What is DBT?

Dialectical Behavioral Therapy (DBT) is an evidence-based psychotherapy that combines Cognitive Behavioral Therapy with Zen Buddhism. Created by Marsha Linehan, it was originally used to treat Borderline Personality Disorder (BPD). Now it is used to treat many different emotional dysregulation and impulse control disorders and symptoms.

DBT is made up of many skills that help you regulate your emotions, improve your relationships and withstand times of distress without impulsivity. These skills take practice to incorporate into your daily life. They work like a muscle, building up strength with practice over time. DBT teaches you which skills are best used when and how best to apply them.

The ultimate goal of DBT is to build a “life worth living.” It has a few core components that help you do this:

The first is the principle of dialectics. Black and white thinking is common among people with BPD and others. Dialectics is the shades of gray in between. The idea is that two opposing things can both be true. It’s something that learners have to accept.

Another core component is Mindfulness. In fact, it’s the first of four modules in the treatment program. Mindfulness practice helps you live in the moment and stop holding onto painful emotions. It also helps you gain the space from the troubling situation that you need to use other DBT skills.

DBT is evidence-based, meaning that there is research supporting its effectiveness. Data show reduced rates of suicidality, hospitalizations, and self-injury. Research on the efficacy of DBT for various disorders is ongoing.

The core of DBT is that there is a therapeutic alliance, where the professional and client are on the same level with no hierarchy and goals are to agree upon. DBT views clients as an ally who work together for solutions to help the client.

The Structure

DBT contains four modules: Mindfulness, Distress Tolerance, Emotion Regulation, and Interpersonal Effectiveness. Official DBT programs rotate between these modules over the course of a year or so. As a client, you have individual as well as group therapy, each once a week. Group is where you learn new DBT skills while individual is more similar to talk therapy.

DBT programs expect clients to keep Diary Cards which track moods, urges, behaviors, and skill use. If you do not complete or bring your diary card to group or individual therapy, you may be asked to complete a Behavior Chain. Behavior chains analyze the series of events leading to the target behavior so you can see where you might be able to intervene next time. They also serve as negative reinforcement for using target behaviors.

DBT also utilizes skills coaching calls. Providers instruct clients to call their therapist or the one on duty when in or approaching crisis in order to receive help choosing and utilizing skills in the moment. Failure to use coaching calls leading to behavior usage can result in behavior chains.

Lastly, DBT therapists attend consultation in a group setting with other DBT counselors to troubleshoot issues with group members as well as issues clinicians are experiencing.

All of these components add up to create the revolutionary treatment of Dialectical Behavioral Therapy.

As well as in-person courses there are now options to learn DBT online in a group setting and on other sites with DBT skills for self-learning.

Books

The official Marsha Linehan DBT books are below. There is a first and second edition of each.

• DBT Skills Training Manual by Marsha M. Linehan
  • This book is largely for providers
• DBT Skills Training Handouts and Worksheets by Marsha M. Linehan
  • These are all the handouts and worksheets you would get in a formal DBT group

Innovative DBT

Since Linehan’s manual in 1993, there have been other professionals who, utilizing the core concepts of DBT, have created their own DBT skills. These are often referred to as “innovative” skills. Other DBT skill texts include:

• The Dialectical Behavior Therapy Skills Workbook: Practical DBT Exercises for Learning Mindfulness, Interpersonal Effectiveness, Emotion Regulation by Matthew McKay PhD , Jeffrey C. Wood PsyD , Jeffrey Brantley MD
  • Also known as “the Green Book”
• Dialectical Behavior Therapy, Vol 2, Second Edition: More Than 275 Worksheets, Activities & Games for Acquiring Competency in DBT 2nd Edition by Cathy Moonshine PhD and Stephanie Schaefer
• Radically Open Dialectical Behavior Therapy by Thomas R. Lynch
  • DBT for disorders with over-control rather than impulsive disorders
  • There is both a Skills Training Manual and a Theory and Practice book
• The New Harbinger Self-Help Workbook series has DBT workbooks for a variety of conditions such as anxiety and anger written by different authors.

View more DBT books and workbooks here.