What is DBT?

We are often asked this question by friends and family and, while there are a number of websites devoted to DBT, it’s hard to get a clear answer on this very important question. Keep in mind that there is no one, specific answer you’ll get to this question. Ask 10 DBT therapists “what is DBT?”, though, and you’ll likely get some combination of these points:

  • Dialectical Behavior Therapy
  • An empirically supported treatment for the treatment of Borderline Personality Disorder. It is expanding its research support to include other conditions such as anxiety disorders, depression, substance use and eating disorders.
  • A skills-based treatment to help one develop a “life worth living”.
  • An acceptance-based treatment designed to help one cope with life.

All of these descriptions are accurate but they don’t really help explain what DBT means and how it might help you more than other types of treatment like Cognitive Behavioral Therapy (which, itself is an EST for a variety of conditions).

When we’re asked what DBT is, depending on the audience, we will go into talking about how DBT is a “third-wave psychological treatment which is based on CBT but adds some essential components like Mindfulness and Acceptance.” Again, this is a completely accurate description, but doesn’t give you a sense of what that actually means.

Dialectical Behavior Therapy is a treatment that works on a number of levels, including some of the same ones found in Cognitive Behavior Therapy. In CBT, there has been, historically, a great emphasis placed upon changing and challenging your thoughts to change how you feel. This is all well and good for many situations and emotions, but there is an essential piece of the puzzle missing. Emotions aren’t just the product of thoughts. As emotion researcher Paul Ekman talks about in his book, Emotional Awareness: Overcoming Obstacles to Psychological Balance, emotions are not just thought about, they are felt, physiologically. As a result, you may be able to successfully challenge your thoughts but still feel the way that you do.

This line of thinking about emotions also leads one to the somewhat judgmental conclusion that if you would just “think differently,” you would feel differently. That is, it’s your fault you feel as you do. While it may be your responsibility to address how you feel, change the situations you find yourself in, and accept your lot in life, it most certainly not your fault. Just like it’s not your fault if you get wet when you’re standing in the rain.

How does DBT address this problem?

DBT focuses on a model of emotion that takes into account not only the thoughts that precede an emotion, but also the physiological changes one experiences prior to its onset. It teaches ways to address those changes so that you can approach emotions in a multi-faceted way. In DBT, You will learn the skills required to effectively challenge your thoughts.You will learn how to change your physiology. But, most importantly, you will learn how to understand and accept your emotions to help keep them from taking over your life. This, I believe, is the key difference between DBT and CBT and the reason DBT is applicable to many conditions aside from the currently researched ones. It is surely not the only treatment that could work, but I find that it is the most useful approach to take.

DBT is a principle-driven, as opposed to protocol-driven, approach to therapy. You will not have an “agenda” per se set at the beginning of a session, for example. What are the principles that can help us understand your current situation and what technique would be helpful to address it?

A comprehensive DBT program is important to help you learn these skills and generalize them to your environment.

DBT will also help you address interpersonal problems that have arisen in your life and get through those times that are so overwhelming all you can hope to do is tread water. On top of all of this is the notion that Mindfulness is a key to your psychological well-being.

The Big Picture

When one talks about DBT as a treatment modality, it’s important to recognize that it’s not just about skills training group. These groups are an essential part of any DBT program, but it’s not the only part. A comprehensive DBT program will incorporate all of the following components:

  • Weekly individual therapy where goals are discussed, motivation is maintained and problem-solving is taught.
  • Weekly group therapy where skills are taught and practiced.
  • Telephone coaching where skills are generalized to your environment.
  • And therapist consultation team meetings where your therapist makes sure he or she is delivering the treatment effectively and not missing important details.

Further, behavior tracking using “diary cards” is important to help you monitor what is going on in your life and how you are using skills to deal with your life. These diary cards also give your therapist a chance to get a quick glance of your week and see where things need to be addressed.

If this sounds like an approach you think might be helpful, contact us.