Introduction
You've probably heard of DBT - Dialectical Behavior Therapy. It's famous for helping people with borderline personality disorder, but it's useful for much more.
But what exactly is DBT? And is it right for you?
In this guide, I'll explain what DBT is, how it works, and the skills it teaches.
What Is DBT?
Definition
Dialectical Behavior Therapy (DBT) is a type of cognitive behavioral therapy developed by Marsha Linehan. It combines cognitive behavioral techniques with mindfulness.
The word "dialectical" refers to the idea that two opposites can both be true:
- Accept yourself as you are
- Change unhelpful behaviors
Originally for BPD
DBT was originally developed to treat borderline personality disorder (BPD). It's now used for many conditions.
What It Helps
DBT is effective for:
- Borderline personality disorder
- Depression
- Anxiety
- PTSD
- Eating disorders
- Substance use
- Self-harm
- Emotion dysregulation
The Four Modules
DBT is organized into four main skills modules:
1. Mindfulness
The foundation of DBT. Skills for being present.
Key skills:
- Observe
- Describe
- Participate
- Non-judgmentally
- One-mindfully
- Effectiveness
2. Distress Tolerance
Skills for getting through crises without making things worse.
Key skills:
- TIPP
- Self-soothing
- IMPROVE
- Radically accept
3. Emotion Regulation
Skills for understanding and changing emotions.
Key skills:
- Identify emotions
- Reduce vulnerability
- Increase positive emotions
- Opposite action
- Check facts
4. Interpersonal Effectiveness
Skills for relationships and communication.
Key skills:
- DEAR MAN
- FAST
- GIVE
- Validation
Key DBT Skills
Mindfulness Skills
"What" Skills
- Observe - Notice without reacting
- Describe - Put words on experience
- Participate - Fully engage in the moment
"How" Skills
- Non-judgmentally - See without评价
- One-mindfully - Focus on one thing
- Effectiveness - Do what works
Distress Tolerance Skills
TIPP
- Temperature - Cold water
- Intense exercise
- Paced breathing
- Progressive muscle relaxation
Self-Soothing
Using the five senses:
- See something beautiful
- Listen to calming music
- Smell something nice
- Taste something soothing
- Touch something comfortable
IMPROVE
- Image - Peaceful place
- Meaning - Find purpose
- Prayer - Connection
- Relax - Breathe
- One thing - Take next small step
- Vacation - Brief break
- Encourage - Talk to yourself
Radical Acceptance
Fully accepting reality, even when painful.
Emotion Regulation Skills
Identifying Emotions
- Name the emotion
- Rate intensity (1-10)
- Note physical sensations
- Note impulse to act
Reducing Vulnerability
- ABC PLEASE:
- Accumulate positives
- Build mastery
- Cope ahead
- Physical health
- Limit alcohol/drugs
- Avoid mood-altering
- Sleep
- Eat balanced
Opposite Action
When emotions urge action, check: Is this action effective? If not, do the opposite.
Interpersonal Effectiveness Skills
DEAR MAN
For getting what you want:
- Describe - The situation
- Express - Your feelings
- Assert - What you want
- Reinforce - Benefits
- Mindful - Stay focused
- Appear confident
- Negotiate
FAST
For maintaining self-respect:
- Fair
- Apologize sparingly
- Stick to values
- Truthful
How DBT Works
Individual Therapy
Weekly sessions with DBT mental health professional.
Skills Group
Weekly skills training group (usually 24 weeks).
Phone Coaching
Between-session support for crises.
DBT Diary Card
Daily tracking of:
- Emotions
- Urges
- Skills used
- Problem behaviors
Effectiveness
DBT has strong research support:
- Reduces self-harm
- Decreases suicide attempts
- Reduces depression
- Improves emotion regulation
- Better than treatment as usual for BPD
Is DBT Right for You?
Consider DBT if you:
- Have difficulty regulating emotions
- Engage in self-harm
- Have BPD symptoms
- Experience intense emotional pain
- Haven't responded to other therapies
How to Get DBT
- Find certified DBT mental health professional
- Some clinics offer DBT programs
- Some apps offer DBT skills (like Paula!)
Frequently Asked Questions
What is DBT used for?
Originally BPD, now many conditions involving emotion dysregulation: depression, anxiety, PTSD, eating disorders, self-harm.
How long does DBT take?
Typically 24 weeks for skills training, plus ongoing individual therapy. Some do DBT for years.
Is DBT the same as CBT?
DBT is a form of CBT with added mindfulness and acceptance components.
Can I do DBT on my own?
Learning skills from books or apps can help, but full DBT includes individual therapy and coaching.
What are DBT skills?
Mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness skills.
Conclusion
DBT is a powerful therapy that teaches practical skills for:
- Being present
- Getting through crises
- Understanding emotions
- Building better relationships
If you struggle with intense emotions, self-harm, or relationships, DBT might help.
The skills are learnable. The practice is worth it.
Want to learn DBT skills? Paula is a free mental health app with DBT-informed exercises and techniques. Download it today.
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Related Reading
- What Is DBT? - Complete Guide
- What Is DBT Therapy? - Complete Guide
- What Is Therapy? - Complete Guide
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