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What is Dialectical Behavioral Therapy?

Dialectical Behavioral Therapy, or DBT, is a form of Cognitive Behavioral Therapy, or CBT, that was originally developed to treat borderline personality disorder. It has since been shown to be effective for other issues, including addiction, depression, eating disorders, self-harm, and PTSD.

Like regular CBT, DBT helps you identify distorted belief patterns and adopt healthier beliefs. For example, if you believe something like “I must do everything perfectly or it will be awful,” you are likely to be frequently angry and disappointed. Identifying that belief and replacing it with something more realistic like “I would like to do things well, but it’s not a disaster if something goes wrong,” makes you both happier and more productive.

The main difference between CBT and DBT is that CBT focuses on strategies for behavioral change, while DBT places greater emphasis on acceptance and emotional regulation. Borderline personality disorder is characterized by volatile emotions, so DBT was developed with emotional regulation and relationship skills in mind.

DBT typically comprises both individual and group therapy. Usually, you’ll start working with a therapist individually. The therapist will assess your needs and you will begin learning new skills and working through specific problems you encountered during the week. Groups are led by trained therapists who teach skills and lead group exercises. Group members help each other learn and practice new skills. There is often homework at the end of a session where you continue developing skills on your own. Sessions typically last about two hours and groups typically last about six months.

The skills you will develop in DBT fall broadly into four categories: Mindfulness, distress tolerance, emotional regulation, and interpersonal effectiveness. Mindfulness techniques will help you learn to accept whatever is happening in the present moment. Distress tolerance is closely related to mindfulness and means learning to be with difficult emotions rather than trying to escape them or push them away. This is especially important for people recovering from addiction because difficult emotions, stress, and cravings are common triggers for relapse.

Emotional regulation helps you understand why you feel what you do and teaches you strategies for improving your emotional state, using strategies such as labeling emotions and increasing positive emotions. Finally, interpersonal effectiveness teaches you how to relate to others in a balanced way so you’re assertive enough to get what you need, but not aggressive or combative. The group setting is particularly important for practicing  interpersonal effectiveness, since many people already have decent interpersonal skills, but have trouble using them in specific situations.

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