one year, though shorter adaptations exist. It's designed for clients who struggle with emotional regulation, self-harm, suicidal behaviors, and interpersonal difficulties.
DBT embraces dialectical thinking—the synthesis of opposites. The core dialectic is acceptance and change: accepting clients exactly as they are while simultaneously pushing for change and growth.
DBT is based on the biosocial theory that emotion dysregulation results from the transaction between a biological vulnerability to emotional sensitivity and an invalidating environment.
DBT teaches concrete skills across four modules: mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness. Skills are practiced both in and out of sessions.
Therapists balance validation (accepting and understanding the client's experience) with change strategies (challenging and modifying behaviors). This balance is crucial for engagement and progress.
The foundation of all DBT skills, mindfulness teaches clients to be present in the moment, observe without judgment, and participate fully in experiences. Core mindfulness skills include:
These skills help clients survive crises without making situations worse. They're about accepting reality when it cannot be changed. Key skills include:
These skills help clients understand, reduce vulnerability to, and change unwanted emotions. Skills include:
These skills help clients navigate relationships effectively while maintaining self-respect. Skills include:
Comprehensive DBT includes four essential components:
Weekly individual sessions focus on motivation, addressing life-threatening behaviors, therapy-interfering behaviors, and quality-of-life-interfering behaviors. Therapists use diary cards to track behaviors and skills use.
Weekly group sessions teach the four skills modules. Groups are structured, educational, and typically run for 24 weeks (one module at a time) or as a continuous cycle.
Clients can call therapists between sessions for skills coaching during crises. This helps generalize skills to real-life situations and prevents self-harm and suicide attempts.
DBT therapists participate in weekly consultation team meetings to maintain treatment fidelity, receive support, prevent burnout, and ensure adherence to DBT principles.
DBT has strong research support and is effective for:
Borderline Personality Disorder, Suicidal behaviors, Self-harm, Emotion dysregulation, Substance use disorders
Eating disorders, PTSD, Depression, Bipolar disorder, Adolescents with emotion dysregulation
Research shows DBT significantly reduces suicidal behaviors, self-harm, hospitalizations, and treatment dropout while improving social and global functioning. It's considered the gold standard treatment for BPD.
Diary Cards: Clients complete daily diary cards tracking target behaviors, emotions, skills use, and urges. These are reviewed in individual sessions and guide treatment priorities.
Target Hierarchy: Address behaviors in order of priority: 1) Life-threatening behaviors, 2) Therapy-interfering behaviors, 3) Quality-of-life-interfering behaviors, 4) Skills acquisition.
Validation Strategies: Use six levels of validation, from listening and observing to radical genuineness. Validation must be balanced with change strategies.
Chain Analysis: Conduct detailed behavioral chain analyses to understand the factors leading to problem behaviors and identify points of intervention.
Consultation Team: Participate in a consultation team to maintain adherence, receive support, and prevent therapist burnout. This is essential for effective DBT delivery.
DBT requires specialized training. The gold standard is training through Behavioral Tech (founded by Marsha Linehan) or other certified DBT training programs. Training typically includes:
Certification is available through the DBT-Linehan Board of Certification. Ongoing consultation and adherence to the DBT model are essential for effective treatment delivery.
DBT has specific requirements and may not be suitable for all therapists or clients:
PracFlow provides specialized tools for DBT practice: diary card tracking, skills module documentation, phone coaching coordination, and consultation team management.