Originally developed in the late 1980s by psychologist Marsha M. Linehan to treat borderline personality disorder, dialectical behavioral therapy (DBT) is a type of cognitive behavioral therapy. The term “dialectical” expresses a reconciliation or combination of two opposing forces or ideas. Most of the term is used in philosophy or theology. However, in this case, techniques of dialectical behavioral therapy seek to bring both “acceptance” and “change” together. In this way, the two brought together yield better results than either one on their own.
Although DBT is a type of cognitive behavioral therapy, there remains key differences between the two. Furthermore, since it’s still relatively novel, DBT has not come without its fair share of criticism.
Techniques of Dialectical Behavioral Therapy
The goals of dialectical behavioral therapy determine its techniques. So, the goal of DBT is to build therapeutic skills in four essential areas:
- Distress tolerance
- Emotion regulation
- Interpersonal effectiveness
Why does DBT identify these four areas? Because it theorizes that some people with certain mental health disorders often react more intensely and out-of-the-ordinary manner when experiencing certain emotional situations. Especially those in romantic, peer, and familial relationships. These people often encounter a faster rate of arousal levels, a higher and more sustained level of distress, and also take a longer time to return to baseline emotional levels. These four areas specifically address these experiences and what to do about them.
Mindfulness revolves around building one’s ability to practice radical acceptance; that is, to accept the situation and be present. Distress tolerance addresses the tendency to run from negative emotion, and instead helps the person deal with a greater degree of negative emotion. Emotional regulation seeks to develop strategies to manage and alter specifically problematic emotions that often rise up. Interpersonal effectiveness strives to establish techniques that allow the person to communicate with others in direct, respectful, assertive (as opposed to passive-aggressive), and mutually strengthening ways.
Through these techniques in dialectical behavioral therapy, people can learn to:
- Properly identify and label emotions
- Increase mindfulness to current emotions
- Take opposite action
- Apply distress tolerance techniques
- Identify obstacles to changing emotions
- Reduce vulnerability to “emotion mind”
- Increase positive emotional events
DBT helps people see things in a both-and rather than simply an either-or way.
Acronyms of DBT
Along with the techniques mentioned above, it’s important to become familiar with the acronyms used in treatment. For example, when it comes to working on distress tolerance, clients are taught to distract themselves temporarily from negative emotions using the acronym ACCEPTS.
- Activities – Do a positive activity you enjoy.
- Contribute – Help someone else or serve in your community.
- Comparisons – Compare yourself either to less fortunate people or to how you used to be at an earlier stage.
- Emotions (other) – bring yourself to a different emotional state by provoking your sense of humor or happiness with like activities.
- Push away – Put your situation in back of your mind for some time and put something else first in your mind.
- Thoughts (other) – Force your mind to think about something else.
- Sensations (other) – Do something that brings an intense feeling other than what you are feeling, like exercising or eating spicy food.
Another acronym in this area is called “IMPROVE the moment.” People will use this acronym to help them relax.
- Imagery – Imagine something relaxing, things going well, or other pleasing things.
- Meaning – Find some purpose or meaning in the feeling.
- Prayer – Either pray to whomever you worship, meditate, or chant a personal mantra.
- Relaxation – Relax your muscles and breathe deeply.
- One thing in the moment – Focus your entire attention on what you are doing right now.
- Vacation (brief) – Take a break from everything for a short time.
- Encouragement – Tell yourself something encouraging.
Professionals use many other acronyms in their DBT techniques, such as PLEASE, DEAR MAN, GIVE, FAST, and others. You can read more about them here.
The Difference Between Dialectical Behavioral Therapy and Cognitive Behavioral Therapy
What’s the difference between DBT and CBT? As we mentioned above, DBT is a form of CBT. The two aren’t mutually exclusive. Some differences do apply, however, these differences are more a matter of emphases than true differences. For example, DBT typically involves:
- Group support: While CBT usually focuses on 1-to-1 treatment between a client and a therapist, DBT also involves concentrated group therapy. It’s rare to receive DBT treatment without group therapy.
- More skill development: Obviously CBT involves building therapeutic skills that the person can use after treatment. However, DBT has a particular emphasis on this.
- Collaboration: Just like group support mentioned above, DBT tends to be bring more people into the picture. It requires constant attention to relationships between clients and staff. DBT techniques encourages people to work through problems in their relationships with their therapist and the therapists to do the same with them. This is why group therapy is so necessary. DBT also involves homework assignments, to role-play new ways of interacting with others, and to practice skills such as soothing yourself when upset.
The differences between dialectical behavioral therapy and cognitive behavioral therapy lie mostly in emphasis. While CBT inclines itself more to 1:1 treatment, DBT brings a strong emphasis on group work.
Criticisms of Dialectical Behavioral Therapy
Although DBT has proven effectiveness, some have criticized it. Some of these include:
- A great deal of training is required to successfully use it. In a lot of the research studies that demonstrate DBT’s effectiveness, doctoral and post-doc professionals were conducting the treatments. Hence, expanding and perhaps even simplifying the necessary training will be useful in the future.
- In some of the same studies mentioned, they did not cover the long-term, post-treatment effectiveness of DBT. Considering DBT specifically treats chronic conditions, proving its long-term effectiveness is invaluable. Note, this does not mean DBT isn’t effective in the long run; only that this has yet to be fully proven.
- To conclude, most of the research on DBT’s effectiveness included small sample sizes. Some critics argue more research needs to be done to determine if DBT works well for those with varied or complex mental health concerns.
If you’d like to learn more about DBT techniques, the differences between DBT and CBT, criticisms of DBT, or just DBT in general, scores of resources are available. You can check out Mindfulness for Borderline Personality Disorder, interviews with Marsha Linehan on borderlinernotes, or the popular-level book I Hate You – Don’t Leave Me by Jerold J. Kreisman.
Master of Divinity (M.Div.) | Westminster Theological Seminary (2020 Graduation)
Bachelor’s of Social Work, Bachelor of Science (B.S.), Bible | Cairn University
More Articles of Interest: