What to Expect From Dialectical Behavior Therapy (DBT)

What to Expect in a Dialectical Behavior Therapy Program

Most outpatient DBT programs last about 6 months.⁴ Traditional DBT has 3 components:

• Group sessions
• One-on-one therapy 
• Phone consultations with your individual therapist

In a residential rehab, your DBT program may look a little different. It will probably be shorter than 6 months with more frequent meetings. But you’ll still have group sessions, and you’ll cover the same subject matter.

Group Therapy

In DBT, group therapy is an essential part of treatment. A therapist guides your group through skill-building activities in each of the 4 modules. They’ll assign homework so you can practice those skills between meetings. Then you’ll review it together during the next session.

In many outpatient DBT programs, you’ll meet with your group once a week for about 2 hours at a time. In residential rehab, you may meet more often, or even daily.

Individual Therapy

In addition to group sessions, most DBT programs include individual therapy. Your therapist might be the same person who leads the group, but not necessarily. These sessions give you more freedom to talk about yourself, instead of just the curriculum. Your counselor will help you set and meet recovery goals, and put your new skills in context.

This aspect of DBT offers short-term solutions. While group lessons equip you with important skills, it takes time to put them all together. Your therapist can get to know you as an individual, and give more specific advice to help you along the way.

Texts and Calls With Your Therapist

In traditional DBT programs, you can call or text your therapist in between sessions. When you begin treatment, the two of you will discuss specific boundaries and expectations. Some therapists are reachable 24/7, so you can always ask for help in an emergency. Others might silence their phone at night, or have you text instead of calling.

This isn’t always a part of treatment. For example, you might attend a DBT group in one therapy practice, but see another therapist somewhere else. In that case, your therapist might not offer this type of care. And if you’re in a residential rehab, you might have 24/7 access to therapy, but not always with your primary counselor.

DBT for Mental Health Recovery

DBT can treat a range of mental health conditions, both on their own and as co-occurring disorders.

Personality Disorders

The National Alliance on Mental Health (NAMI) calls DBT the “gold standard” therapy for borderline personality disorder.⁸ This treatment targets the specific symptoms of BPD, so patients can heal in a sustainable way. It also helps people with other personality disorders.

Studies show that DBT is one of the most effective personality disorder treatments.⁹ And treatment can improve these patients’ other mental health symptoms. For instance, DBT often reduces symptoms of depression in patients with personality disorders.

Depression

DBT is also a popular treatment for depression¹⁰ as a primary diagnosis. It’s especially helpful for patients with treatment-resistant depression. And studies show that DBT for depression can even be a short-term treatment.¹¹ Many patients show marked improvement after only 29 days of therapy. So even if you stop attending DBT when you leave rehab, it can still make a huge difference in your ongoing recovery.

Even if you don’t have a diagnosis of depression, research supports DBT as a treatment for suicidal ideation.¹² The practical skills you learn in therapy can help you manage crisis situations, intrusive thoughts, and the urge to self-harm.

If you or someone you know is thinking about suicide or self-harm, get help right away. Call the National Suicide Prevention Lifeline at 1-800-273-8255 for free, 24/7.

You can also learn more about supporting someone with suicidal ideation.

Trauma Recovery

Some providers offer specialized DBT to treat trauma symptoms.¹³ You might benefit from this therapy if you have post-traumatic stress disorder (PTSD), complex PTSD (c-PTSD) or a history of trauma.

The skills you’ll learn in DBT directly address some common symptoms of trauma:¹⁴

• Difficulty regulating emotions
• Trouble forming and maintaining healthy relationships
• Impulsive behavior

Research shows that DBT helps people with PTSD¹³ and c-PTSD commit to treatment, and it reliably reduces their symptoms.

Treating Addiction With DBT

DBT is a highly effective treatment for addiction.¹⁵ After Dr. Linehan developed this therapy for BPD, she noted how common it was for her patients to have addiction as well. So she and Dr. Linda Dimeff went on to design a specialized type of DBT to treat these conditions together.

While most of the research focuses on drug addiction, some studies show that DBT can also treat behavioral addictions,¹⁶ like gambling or shopping addiction. And in any DBT program, you’ll learn similar skills. But DBT specifically for addiction¹⁵ has some unique benefits:

• • Studies show that mindfulness exercises can prevent relapse.

((Priddy SE, Howard MO, Hanley AW, Riquino MR, Friberg-Felsted K, Garland EL. Mindfulness meditation in the treatment of substance use disorders and preventing future relapse: neurocognitive mechanisms and clinical implications. Subst Abuse Rehabil. 2018 Nov 16;9:103-114. doi: 10.2147/SAR.S145201. PMID: 30532612; PMCID: PMC6247953.))

• Being able to tolerate discomfort can alleviate cravings.

((Shorey RC, Gawrysiak MJ, Elmquist J, Brem M, Anderson S, Stuart GL. Experiential avoidance, distress tolerance, and substance use cravings among adults in residential treatment for substance use disorders. J Addict Dis. 2017 Jul-Sep;36(3):151-157. doi: 10.1080/10550887.2017.1302661. Epub 2017 Mar 6. PMID: 28358236; PMCID: PMC6126664.))

• Strong interpersonal relationships¹⁷ are an important part of successful addiction recovery.
• Data shows that regulating your emotions can minimize cravings¹⁸ and protect against relapse.

In most rehabs, this is just one of many approaches to treatment. So your care plan will probably include several different types of therapy. But the philosophy of DBT can be central to your long-term recovery.

Create Your Own Positive Change

DBT doesn’t “fix” your mental health. In fact, it rejects the idea that your emotions are problems for you to solve. Instead, it teaches you to validate your own feelings and center yourself in present reality—and that self-acceptance can be the foundation of your recovery.

Browse a list of rehabs with DBT to learn about their pricing, locations, housing options, and more.

Reviewed by Rajnandini Rathod

1. Chapman AL. Dialectical behavior therapy: current indications and unique elements. Psychiatry (Edgmont). 2006 Sep;3(9):62-8. PMID: 20975829; PMCID: PMC2963469. [↩]
2. Robins, Clive J. “Zen Principles and Mindfulness Practice in Dialectical Behavior Therapy.” Cognitive and Behavioral Practice, vol. 9, no. 1, Dec. 2002, pp. 50–57. ScienceDirect, https://doi.org/10.1016/S1077-7229(02)80040-2. [↩]
3. “Foundations of Dialectical Behavioral Therapy.” Wisconsin Department of Health Services. https://dhs.wisconsin.gov/non-dhs/dcts/5-nov-2020-foundations-dialectical-behavioral-therapy.pdf [↩]
4. May JM, Richardi TM, Barth KS. Dialectical behavior therapy as treatment for borderline personality disorder. Ment Health Clin. 2016 Mar 8;6(2):62-67. doi: 10.9740/mhc.2016.03.62. PMID: 29955449; PMCID: PMC6007584. [↩] [↩] [↩]
5. Görg, Nora, et al. “Trauma-Related Emotions and Radical Acceptance in Dialectical Behavior Therapy for Posttraumatic Stress Disorder after Childhood Sexual Abuse.” Borderline Personality Disorder and Emotion Dysregulation, vol. 4, no. 1, July 2017, p. 15. BioMed Central, https://doi.org/10.1186/s40479-017-0065-5. [↩]
6. Schubert, Kimberly N., “Evaluation of a Brief “Surf the Urge” Intervention” (2018). UNLV Theses,
   Dissertations, Professional Papers, and Capstones. 3382.
   https://dx.doi.org/10.34917/14139909 [↩]
7. Perepletchikova F, Axelrod SR, Kaufman J, Rounsaville BJ, Douglas-Palumberi H, Miller AL. Adapting Dialectical Behaviour Therapy for Children: Towards a New Research Agenda for Paediatric Suicidal and Non-Suicidal Self-Injurious Behaviours. Child Adolesc Ment Health. 2011 May 1;16(2):116-121. doi: 10.1111/j.1475-3588.2010.00583.x. PMID: 21643467; PMCID: PMC3105788. [↩]
8. “Treating Borderline Personality Disorder.” National Alliance on Mental Illness. https://www.nami.org/Blogs/NAMI-/resources/June-2017/Treating-Borderline-Personality-Disorder [↩]
9. Rosemery O. Nelson-Gray et. al. “Assessment and Treatment of Personality Disorders: A Behavioral Perspective.” The Behavior Analyst Today, Volume 10, Number 1. https://files.eric.ed.gov/fulltext/EJ862336.pdf [↩]
10. Harley R, Sprich S, Safren S, Jacobo M, Fava M. Adaptation of dialectical behavior therapy skills training group for treatment-resistant depression. J Nerv Ment Dis. 2008 Feb;196(2):136-43. doi: 10.1097/NMD.0b013e318162aa3f. PMID: 18277222. [↩]
11. Lothes JE, Mochrie KD, St. John J (2014) The Effects of a DBT Informed Partial Hospital Program on: Depression, Anxiety,
    Hopelessness, and Degree of Suffering. J Psychol Psychother 4: 144. doi:10.4172/2161-0487.1000144 [↩]
12. McCauley E, Berk MS, Asarnow JR, et al. Efficacy of Dialectical Behavior Therapy for Adolescents at High Risk for Suicide: A Randomized Clinical Trial. JAMA Psychiatry. 2018;75(8):777–785. doi:10.1001/jamapsychiatry.2018.1109 [↩]
13. Bohus M, Kleindienst N, Hahn C, Müller-Engelmann M, Ludäscher P, Steil R, Fydrich T, Kuehner C, Resick PA, Stiglmayr C, Schmahl C, Priebe K. Dialectical Behavior Therapy for Posttraumatic Stress Disorder (DBT-PTSD) Compared With Cognitive Processing Therapy (CPT) in Complex Presentations of PTSD in Women Survivors of Childhood Abuse: A Randomized Clinical Trial. JAMA Psychiatry. 2020 Dec 1;77(12):1235-1245. doi: 10.1001/jamapsychiatry.2020.2148. PMID: 32697288; PMCID: PMC7376475. [↩] [↩]
14. Karatzias T, Cloitre M, Maercker A, Kazlauskas E, Shevlin M, Hyland P, Bisson JI, Roberts NP, Brewin CR. PTSD and Complex PTSD: ICD-11 updates on concept and measurement in the UK, USA, Germany and Lithuania. Eur J Psychotraumatol. 2018 Jan 15;8(sup7):1418103. doi: 10.1080/20008198.2017.1418103. PMID: 29372010; PMCID: PMC5774423. [↩]
15. Dimeff LA, Linehan MM. Dialectical behavior therapy for substance abusers. Addict Sci Clin Pract. 2008 Jun;4(2):39-47. doi: 10.1151/ascp084239. PMID: 18497717; PMCID: PMC2797106. [↩] [↩]
16. “How Might Dialectical Behavior Therapy Work for Individuals with Addictive Behaviors?” Recovery Research Institute, 27 July 2020, https://www.recoveryanswers.org/research-post/dialectical-behavior-therapy-individuals-addictive-behaviors/. [↩]
17. Pettersen H, Landheim A, Skeie I, Biong S, Brodahl M, Oute J, Davidson L. How Social Relationships Influence Substance Use Disorder Recovery: A Collaborative Narrative Study. Subst Abuse. 2019 Mar 9;13:1178221819833379. doi: 10.1177/1178221819833379. PMID: 30886519; PMCID: PMC6410387. [↩]
18. Choopan H, Kalantarkousheh SM, Aazami Y, Doostian Y, Farhoudian A, Massah O. Effectiveness of Emotion Regulation Training on the Reduction of Craving in Drug Abusers. Addict Health. 2016 Apr;8(2):68-75. PMID: 27882203; PMCID: PMC5115639. [↩]