Dialectical Behavioral

Therapy
- By Pavitra Somaiya
What is DBT?
Dialectical Behavior Therapy (DBT) is a type of cognitive-behavioral therapy (CBT) developed by psychologist Marsha Linehan in
the late 1980s. Originally created to treat individuals with borderline personality disorder (BPD), DBT has since been adapted to
treat a range of mental health conditions, including depression, anxiety, post-traumatic stress disorder (PTSD), eating disorders, and
substance use disorders.

The core principle of DBT is the dialectical concept, which means the therapist helps clients accept the inherent contradictions within
themselves, such as the simultaneous need for change and acceptance. DBT combines two key aspects:

1. Acceptance: Helping individuals accept themselves and their circumstances without judgment. This is achieved through
mindfulness and validation, allowing clients to recognize their feelings and experiences as valid, while not allowing them to be
overwhelmed by them.
2. Change: Encouraging individuals to change unhelpful behaviors and thought patterns that may be contributing to emotional
distress. This is done through skill-building in areas such as emotional regulation, interpersonal effectiveness, distress
tolerance, and mindfulness.
When to use DBT?
1. Borderline Personality Disorder (BPD)

● Core Application: DBT was specifically designed for people with BPD, a condition characterized by emotional dysregulation,
impulsive behaviors, unstable relationships, and a fragile sense of self.
● When to Use: If someone is struggling with intense mood swings, self-harming behaviors, frequent suicidal ideation, or difficulty
in maintaining stable relationships, DBT can help. The therapy targets these core symptoms, improving emotional regulation
and interpersonal functioning.

Emotion Regulation Disorders

● Unstable Emotions: DBT is highly effective for people who have trouble managing intense emotions like anger, sadness, or
anxiety, which can overwhelm them and lead to destructive behavior (e.g., substance abuse, interpersonal conflicts).
● When to Use: If an individual has difficulty tolerating distress or experiences extreme emotional shifts (e.g., going from calm to
rage), DBT can help regulate these intense emotions and teach more adaptive ways to respond.
Eating Disorders (e.g., Binge Eating Disorder, Bulimia Nervosa)

● Emotionally Driven Behaviors: DBT is effective for treating eating disorders, especially those where emotional distress or
impulsivity plays a significant role in unhealthy eating behaviors.
● When to Use: DBT is often used for binge eating disorder or bulimia, where individuals struggle with emotional eating,
self-image issues, and distorted eating patterns. DBT helps reduce these behaviors and teach clients healthier coping
strategies.

Substance Use Disorders

● Addiction and Emotional Dysregulation: DBT is also used to treat substance use disorders, particularly when the individual
struggles with impulsive behavior or uses substances to manage emotions.
● When to Use: If a person with substance use disorder also exhibits emotional instability, impulsivity, or chronic feelings of
emptiness or anger, DBT helps address these emotional triggers and provide tools for better impulse control and distress
tolerance
Efficiency of DBT in Counseling
DBT has proven to be particularly effective in treating individuals with borderline
personality disorder (BPD), especially those struggling with self-harming behaviors,
suicidal thoughts, and emotional dysregulation. Research has shown that DBT can
significantly reduce these behaviors and improve overall emotional functioning.
Additionally, DBT has been successfully applied to treat other conditions, such as
substance use disorders, eating disorders, and depression.
Know the Right Time to use DBT
The right time to use Dialectical Behavior Therapy (DBT) is when an individual struggles with emotional dysregulation,
self-destructive behaviors, and interpersonal difficulties, particularly when these issues are severe or chronic. DBT is most effective
when these difficulties are causing significant distress or impairing an individual's ability to function in daily life. Below are the key
situations when DBT is particularly beneficial.

1. When an Individual Exhibits Intense Emotional Dysregulation

● Emotional instability is a hallmark of several mental health conditions, especially Borderline Personality Disorder (BPD).
DBT is designed to help individuals who have difficulty managing intense emotions, leading to frequent mood swings, anger
outbursts, deep sadness, or anxiety.
● When to use DBT: If someone is consistently overwhelmed by their emotions to the point that it affects their relationships,
work, or daily functioning, DBT can help them learn to regulate these emotions effectively.
2. When Self-Harm or Suicidal Behaviors Are Present
● DBT is one of the most effective treatments for self-harming behaviors (such as cutting, burning) and suicidal ideation or
actions. It focuses on helping individuals manage distress without resorting to harmful coping mechanisms.
● When to use DBT: If someone has a history of suicidal thoughts, attempts, or self-injury (e.g., cutting, burning, overdosing)
and is at risk of repeating these behaviors, DBT should be considered to address the root causes of emotional pain and provide
alternative coping strategies.

4. When There Are Co-occurring Disorders

● DBT is also used when an individual has multiple, co-occurring disorders. Common examples include:
○ Substance use disorders: People who engage in substance abuse to cope with intense emotions.
○ Eating disorders (e.g., binge eating disorder, bulimia nervosa): Often linked with emotional dysregulation.
○ Post-Traumatic Stress Disorder (PTSD): Individuals with PTSD may struggle to regulate intense emotional responses
to trauma reminders.
● When to use DBT: If an individual struggles with emotional dysregulation alongside other conditions (e.g., PTSD, substance
use, eating disorders), DBT can address the emotional and behavioral components, improving overall treatment outcomes.
Emotional Regulation Techniques in DBT are essential strategies that help individuals identify, understand, and manage their emotions in
healthier ways. One of the core goals of Dialectical Behavior Therapy (DBT) is to improve emotional regulation, particularly for those who
experience intense, fluctuating emotions, like individuals with Borderline Personality Disorder (BPD), depression, or anxiety disorders. DBT
helps clients reduce emotional suffering, improve emotional stability, and increase adaptive emotional responses.

Here are some of the primary emotional regulation techniques used in DBT:

1. Understanding and Labeling Emotions

● Purpose: To increase awareness of emotions and their underlying causes.
● How It Works: In DBT, clients are encouraged to recognize and accurately label their emotions. Often, people with emotional
dysregulation either don't fully recognize what they're feeling, or they use vague terms like "bad" or "good," which can increase emotional
confusion.
● Technique:
○ Observe the emotion: Identify what you're feeling (e.g., anger, sadness, frustration, guilt).
○ Label the emotion: Use precise language like "I feel anxious," "I am overwhelmed," or "I am feeling rejected."
○ Check the intensity: Rate how intense the emotion is on a scale from 1-10.
● Example: Instead of saying "I'm feeling bad," the person might say, "I'm feeling really anxious and a bit angry because of that argument."
2. Opposite Action

● Purpose: To change an emotion by doing the opposite of what that emotion urges you to do.
● How It Works: Each emotion leads to a particular action urge (e.g., anger often leads to aggression, sadness may lead to
withdrawal). In DBT, clients are taught to identify these urges and act in the opposite direction to break the emotional cycle.
● Technique:
○ Identify the emotion: Understand what emotion you're feeling (e.g., anger, sadness, anxiety).
○ Recognize the action urge: What does the emotion make you want to do (e.g., yell, isolate, avoid)?
○ Do the opposite action: Purposefully act in a way that contradicts the urge. For example, if you’re feeling angry and
want to shout, instead try breathing deeply and speaking calmly.
● Example: If feeling anxious and wanting to avoid social situations, go ahead and participate in a social activity, even if it's
uncomfortable.