Dialetical Behavior Therapy (DBT)

What is Dialetical Behavior Therapy?

Created by Dr. Marsha Linehan, Dialectical Behavior Therapy (DBT) is a type of cognitive-behavioral therapy that focuses on the psychosocial aspects of therapy, emphasizing the importance of a collaborative relationship, support for the client, and the development of skills for dealing with highly emotional situations.

DBT was created for the treatment of individuals struggling with suicidal thoughts but has matured into a treatment for a range of other conditions that involve dysfunctional emotional regulation. It is currently considered the “gold standard” for borderline personality disorder and has even been applied to the treatment of substance abuse and eating disorders (Linehan Institute, 2016).

DBT is generally characterized by its two main components:

  • Individual weekly therapy sessions;
  • Weekly group therapy sessions.


Individual Weekly TELETherapy or onsite Sessions

These individual sessions are an opportunity for the therapist and client to address the issues and solutions that came up over the last week, with special attention paid to self-destructive or potentially self-harmful behaviors. These behaviors are targeted not only because they are inherently worrisome, but also because they can seriously disrupt the treatment process and undermine treatment goals.

Clients and therapists work as a team in these individual sessions, with the focus on learning and improving social andcoping skills. They may also discuss more general issues relevant to improving the client’s quality of life, or more specific issues like post-traumatic stress disorder.


Weekly Group TeleTherapy or onsite Sessions

The weekly sessions are also intended to foster skill-building, but clients learn together with the guidance of a therapist rather than working one-on-one.

These sessions are usually scheduled for two and a half hours and generally focus on developing skills from one of four skill areas:

  1. Interpersonal effectiveness;
  2. Distress tolerance/reality acceptance skills;
  3. Emotion regulation;
  4. Mindfulness skills.


Skill Modules

These four skill modules cover a wide range of useful skills that can be applied in daily life:

1. Interpersonal Effectiveness Module

The skills in this module are related to interacting with others, especially in difficult or potentially damaging situations.

These skills are intended to help clients function effectively when trying to change something, or in trying to resist changes . The intention is to aid the client in meeting their goals in each situation while avoiding any damage to the relationship or to the client’s self-respect.

2. Distress Tolerance Module

This module includes skills that are extremely important yet often overlooked: skills relating to accepting, tolerating, and learning from suffering.

Many other mental health treatment regimens focus on avoiding pain, changing difficult situations, or walking away from circumstances that cause suffering, but the distress tolerance skills taught through Dialectical Behavior Therapy focus on dealing with the pain and suffering that is inevitable to the human condition.

The distress tolerance module is split into four crisis survival strategies:

  1. Distracting;
  2. Self-soothing;
  3. Improving the moment;
  4. Thinking of pros and cons.

In addition, there are many skills that relate to accepting and tolerating the current situation, like radical acceptance and willingness vs. willfulness.

3. Emotion Regulation Module

Many clients who participate in DBT are struggling with personality or mood disorders and can benefit immensely from emotion regulation skills.

Some of these skills that can help clients deal with their emotions include:

  1. Identifying and labeling emotions;
  2. Identifying obstacles to changing emotions;
  3. Reducing vulnerability to “emotion mind;”
  4. Increasing positive emotional events;
  5. Increasing mindfulness to current emotions;
  6. Taking the opposite action;
  7. Applying distress tolerance techniques (Psych Central, 2016).

4. Mindfulness Module

Readers of this blog are likely already aware of the numerous mindfulness-related skills that can benefit them in their daily life.

These skills include “what” skills or skills that answer the question “What do I do to practice core mindfulness skills?” like observing, describing, and participating. There are also “how” skills or skills that answer the question “How do I practice core mindfulness skills?”, like non-judgment and practicing “One-mindfully” effectively.

Many of these mindfulness skills feed into skills from the other modules; for example, the nonjudgment encouraged in mindfulness is also encouraged in distress tolerance, and the observing and describing skills can be helpful in identifying and labeling emotions.


For more information on DBT or other Texas Care treatment services, feel free to call 1-88-98TODAY and an Intake Coordinator will be happy to take your call and direct you to the appropriate department. Visit our FAQ page for more information on how Telehealth, Telemedicine, and TeleBehavioral Health can work for you.