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What Is DBT?

Aug 27, 2024

When individuals seek mental health treatment, they will come across the terms cognitive behavior therapy (CBT) and dialectical behavior therapy (DBT). While both of these can succeed in helping patients, they have fundamental differences.

In this blog, we’ll focus on the differences between the two and how DBT extends well beyond the focus of CBT. We’ll identify how DBT can be helpful for those struggling with a number of mental health diagnoses and those who would benefit from learning coping skills for everyday life stressors.

Dialectical Behavior Therapy (DBT) and Cognitive Behavioral Therapy (CBT) are both evidence-based approaches to psychotherapy. Still, they have distinct differences in focus and methodology. Here’s a breakdown of how they differ:

Focus and Philosophy

• CBT: Focuses on identifying and changing negative thought patterns and behaviors. The core idea is that thoughts influence feelings and behaviors. By changing maladaptive thoughts, individuals can improve their emotional well-being and behaviors.
• DBT: Builds on CBT principles but specifically focuses on dialectics—balancing acceptance and change. It acknowledges that individuals can simultaneously accept themselves as they are while also striving to change problematic behaviors. DBT strongly emphasizes emotional regulation, interpersonal effectiveness, and mindfulness.

Target Population

• CBT: Used for a broad range of psychological disorders, including depression, anxiety, and various other mental health issues. It is generally applicable to many different conditions.
• DBT: Initially developed for individuals with Borderline Personality Disorder (BPD), especially those with self-harming behaviors and emotional dysregulation. DBT is also used for other conditions, including mood disorders, PTSD, and substance abuse, mainly when emotional regulation is a significant issue.

Therapy Components

• CBT: Typically involves individual therapy sessions where clients work on cognitive restructuring and behavior change. It may also include some form of behavioral experiments or homework assignments.
• DBT: Includes individual therapy, group skills training, and sometimes phone coaching to help clients apply skills in real-life situations. The therapy is structured around four key skill areas: mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness.

Emphasis on Validation

• CBT: Focuses on challenging and changing dysfunctional thoughts and behaviors, with less emphasis on validating the individual’s experience.
• DBT: Places a strong emphasis on validating the client’s feelings and experiences while simultaneously working on changing harmful behaviors. This validation is crucial for building a therapeutic relationship and enhancing self-acceptance.

Treatment Structure

• CBT: Often involves a more straightforward approach focusing on specific problems and cognitive restructuring.
• DBT: Has a more comprehensive structure, including weekly individual therapy, weekly group skills training, and availability of phone coaching. The structure is designed to provide continuous support and skill reinforcement.

In summary, while DBT and CBT share some foundational principles, DBT extends CBT’s framework by incorporating dialectical principles, a focus on validation, and a more structured approach to skills training and support.

How Does DBT Work?

In most cases, DBT is conducted in a group setting. A therapist leads the session and guides the participants through the various skills paramount in DBT, including mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness. DBT also includes diary cards to track symptoms and behavior chain analyses to increase awareness of behaviors and problem-solving barriers to skill use. 

There are many essential functions of DBT, including:

• Improve clients’ motivation for change
• Enhance clients’ capabilities
• Help clients generalize skills/behaviors to their natural environments
• Structure the treatment/program and environment

In addition to group sessions, individuals typically meet with an individual therapist.

At MHS, we offer specialized DBT programs for adults, adolescents, health care providers, and those struggling with addictions (adults and teens) and developmental disorders.

What Are the DBT Skills?

DBT is a skills-based treatment modality. DBT skills provide a common language for effective behaviors and help clients label, remember, and use adaptive behaviors. These skills teach individuals new behaviors. Therapists can refer to DBT language to help clients through an issue and reinforce skill use.

DBT teaches the skills of mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness.

Mindfulness

When individuals achieve mindfulness, they can experience:

• Feelings, thoughts/beliefs, and behavior being noticed and respected
• Awareness of environmental information and cues
• Decreased impulsive behavior
• Decreased passive and “stuck” behavior
• Increased emotion regulation and decreased (ineffective) mood congruent behavior
• Improved connection to experience, enjoyment, and peace

Distress Tolerance

When an individual achieves effective distress tolerance, they will be able to experience less emotion-based coping, have fewer impulsive behaviors, and have fewer self-injury urges, suicidal urges, and chronic distress avoidance.

 Effective distress tolerance skills teach:

• Ability to tolerate painful emotion
• Distraction without avoiding
• Paths to other skills
• Action instead of reaction
• Managing a crisis without making it worse

Emotion Regulation

When individuals can effectively control their emotions, they will experience many positives, including a greater understanding of how emotions work, decreased emotional vulnerability, more balanced emotions, and overall greater effectiveness.

When they master these skills, they will be able to:

• Engage in activities of daily living
• Accomplish tasks that need to be done
• Take steps toward a challenging goal
• Build a sense of control, confidence, and competence
• Give themselves credit

Interpersonal Effectiveness

The fourth skill is interpersonal effectiveness. When they achieve effective interpersonal skills, individuals will be more able to meet wants and needs, set effective boundaries, say no, make and maintain positive relationships, and build self-respect because their interactions are grounded in values.

How to Start DBT

When individuals are ready to start DBT, they can contact MHS. We have five clinics throughout the Twin Cities and offer virtual services. For intakes or questions, call us at 952-835-2002.