Dialectical Behavior Therapy

Irritation, annoyance, anxiety, happiness and joy are all part of life’s emotional landscape. Moving from one feeling to another isn’t easy, but often, people experience only a tiny blip in emotion. They might feel mildly happy one moment and then mildly irritated the next, so shifting is relatively easy. There are some people, however, who experience such intense emotions that they can’t make a smooth move from one pole to the next. They might always seem hyper-aroused and unusual as a result.

Living with an issue like this can be devastating, and throughout life, the person might hear loved ones utter statements like this: “What you’re doing is wrong and bad, and you simply must change.” The person, however, might not know how to change, and each statement of blame can make the person feel yet more isolated and alone. In time, people like this might feel as though suicide is the only option that could relieve pain.

Dialectical behavior therapy (DBT) is designed to help.

With DBT, people have the opportunity to learn more about how to soothe their troubled minds, and how to behave in ways that are more in line with the expectations of sobriety.

As therapy progresses, they may even find a way to develop a life and a lifestyle that provides them with both validation and happiness.

A New Approach

People who arrive in a standard treatment program are asked to think about how their lives are now and make changes that could result in a happier and healthier life. Often, this involves listening to a counselor who might explain how the behaviors the person uses are maladaptive, and why they should be replaced with other choices. While few adults appreciate being told what to do, many people in therapy find that the advice they get really helps, and they’re able to overcome their irritation in order to accept those benefits. For some, however, this form of therapy tends to awaken old wounds.

For sensitive people like this, therapy that emphasizes change sounds a lot like criticism, and they might respond with phrases such as:

  • I don’t need to change.
  • Why doesn’t everyone else do something to accommodate me?
  • I’m the real victim here.
  • No one ever listens to what I want.

Sessions like this are combative, and they just don’t help. The relationship between the therapist and the client is strained, and the person who needs care can walk out of therapy feeling like no progress has been made in dealing with a very painful problem.

DBT sessions involve a significant amount of validation, sprinkled in among the requests for change.People might still be expected to work hard and amend their lives, but the ways in which they’ve behaved in the past might be considered a reasonable adaptation to the way in which the person grew up. The therapist might be the very first person who is willing to listen and understand, and when this connection is firm, the person might actually be willing to change.

Spotting the Contradictions

Revising a life like this means dealing with the underlying prompts that can lead to poor behavior, and often, this means dealing with strong emotions. According to a study in the Journal of Clinical Psychology, the goal of DBT is to help people to engage in behavior that enhances their lives, even while they’re feeling a strong emotion. It’s a contradiction, to be sure, as these people may have spent decades behaving in harmful ways due to their emotions. Now, they’ll need to learn how to hold two opposing thoughts in their mind at the same time, and make a good choice as a result.

This is the “dialectical” portion of DBT, and it can be powerful. For people who have spent most of their lives hearing about how they should change their thoughts, they can instead focus on just choosing a different expression. Their past behaviors aren’t wrong; they’re just one choice out of many that are open.

Therapy Tools

DBT is a time-intensive form of treatment that involves many different components. Those who enroll might spend time in individual therapy sessions with a licensed therapist, but they might also spend hours of time in group classes in which they learn how to:

  • Speak openly with others in a calm and effective manner
  • Accept the tensions and emotions of life while choosing not to act upon them
  • Soothe deep emotions in a healthful manner
  • Stay in the moment, aware of feelings, rather than sedating with drugs or avoiding the matter altogether

It’s not uncommon for people to work on homework assignments or journaling assignments when not in active therapy too, and some clients are even asked to try out different techniques on coworkers and friends when they’re under distress, and keep track of the effectiveness of those methods.

People who participate in DBT often have few coping skills for dealing with intense stress and emotions, and without therapy, they might be tempted to take their own lives or at least feign some sort of life-threatening action.

Since this is the case, DBT practitioners often follow up with clients via telephone between sessions, or give out an emergency number that people can use when times are tough, so they won’t harm themselves. Since the therapy is so supportive, and the counselors make themselves so available, suicide risks tend to drop in people who have DBT. For example, a study funded by the National Institute on Mental Health found that participating in DBT reduced suicide attempts by 50 percent, when it was compared to other therapies used on people who had borderline personality disorder (BPD).

Other Benefits

In addition to reducing suicide rates, and allowing people to choose a different way to behave when they’re under stress, DBT has been associated with significant benefits when it’s used for a variety of different disorders. For example, some therapists have modified the treatment in order to deal with the issues surrounding eating disorders. In these settings, the disordered behavior involves eating patterns, and the triggers that spur that behavior are the target for change. In a study in the Journal of Consulting and Clinical Psychology, researchers found that 89 percent of women who got DBT for a binge eating disorder had stopped that behavior by the time treatment was complete. That’s a remarkable result, demonstrating how well this therapy might work in people who use their eating habits to express their pain.

The therapy has also been modified to assist people who have serious cases of depression. These people may not suffer from the intense swings of emotion seen in other mental illnesses, but they might have an inability to pull themselves out of a sore mood when something horrible takes place. Their reaction to a trigger is extreme, and it might be hard for them to control. In a study of the effectiveness of DBT in people like this, published in The American Journal of Geriatric Psychiatry, researchers found that 71 percent of those who got the therapy were in remission when treatment ended, while only 47 percent of those who had another form of therapy had the same result. DBT seems to touch people like this, allowing them the opportunity to heal.

Dr. Eboni Webb had a chance to sit down with Recovery Unscripted. Webb is an internationally renowned trainer in Dialectical Behavioral Therapy. She explains the role that mindfulness plays in overall mental health and how therapists can help make DBT more accessible to everyone.

While DBT can be used to help all sorts of people with all sorts of mental health concerns, it’s considered the gold standard of treatment for people with borderline personality disorder. While people with depression, anxiety, eating disorders, addictions or some other form of mental illness might benefit from all kinds of therapy, including DBT, most people with BPD just need the help that this one kind of therapy can provide. It was made for them, and it remains the best option for them, in most cases. Often, the benefit is attributed to low dropout rates.


People who have BPD are often tempted to walk right out of their treatment programs, as they feel attacked or judged in their sessions. In DBT, they just don’t have that experience. Instead of feeling attacked, they feel accepted and even a little bit appreciated. As a result, they tend to stay engaged with therapy, learning and growing all along the way. In a study profiled in Social Work Today, researchers found that only 36 percent of people with BPD dropped out of their DBT sessions, while 73 percent of those who had BPD and another treatment format chose to leave help behind.The intensive form of the treatment is likely to help anyone to make the sorts of big changes that can lead to intensive healing and long-term health. It’s just a comprehensive form of care that provides assistance and solutions on many fronts, and it can help people both come to a new understanding and develop important new habits.


Learning More

Often, people who need therapy aren’t required to make choices about what kind of help they will accept. The treatment team assesses their issues, develops a plan and then puts that plan into action. The person really isn’t required to find out about how therapy works and then order up a specific therapy that seems right. That being said, it’s not uncommon for people to read up on a specific type of therapy and become convinced that it’s the right choice for them. If that’s happened to you and you’d like to find a program near you that provides DBT, please contact us. We can help you find a solution, and we can even help you through the enrollment process. Call to get started.

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