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Dialectical Behavior Therapy (DBT)

DBT effectively combines cognitive and behavioral therapies to provide clients with new skills that can both redefine their identities and transform negative thinking patterns and destructive behaviors toward a healthier life. 

DBT is influenced by the philosophy of dialectics: balancing opposites. The therapist and client work together to find ways of holding two seemingly opposite perspectives at once, promoting balance and avoiding “black-and-white”—or “all-or-nothing”—styles of thinking. The dialectic in DBT is acceptance and change.

Specifically, DBT helps clients develop skills in four key areas:

  1. Mindfulness to better accept and be present in the current moment, with clients often keeping journals to reflect on difficulties and successes as they progress
  2. Distress tolerance to cope with stressful or anxiety-producing situations by reframing thoughts, implementing self-soothing techniques and staying present—without trying to escape from it 
  3. Emotion regulation to understand, adapt and change negative emotions to improve one’s mindset and take positive actions 
  4. Interpersonal effectiveness to communicate and interact with others in a way that is assertive, maintains self-respect and builds healthy relationships

Developed in the 1980s to help chronically suicidal individuals diagnosed with borderline personality disorder (BPD), DBT has been successfully adapted to treat people with: 

DBT requires a deep commitment from therapist and client to work collaboratively toward the client’s improved life. Treatment typically consists of weekly individual therapy sessions and DBT skills groups

Individual sessions help clients stay motivated, apply DBT skills in daily life and address obstacles, often targeting some event or incident that just occurred. Using a process called “behavioral analysis,” the client identifies factors leading up to and following the event, in order to find and practice new ways of responding in similar situations.

DBT skills group encourages participants to share their experiences and provide mutual support, while practicing skills together. Group members are assigned homework, such as practicing mindfulness exercises. Groups typically last six months, but duration can depend on participants’ needs. 

Individual and/or group: Some clients complete one-on-one therapy without attending a skills group; others might choose the group without individual sessions—while the most effective treatment involves both.

Consultations outside of sessions, as needed, can help clients apply DBT skills to prevent a relapse of problematic behaviors or to reinforce skills practice.

DBT therapist consultations can help therapists get needed support from their peers trained in DBT, especially if treating suicidal clients. Weekly sessions can also increase motivation and adherence to DBT principles.


Numerous studies comparing DBT to traditional therapies finds: 

    • DBT is an effective BPD treatment for reducing suicidal or self-injurious behaviors, reducing hospitalizations and decreasing depression and anxiety. 
    • While most clinicians believe BPD can take several years to see enduring improvement, research suggests 4-8 months of comprehensive DBT can result in “behavioral control.” 

For adapted treatment of other behavioral disorders, there are fewer studies—most of which focused on one year or less of treatment:

    • Pilot studies indicate DBT is effective at reducing such symptoms as binge/purge episodes in bulimia and substance-use frequency. 
    • Since most adaptations are shorter than one year, this suggests improvement can be achieved more rapidly. 
    • Other conditions using DBT include suicidal and self-injurious behavior in adolescents and treatment-resistant depression.

Learn more about Evidence-Based Treatments offered at CFI…



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