DBT Explained

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If you’ve been referred to Woodview Psychology Group for DBT, chances are you will speak with me when you call. Like many of the people I speak with on the phone and in formal intake sessions, you may be wondering, “what exactly IS this DBT?” If you Google “DBT,” you might be met with a variety of articles bogged down with clinical terminology, a Wikipedia page, and maybe a few pictures of Marsha Linehan, the founder of DBT.

Many of our clients have tried therapies that work for other people, but not them. Being met with a bunch of medical jargon is usually not very comforting to stressed, discouraged patients. In this article, I will aim to summarize what DBT is, and why this therapy approach offers hope to many who may be feeling hopeless.

What is DBT?

DBT stands for Dialectical Behavior Therapy. It is an evidence-based treatment (meaning that its effectiveness is supported by research) developed by Marsha M. Linehan (Ph.D., ABPP). “Dialectical philosophy” is the theoretical basis of the theory, which is about finding a way to reconcile, or synthesize, two seemingly opposite ideas. DBT’s goals include: increase patients’ skillful behavior (and with it, improve their functioning), improve patient motivation for treatment and change, generalize change to all aspects of patients’ lives (that is, see that change happens at other places, like at home or at work or school, not just within therapy), and support changes in patient environments to support patient growth (such as by working with parents, teachers, or other providers, with patient authorization). All of this is done with the intent of helping the patient build a “life worth living,” a common phrase in DBT used to describe building a life that the patient truly wants to live. Comprehensive and adherent DBT includes individual therapy once per week, skills training group therapy once per week, and phone coaching with your individual therapist (where you can contact your therapist outside of sessions to support generalizing your growth to other contexts). It also means that your DBT therapist has a consultation team of other DBT therapists. This means that your therapist seeks advice and support from other DBT therapists to ensure that they are providing you with the best care that they can. Often, these other therapists are providers within your therapist’s practice. If they are outside providers, your therapist should discuss this with you.

I’ve heard of CBT; is it like that?

Somewhat! CBT stands for Cognitive Behavioral Therapy, a common evidence-based treatment for a variety of diagnoses. DBT was developed using CBT as a springboard, after Linehan noticed that CBT tended to be ineffective for patients with a diagnosis of borderline personality disorder. One of the primary differences between these treatments is that DBT is about teaching someone how to effectively regulate and tolerate their emotions, going beyond identifying what to do.

What do DBT sessions look like?

DBT is something known as a “manualized therapy.” Much like what it sounds like, DBT has treatment manuals that clearly outline what therapists need to do during sessions. As a result, this therapy tends to be structured; you’ll know what you’ll be discussing most sessions. You can expect your therapist to spend much of your early sessions getting to know you, building trust between the two of you, learning more about your strengths and the challenges you face, and learning about what your goals are. As treatment progresses, you can expect your individual therapist to increasingly provide you with things to practice or handouts to complete outside of session (such as a Diary Card, used to track things such as your emotions, urges, and behaviors). Once you start skills group, your individual therapist will also help answer any questions you have about the skills you are learning and help you find ways to use those skills in your own unique circumstances. You can expect to discuss your diary card with your individual therapist who will help you identify things that went well (and reinforce those behaviors), as well as identify challenges you may have faced (and assist you in finding ways to work through similar situations in the future).

For skills group, you can expect to attend sessions led by one or two counselors or psychologists who will teach you skills, usually 1 or 2 skills per session, to support your growth. They will discuss what the skill is, what it is used for, why it is effective, and will find a way to practice the skill as a group. They will also provide you with a take-home activity to help you practice the skill in your day-to-day life, which they will follow up on at the next session. These skills are used to practice mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness.

Wait, GROUP therapy is involved??

Yes, although it is likely much different than what you might be expecting! Group therapy in DBT is about skills building. As such, it is structured similarly to how a class might be structured. Rather than group members sharing freely, participants are prompted to share specific experiences. Group leaders (the counselors and/or psychologists running the group) teach the skills, practice the skills with the participants, and answer questions about the skills from participants. You won’t be asked to share details about your experiences; just enough general information for the group leader to understand how you applied a skill, or what challenges you faced to applying a skill. Details are usually discussed with your individual therapist. Additionally, group members are asked to not share information that could be triggering for other group members; for example, details of self-harm are best discussed in individual therapy.

Why should I believe that DBT will be helpful?

Fair question! If you haven’t found past therapy helpful, you might be skeptical that DBT will be any different. Although no treatment can guarantee 100% improvement, you can rest assured that DBT has several years of research supporting its effectiveness. DBT was first tested in 1991 with a randomized controlled trial. This is a type of research trial where participants in the research are randomly assigned to receive either the treatment being researched or a different treatment or placebo for comparison. Additionally, researchers keep other factors consistent between groups so that they can be confident that any differences in outcome are due to the treatment, rather than other factors (such as the skill of the treatment provider or the time the treatment was given). This research in 1991 supported DBT as an effective treatment for chronic suicidality and self-harm in women with diagnoses of borderline personality disorder. Since then, many other research studies have further supported the efficacy of DBT for many different diagnoses and concerns, including major depressive disorder (including treatment resistant depression), PTSD related to childhood sexual abuse, suicidality and self-harm in adolescents, and bipolar disorder, to name a few. It has also been found to be effective for people from many different backgrounds, including children, adolescents, young adults, and adults; straight, lesbian, gay, and bisexual people; and Hispanic/Latinx, Black, multi-racial, White, American Indian, and Alaska Native people. DBT has also been researched in many different parts of the world, including the United States, Australia, Canada, Germany, Spain, Sweden, and the United Kingdom, to name a few. No need to just take my word for it though! Behavioral Tech institute, which supports the training of DBT clinicians, has archived many research articles about DBT, which you can view here: https://behavioraltech.org/evidence/

Is there a difference between “DBT informed” and “comprehensive and adherent DBT”?

Yes, there is a difference! “DBT informed” typically means that someone is incorporating elements of DBT into their clinical work. Typically, someone using a DBT-informed approach has studied some DBT, and aspects of DBT are combined with another type of therapy or are added to another theoretical framework. For example, someone might include some DBT skills training in their Rogerian/person-centered therapy approach. Some patients may find this helpful, though it is different from how DBT was designed to be used. Research about DBT does not necessarily generalize to this type of use, because the therapy is in this case being conducted differently than how it was conducted during the research. “Comprehensive and adherent DBT” is when DBT is conducted in accordance with the DBT treatment manuals. This means that the work that the therapist is doing is supported by DBT research (individual DBT therapy, group skills training, and phone coaching). It also means that your therapist has a DBT treatment team that they consult with to make sure that they are providing you with the best care that they can.

What’s the difference between standard DBT and RO DBT?

Before we get too far into this question, it’s important to know that deciding what type of DBT is best for you is largely your provider’s job. If you’re stressed about choosing what type of DBT might be best for you, rest assured that a well-trained DBT provider wil ask questions and administer assessments to get the information needed to make that decision. Still, you might be curious about these different types of DBT.

For a bit of background information, we’ll start by discussing self-control. Self-control refers to how much control a person has over their emotions, thoughts, and behaviors when faced with urges. Commonly, people focus on situations where they would have liked to have had more self-control, such as a time they lost their temper and snapped at a friend, or kept eating even when they weren’t hungry and ended up feeling sick. Sometimes though, we have more self-control than is helpful for us. Maybe instead of lashing out at a friend when we’re upset with them, we don’t speak with them at all about it, leaving the conflict unaddressed, and cut them off as a friend. Or maybe we restrain ourselves from eating at all, even when we need to eat and we are hungry.

Standard DBT focuses on supporting people in building more self-control. Often, people who would benefit from support building self-control are highly impulsive and struggle to regulate their emotions (for example, when they feel an emotion, they feel it so strongly it is overwhelming).
RO DBT (or radically open DBT) focuses on managing an excess of self-control by supporting people’s openness to new experiences. Often, people who would benefit from this treatment are socially isolated, and highly anxious about interpersonal situations.

Wondering if DBT is the treatment for you? Have more questions about DBT before you make your decision? Woodview Psychology Group offers comprehensive and adherent standard DBT, as well as RO DBT services. We invite you to reach out to ask any questions you have or to ask about receiving treatment here at Woodview! You can contact Woodview at 317-573-0149, or view our Contact Us page for more information.

Anya Polito, M.A.
Counselor at Woodview Psychology Group