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Learn / What to Expect From Dialectical Behavior Therapy (DBT)

What to Expect From Dialectical Behavior Therapy (DBT)

By 
Hannah Friedman
|
 March 8th, 2023|   Clinically Reviewed by 
Rajnandini Rathod

When you find the right type of therapy for you, it can change your life. And if you’re considering rehab, you might already know what you need to be different.

Dialectical behavior therapy (DBT) can help you make those changes. But here’s the thing: it won’t change who you are.

Rehab programs with DBT address the patterns that keep you from living your best life. They do that by validating your feelings, without trying to change them. And when you learn to accept yourself, just as you are, you can let go of behaviors that aren’t serving you.

What Is Dialectical Behavior Therapy?

Dialectical behavior therapy (DBT) is an evidence-based treatment.1 It was originally developed by Dr. Marsha Linehan to treat patients with borderline personality disorder (BPD). Today, therapists use it for a much wider variety of mental health issues, including addiction.

DBT incorporates some tenets of Zen Buddhism2 and has a strong focus on mindfulness. This treatment differs from other popular therapies, like cognitive behavioral therapy (CBT), in a few ways. For one, DBT encourages you to accept your feelings3 instead of challenging them. A cognitive behavioral therapist might have you question negative thought patterns, reasoning your way out of them. But in DBT, you’ll validate your own emotions—even painful ones. Group therapy is also a key element of DBT.

The idea of a dialectic, or discussion, is central to this treatment.4 Patients learn to embrace seemingly opposite ideas at the same time. For instance, your therapist might tell you that you are doing your best, and you can do better. DBT teaches you to accept both of these ideas as equally true, and equally important. And you can apply that skill to other parts of your recovery. So if you’re healing from addiction, for example, you might accept that you can have cravings, and choose not to drink or take drugs.

The 4 Modules of DBT: What You’ll Learn in Session

DBT might feel more like a class4 than traditional talk therapy. Patients work from a textbook, discuss new ideas with a group, and even do homework assignments. During treatment, you’ll progress through 4 separate modules. All of them are related, but each one focuses on a specific topic.

Mindfulness

Mindfulness is a central theme in DBT. The lessons in this module can help you focus on the here and now. This empowers patients to avoid negative thought spirals. And when you’re grounded in the present moment, you can take action that aligns with your recovery goals.

Emotion Regulation

Many people try to minimize difficult feelings, like shame and grief. And in one sense, that’s normal. Avoiding pain is a survival strategy. But when it comes to your mental health, avoidance isn’t sustainable. And it can lead directly to addiction.

In this module of DBT, you’ll first learn how to identify your emotions. Just naming them can help you accept what you feel, without judgment. And when you consistently validate your own feelings, they naturally become more manageable. For a lot of patients, this approach is even more effective than resisting an emotion.

Interpersonal Effectiveness

This module teaches you how to build strong relationships. Patients learn specific, practical skills to help with that:

  • Identifying and articulating your own needs
  • Setting and maintaining healthy boundaries
  • Handling disagreements calmly
  • Balancing your needs with someone else’s

You’ll practice these skills within the group and in between sessions. You might even roleplay certain scenarios in therapy. In that case your therapist will give you direct feedback, suggesting ways to improve.

Distress Tolerance

Much as you might want to avoid it, pain is an inevitable part of life. DBT doesn’t change that. Instead, it gives you the tools to work through stress. These strategies are clear and simple, so it’s easy to recall them when you’re under stress:

  • Radical acceptance5 teaches you to identify and sit with painful feelings, without trying to change them in any way.
  • Urge surfing6 can be especially helpful during addiction recovery. You can use it when you experience an urge that could be harmful, like a drug craving. Instead of acting on that desire, you’ll just observe it. Most urges grow, crest, and then subside, like ocean waves.
  • Self-soothing skills7 engage the 5 senses. You might touch a soft blanket, drink a cup of tea, or light a scented candle. Activities like these can help you stay calm.

The skills you learn in DBT won’t make your problems disappear. But they can keep you centered, making it easier to face life’s challenges.

What to Expect in a Dialectical Behavior Therapy Program

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

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:

((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.))

((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.))

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

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  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. []
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  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. [] []
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  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/. []
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