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What is Dialectical Behavior Therapy

August 13, 2020
All Points North Lodge

The following information was sourced by APN Lodge from Marsha Linehan's website for Behavioral Tech, with help from Eva Goode, Primary Therapist at APN Lodge

What is Dialectical Behavior Therapy?

Dialectical behavior therapy is a specialized therapeutic modality developed by Marsha Linehan, Ph.D., ABPP in the 1980s as an approach to treatment for patients with borderline personality disorder. Since then, Dialectical Behavior Therapy has become a valuable specialty therapy for patients with a variety of mental health diagnoses or even just emotional struggle.

The word “dialectical” refers to two opposing forces, according to Linehan Institute-trained DBT clinician Eva Goode (Primary Therapist at All Points North Lodge). The idea behind Dialectical Behavior Therapy is that in many cases, two opposing forces or opposing ideas can be true at the same time. In her February 2020 interview with Good Morning Vail, Eva gave this example:

“A lot of us are skiers, right? We may come upon a big cliff and want to ski off of it because it would be really exciting and fun. And we could be terrified at the same time. Those two opposing forces can be true at the same time.”

She adds, “Being able to hold those two truths at the same time can bring a lot of inner peace. Then I don’t have to judge myself for feeling terrified while I also have a lot of excitement.”

As a modality, Dialectical Behavior Therapy hinges on the idea that dysfunction and problematic behavior often are caused by a lack of skills. These skills fall into two major categories: acceptance and change. These seemingly opposite categories are both equally important and exist best when hand-in-hand. Under the two categories lie four specific skills - which form the four modules or main principles of DBT skills groups:

  1. Mindfulness
  2. Emotion Regulation
  3. Distress Tolerance
  4. Interpersonal Effectiveness

These four modules exist to teach, build, and practice acceptance and change skills in order to equip clients to live better and more satisfied lives - whether they have a clinical diagnosis or not.

What are the Modes of Dialectical Behavior Therapy?

According to the website of Behavioral Tech (Marsha Linehan’s training institute), there are four main modes of Dialectical Behavior Therapy:

  1. Individual Psychotherapy
  2. DBT Skills Training
  3. In the Moment Phone Coaching
  4. DBT Consultation Teams for Therapists

Eva emphasizes that Dialectical Behavior Therapy can be utilized in both one-on-one therapy with an official DBT therapist AND in skills groups that function much like a college class. These are sometimes referred to as Standard Dialectical Behavior Therapy and Skills-Only Dialectical Behavior Therapy. Both formats can be useful in-person or via telehealth platforms. In-person meetings with a therapist are not essential for the progress that can be made with Dialectical Behavior Therapy, though for some people, in-person work may feel more personal or comfortable.

The Origin of Dialectical Behavior Therapy

Dialectical Behavior Therapy was originally developed by Linehan to treat borderline personality disorder. However, it became clear that the principals and modules utilized in DBT could be helpful for a much wider range of clients.

According to Behavioral Tech, the research on Dialectical Behavior Therapy began in 1991 when DBT was shown in a randomized controlled trial to significantly benefit a group of women with borderline personality disorder who were struggling with chronic suicidal ideation and self-harm.

Since that first study, many subsequent trials, implementation studies, mechanism of action evaluations, meta-analyses, and systematic reviews have been carried out and published.

After the development and widespread adoption of Dialectical Behavior Therapy, Marsha Linehan founded the DBT-Linehan Board of Certification in order to offer certification for providers who have been both trained and tested in the knowledge and offering of Dialectical Behavior Therapy in their practices.

Who is Dialectical Behavior Therapy Good For?

Eva Goode says Dialectical Behavior Therapy can be extremely useful for anyone who struggles to regulate their emotions or tends toward avoidance behaviors. These avoidance behaviors may include coping through the use of alcohol, drugs, or any other addiction. Based on randomized controlled trials, Dialectical Behavior Therapy has been shown to be effective in the treatment of at least twelve different mental health issues and conditions - including major depression, ADHD, bipolar, bulimia nervosa, childhood trauma-related PTSD, and more. Studies have also shown that DBT can be effective across a variety of ages, sexual orientations, races and ethnicities, genders, and even cultures and country residences.

How Does Dialectical Behavior Therapy Fit into Trauma Therapy at APN Lodge?

At All Points North Lodge, trauma is a key component of nearly every treatment plan. In alignment with Marsha Linehan, we believe that dysfunctional behaviors can nearly always be resolved. Though genetic, biological, and environmental factors certainly play a roll in addiction and mental health, the struggle and manifestation of these issues is often tied to some kind of past trauma.

For clients with obvious past trauma and clients without, we utilize Dialectical Behavior Therapy as one of many therapeutic modalities from which clinicians may pull for a custom-curated treatment plan for each individual client.

Dialectical Behavior Therapy is a great fit for some clients but may not be right for others. DBT therapists may work with clients individually or in Skills Groups as a part of their larger treatment plan. DBT Skills Groups also run periodically for telehealth clients of All Points North Lodge.

References & Resources

  1. https://behavioraltech.org/resources/faqs/dialectical-behavior-therapy-dbt/
  2. https://behavioraltech.org/

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