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What is DBT? 4 Questions Answered

Earlier this month, I was excited to see Playmore & Prosper host the space for DBT Associates’ Intensive Dialectical Behavioral Therapy (DBT) Training. Since DBT has grown in popularity in recent years, it’s a term that many people in the psychological community are familiar with. Intrigued by the hype about DBT—it’s the treatment of choice for Borderline Personality Disorder—I set out to research a few questions about it. What is the history of DBT – and crucially, what IS it? What does a DBT session look like – and what evidence shows that it’s effective? (In other words, does it live up to its reputation?) These questions provided me the inspiration for this week’s blog – so if you’re wondering about these things too, stick with me.

What is the history of DBT?

DBT is a type of therapy that was founded by Dr. Marsha Linehan in the 1990s and was originally meant to be a treatment for Borderline Personality Disorder (BPD). Linehan herself has BPD: she was hospitalized at 17 after several self-harm attempts and struggled throughout her 20s with mental health concerns. After recovering and gaining a PhD in Psychology from Loyola University Chicago, Linehan developed DBT in part through her own struggle with the disorder.

BPD is characterized by extreme shifts in mood and instability in relationships. Linehan noticed how BPD patients, including herself, experienced treatment as dehumanizing. In other words, BPD patients would be treated as a collection of problems that needed to be solved instead of people. DBT addresses this negative therapeutic mindset through its emphasis on validation. Key to this concept of validation is DBT’s dialectic of acceptance and change: clients are encouraged to both accept who they are at the core and commit to change maladaptive behaviors. From being a treatment focused mainly on BPD, DBT has evolved to treat a variety of mental health disorders, including mood disorders such as depression and substance abuse disorders.

What are the core principles of DBT?

There are four “modules” of DBT that clients learn: Mindfulness, Emotion Regulation, Distress Tolerance, and Interpersonal Effectiveness. Mindfulness is considered the core module for DBT; it is based on Eastern meditation and Zen practices modified to emphasize behavioral and psychological principles. The purpose of mindfulness is to balance “reasonable mind” (cold, hard logic) with “emotional mind” (instinct and emotion) to reach “wise mind” as a synthesis of the two extremes. “Wise mind” is a dialectical balance between two opposing forces, a recognition that life can be “both…and” rather than "either…or.”

Emotion Regulation teaches skills to reduce a person’s vulnerability to negative emotions while increasing their experience of positive emotions. Emphasis is often placed on healthy living, such as getting enough sleep and exercising. Distress Tolerance focuses on how to change your emotional response to upsetting situations through acceptance, distraction, or tolerance. The last module is interpersonal effectiveness; its core principles are assertiveness, sticking to your values, and showing interest in others to build relationships. Together, the four modules of DBT address symptom reduction, improve quality of life, and enhance the ability to live in the moment.

What happens during a session of DBT?