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Introduction to Dialectical Behavior Therapy (DBT)

Dr. Melanie du Preez

1. Introduction

"Life isn’t about finding yourself. Life is about creating yourself." — George Bernard Shaw

Dialectical Behavior Therapy (DBT) is a unique form of psychotherapy that combines cognitive-behavioral techniques like problem-solving and chain analysis with acceptance-based techniques such as mindfulness and validation. These skills are taught in both individual therapy and group skills training sessions. The therapy was developed by Marsha Linehan, who has written several treatment manuals outlining how to apply the principles to clients with different issues. DBT has a substantial body of research supporting its effectiveness and is considered an evidence-based treatment. Due to its focus on acceptance and change, as well as helping individuals build a meaningful life, DBT is still widely used today to assist clients in creating a fulfilling life. (Petsagourakis et al., 2024)

 

Initially designed to help individuals with severe emotion dysregulation and high harm avoidance, DBT has expanded to treat a wide range of clinical diagnoses and problems effectively. The therapy is named after "dialectical philosophy," which emphasizes synthesizing conflicting ideas. In DBT, therapists and clients work together to synthesize acceptance and change, teaching clients to accept themselves and their situations while also working to change and grow (Afshari & Hasani, 2020).  

1.1. What is Dialectical Behavior Therapy?

The main objective of Dialectical Behavior Therapy (DBT) is to assist individuals in creating a meaningful and worthwhile life. To achieve this, DBT focuses on two main functions: 1) improving behavioral skills, capabilities, and motivation; and 2) structuring the environment in a way that allows individuals to build their lives based on their abilities. DBT is based on a dialectical worldview that emphasizes that change is a constant part of life and that opposing forces are at play in the universe, with everything being interconnected. It acknowledges that individuals have the capacity for both acceptance and change, and they do what they can to survive. Additionally, DBT assumes that people and the world are doing their best and that individuals need to learn and capitalize on their strengths rather than being labeled weak and unlikely to change. This approach is only effective when individuals actively participate in their treatment (Schaich et al. 2021).

Dialectical Behavior Therapy (DBT) is a type of cognitive-behavioral treatment developed by Marsha Linehan. It focuses on combining opposites, such as acceptance and change. Initially designed to treat individuals with suicidal behavior and Borderline Personality Disorder (BPD), DBT has been extensively researched and proven to be effective for these conditions. Since its development, DBT has also been found to be effective in treating a wide range of other issues, including depression, post-traumatic stress disorder, and eating disorders.  

1.2. Brief History of DBT

Marsha Linehan created Dialectical Behavior Therapy (DBT) as an adaptation of basic behavior therapy. DBT was developed to help individuals with Borderline Personality Disorder. Over time, DBT has expanded and is now used for various populations and issues. Despite evolving, DBT remains centered on validating and accepting the client while also working to change their behavior (Linehan, 2020).

In the beginning, behavior therapy was the only approach, based on the principles of learning theory. It aimed to change unhealthy or negative behaviors by leveraging the idea that behaviors can be learned and unlearned. Linehan modified basic behavior therapy with acceptance and validation to create DBT. She discovered the need for validation and acceptance for a population of women diagnosed with Borderline Personality Disorder (BPD) who had attempted suicide. Linehan realized that trying to change their behaviors without validation led to worsening conditions and therapy dropouts. As a result, she incorporated validation and acceptance into the therapy process. Additionally, Linehan introduced four components of DBT: individual therapy, group skills training, telephone coaching, and therapist consultation team. Individual therapy incorporates a hierarchy of targets, focusing on life-threatening behaviors, therapy-interfering behaviors, quality-of-life issues, and skills acquisition. 

2. Premises of DBT

The biosocial model, as illustrated by the developer of DBT, uses the analogy of a person falling into a well. The well symbolizes pervasive instability and emotional dysregulation, while the person falling into the well represents the current suffering self. The evolutionary development and the current reinforcement and punishment contingencies that have powerfully affected the person's behavior, biology, and environment represent the sides of the well. The person falling into the well is seen as doing the best they can given the pull of gravity and the shape of the well. The developer created DBT to assist suffering individuals in getting out of the well, positing that validation, the non-judgmental acknowledgment of the other person's experience as valid and understandable, is the key to helping individuals get out of the well. The validation premise of DBT has been supported by empirical evidence from various research areas of psychology and neuroscience. In addition to providing validation, DBT therapists act as consultants, offering suggestions and guidance regarding more skillful ways of coping with problems and regulating emotions (Veroniki et al., 2021).

Dialectical Behavior Therapy (DBT) was originally developed and researched for treating chronically suicidal individuals with Borderline Personality Disorder (BPD). DBT is one of the empirically supported treatments (EST) and is the most established and researched intervention among the ESTs for BPD. Since its development, DBT has been modified for treating other conditions and problems as well. The philosophy of DBT proposes that people's behavior, cognitions, and emotions have been shaped by their biology and the reinforcement and punishment they have experienced in their environment. In other words, people are doing the best they can (Iskric & Barkley-Levenson, 2021).  

3. Learning Theory in DBT

The therapist's use of validation is an essential part of the treatment process. Patients come in with intense suffering and destructive behavior that needs to change, and the goal is to help them build a life that is worth living. The therapist asks the patient to change their behavior while also showing acceptance of the patient's experience, which introduces a principle of behavior modification. This is part of the dialectical agreement that acknowledges the patient's suffering while also recognizing that some solutions may seem counterintuitive. Additionally, the dialectical philosophy extends to the patient's worldview and how they process external events, aiming to encourage change while fostering self-acceptance. This forms the foundation of dialectical behavior therapy (DBT).

Most behaviors are believed to develop in response to their consequences, which is the core belief of the learning theory that DBT is based on. DBT integrates behavioral and supportive cognitive behavioral interventions, but what sets it apart from other CBT methods is its primary commitment to validation and acceptance as the primary modes of addressing problems and building a relationship with the patient. The term "dialectical" in the therapy's title refers to the principle that seemingly opposite forces should be integrated for the best outcome. In the case of DBT, patients should learn to accept and validate themselves as well as change their behavior. (Ohlis et al., 2023)

4. Benefits of Dialectical Behavior Therapy

DBT is a unique treatment program that combines individual and group therapy. Each week, individuals in therapy are given homework to practice specific skills. DBT consists of four modules of skills training: core mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness. The skills learned in DBT help individuals build a more fulfilling life. DBT is a structured program with specific goals and benchmarks, which is especially helpful for those seeking tangible ways to improve their mental health.

Dialectical Behavior Therapy (DBT) is a type of cognitive-behavior therapy with the main goals of teaching people to live in the moment, cope with stress in a healthy way, regulate their emotions, and improve their relationships with others. Initially designed to help individuals with Borderline Personality Disorder, DBT has proven effective for a wide range of issues including mood disorders, PTSD, and eating disorders. DBT uses four primary strategies: validation, behavior chain analysis, dialectical strategies, and problem-solving strategies. These strategies, combined with the skills learned and practiced in therapy, contribute to the effectiveness of DBT.

References: 

Petsagourakis, D., Driscoll, C., Viswanadhan, K., & Lois, B. H. (2024). Promoting Validation and Acceptance: Clinical Applications of Dialectical Behavior Therapy With Pediatric Populations and Systems. Cognitive and Behavioral Practice. [HTML] 

This post is for informational purposes only. It should not be considered therapy. This blog is only for informational and educational purposes and should not be considered therapy or any form of treatment. We are not able to respond to specific questions or comments about personal situations, appropriate diagnosis or treatment, or otherwise provide any clinical opinions. If you think you need immediate assistance, call your local doctor/psychologist or psychiatrist or the SADAG Mental Health Line on 011 234 4837. If necessary, please phone the Suicide Crisis Line on 0800 567 567 or sms 31393. 

This blog is only for informational and educational purposes and should not be considered therapy or any form of treatment. We are not able to respond to specific questions or comments about personal situations, appropriate diagnosis or treatment, or otherwise provide any clinical opinions. If you think you need immediate assistance, call your local doctor/psychologist or psychiatrist or the SADAG Mental health Line on 011 234 4837. If necessary, please phone the Suicide Crisis Line on 0800 567 567 or sms 31393.