Dialectical Behavioral Therapy: Managing Your Emotional Health

Role-playing different approaches when interacting with others. Practicing ways to calm down when emotionally upset. Dialectical Behavioral Therapy (DBT) involves these and other real-life skill-building scenarios designed to improve a person's emotion regulation, coping techniques and overall sense of well-being.

Here are answers to frequently asked questions about this therapeutic approach.

What Is Dialectical Behavior Therapy?

Dialectical Behavior Therapy or "DBT" is a form of cognitive therapy or talk therapy that can help you learn new skills to more effectively manage difficult emotions and decrease conflict in relationships. Therapy sessions focus on four main areas:

• Mindfulness
• Distress tolerance
• Emotional regulation
• Interpersonal effectiveness

Mindfulness is a state of mind in which you become aware of the present moment while calmly acknowledging and accepting your feelings, thoughts and body. Mindfulness therapy techniques train you to put your life experiences into a healthier perspective instead of reacting emotionally to situations.

Distress tolerance is just what it sounds like, a way to increase your ability to cope with distress. When you're stressed, your body reacts physically. Your muscles may tense, you may become hot, and your breathing can become labored. By adapting DBT skills, you can reverse these types of physical reactions to stress.

Emotional regulation is something we learn to do as we mature. Negative emotions such as anxiety, anger or frustration can cause us to behave in ways we dislike. It can cause us to regret things we say or do, increasing our negative emotions and self-image. Emotion regulation therapy teaches you to take charge of your emotions in order to improve your mood and increase your feelings of self-worth and empathy toward others.

Interpersonal effectiveness refers to skills that help you balance priorities versus demands in daily life, tend to your relationships, differentiate between "wants" and "should," gain a better sense of mastering your life, and develop greater self-respect and overall well-being. These types of interpersonal skills help to improve your relationships with those around you.

What Types of Mental Health Issues Are Treated with Dialectical Behavior Therapy?

DBT is used to treat a number of mental health and behavioral health conditions, including borderline personality disorders, depression, anxiety, eating disorders, post-traumatic stress disorder, suicidality and substance abuse. The approach is also an effective form of cognitive therapy to address non-suicidal self-injury such as cutting, burning or other self-harm. In general, a DBT therapist can work with you to improve your mindfulness skills, distress tolerance, emotional regulation and interpersonal effectiveness.

How Does Dialectical Behavior Therapy Work?

Typically, this form of therapy combines individual sessions with a certified therapist and participation in a DBT group—so both individual therapy and group therapy are involved. Your therapist will introduce you to a number of coping, interpersonal and mindfulness skills that you will then practice outside of the individual therapy setting. DBT therapists may assign "homework" and then have you report back to the group about your experiences. Both the DBT therapist and group members can provide advice and feedback about those experiences to keep you motivated and on course. The length of time in therapy depends on your progress in developing DBT skills and reaching the goals you have identified with your therapist. 

Why Is Dialectical Behavior Therapy Deemed to Be an Effective Therapeutic Approach?

DBT is based on the idea that, for whatever reasons, people lack important skills to cope with life. That's why DBT sessions focus on teaching skills that are central to functioning successfully in life. The approach provides real-life techniques to practice those skills and clinical support to strengthen and improve on those skills. DBT may also be paired with other evidence-based therapies such as Cognitive Behavioral Therapy (CBT), Mindfulness-Based Cognitive Therapy (MBCT) or Motivational Interviewing.

How Effective Is Dialectical Behavior Therapy?

Many studies show DBT as particularly effective among individuals who are motivated to change. The approach has also been proven effective for individuals from diverse backgrounds in terms of age, gender, sexual orientation or ethnicity. The effectiveness of DBT has been validated by research.

Who Benefits from Dialectical Behavior Therapy?

Although originally developed to treat mental health conditions such as personality disorders, DBT has been effective in treating a number of other behavioral and mental health disorders such as depression, mood disorders, anxiety, eating disorders, post-traumatic issues and alcohol or other drug addiction.

When Was Dialectical Behavior Therapy Developed?

According to the National Center for Biotechnology Information (NCBI), a division of the National Library of Medicine (NLM) at the National Institutes of Health (NIH), DBT was developed by Marsha Linehan in the late 1980s as a way to treat people with borderline personality disorders and chronically suicidal individuals. Linehan combed through the literature on efficacious psychosocial treatments for other disorders, such as anxiety disorders, depression and other emotion-related difficulties, and assembled a package of evidence-based, cognitive-behavioral interventions that directly targeted suicidal behavior.

How Does DBT Compare to Other Treatment Modalities?

In some ways, DBT is similar in approach to other behavior therapies such as Cognitive Behavioral Therapy, which is another widely practiced evidence-based therapy. Therapists often use these types of cognitive therapy together, but psychotherapy should always be individualized and based on a thorough mental health assessment by a licensed provider. Although your individual therapy plan will be built on that initial assessment, the types and frequency of therapy may vary over time as you reach clinical milestones and improve your mental health and quality of life.