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What is Dialectical Behavior Therapy (DBT)?

By The Science of Mindfulness

Dialectical Behavior Therapy (DBT)

Dialectical Behavior Therapy, also known as DBT, is a comprehensive cognitive-behavioral treatment developed by Marsha Linehan at the University of Washington. It was first designed for chronically suicidal people with borderline personality disorder1, 2. “Dialectical” refers to the balance at the heart of the approach: accepting people and their experiences as they are, while also working toward change. DBT is better described as mindfulness-informed than purely mindfulness-based, because mindfulness is one of several skill sets within a larger treatment, but it is one of the most widely used therapies to place mindfulness at its core.

Course Format: Standard DBT has four components: weekly individual therapy, group skills training, telephone coaching between sessions, and a consultation team that supports the therapists3. The skills curriculum covers four modules: mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness4. Mindfulness is taught first and revisited throughout. “What” skills (observing, describing, participating) teach people what to do, and “how” skills (non-judgmentally, one-mindfully, effectively) teach how to do it. Clinical trials of standard DBT have typically involved one year of treatment5.

Instructor Requirements: DBT is delivered by mental health professionals who complete intensive training and usually work in a consultation team. Training programs, including the Linehan Institute’s DBT training, teach clinicians both the skills curriculum and the suicide risk assessment and management protocol used in the research trials.

Course Outcomes: In a two-year randomized trial of 101 women with recent suicidal and self-injurious behavior, DBT was compared with one year of community treatment by experts. Women who received DBT were half as likely to make a suicide attempt (hazard ratio 2.66), required less hospitalization for suicidal thinking, had fewer psychiatric hospitalizations and emergency department visits, and were less likely to drop out of treatment5.

A later trial of 99 women with borderline personality disorder compared standard DBT with skills training plus case management and with DBT individual therapy plus an activities group. All three conditions led to similar improvements in suicide attempts and suicidal thinking. Conditions that included skills training produced greater improvement in the frequency of non-suicidal self-injury and in depression than individual therapy without skills training, and standard DBT had a lower dropout rate than the individual-therapy-only condition (24% versus 48%)3. A meta-analysis of 16 studies, eight of them randomized trials, found moderate effects on global outcomes and on suicidal and self-injurious behavior, with a small decline between the end of treatment and follow-up6.

Clinical Populations: DBT has its strongest evidence in adults with borderline personality disorder and recent suicidal or self-injurious behavior, and it has since been adapted for other problems involving difficulty regulating emotion. Because standard DBT involves several components and a trained team, access can be limited; skills-only formats are also widely used.

Learn More: The Linehan Institute lists official DBT training. For a mindfulness program built specifically for depression relapse, see Mindfulness-Based Cognitive Therapy (MBCT).

This page is for general education and is not medical advice. Please speak with a qualified health professional about treatment options.

References

  1. Linehan, M. M. (1991). Cognitive-Behavioral Treatment of Chronically Parasuicidal Borderline Patients. Archives of General Psychiatry, 48(12), 1060. https://doi.org/10.1001/archpsyc.1991.01810360024003
  2. Linehan, M. M. (1993). Cognitive-behavioral treatment of borderline personality disorder. Guilford Press.
  3. Linehan, M. M., Korslund, K. E., Harned, M. S., Gallop, R. J., Lungu, A., Neacsiu, A. D., McDavid, J., Comtois, K. A., & Murray-Gregory, A. M. (2015). Dialectical Behavior Therapy for High Suicide Risk in Individuals With Borderline Personality Disorder. JAMA Psychiatry, 72(5), 475. https://doi.org/10.1001/jamapsychiatry.2014.3039
  4. Linehan, M. M. (2015). DBT skills training manual (2nd ed.). Guilford Press.
  5. Linehan, M. M., Comtois, K. A., Murray, A. M., Brown, M. Z., Gallop, R. J., Heard, H. L., Korslund, K. E., Tutek, D. A., Reynolds, S. K., & Lindenboim, N. (2006). Two-Year Randomized Controlled Trial and Follow-up of Dialectical Behavior Therapy vs Therapy by Experts for Suicidal Behaviors and Borderline Personality Disorder. Archives of General Psychiatry, 63(7), 757. https://doi.org/10.1001/archpsyc.63.7.757
  6. Kliem, S., Kröger, C., & Kosfelder, J. (2010). Dialectical behavior therapy for borderline personality disorder: A meta-analysis using mixed-effects modeling. Journal of Consulting and Clinical Psychology, 78(6), 936-951. https://doi.org/10.1037/a0021015

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