What Is Dialectical Behavior Therapy and How Is It Different from CBT?
Dialectical Behavior Therapy (DBT) is a therapeutic modality specifically developed for people who engage in harmful or dangerous behavior directed at themselves or others. Such people are often diagnosed with borderline personality disorder (BPD), bipolar disorder, anorexia, major depressive disorder (MDD), or other treatment-resistant mental-health conditions. While presenting different outward symptoms, at their core, these conditions are usually caused by a person’s inability to effectively cope with his or her emotions.
This kind of profound emotional dysregulation is thought to be biosocial in nature, which is to say it arises when an individual’s genetic predisposition is coupled with adverse environmental factors, such as a traumatic upbringing. For people suffering from borderline-like conditions, self-harm becomes a way to release what they experience as unbearable psychological tension by transforming their emotional pain into the physical. This is why such people may have suicidal ideation or even a history of suicide attempts. Of course, dysfunctional emotional release can also take other forms, from addiction to all sorts of impulsive behavior, including outright aggression.
It is important not to confuse DBT with CBT. The latter stands for cognitive behavioral therapy. While the two modalities have very similar names and DBT belongs to what’s known as “third-wave CBT,” they are quite different. In fact, in some important ways, DBT stands in opposition to classical CBT. CBT works on changing thought patterns that lead a person to maladaptive emotions and behaviors. DBT, on the other hand, emphasizes the acceptance of problematic thoughts and focuses on a person’s ability to respond to them in a healthier way. The goal of DBT is to help the client come to terms with his or her painful emotions and understand that they will pass. DBT’s main principle is change through acceptance. The contradictory nature of this principle is reflected in DBT’s adoption of the term dialectical as part of its name.
DBT is a highly structured therapeutic modality. It consists of three mandatory parts: group therapy, individual therapy, and emergency phone consultations. Because of this, it cannot realistically be performed by a single therapist. Normally, DBT is practiced in clinical settings by teams of professionals and is geared towards patients with higher-level-of-care needs. In group therapy, clients learn practical skills in the areas of mindfulness, distress tolerance, emotional regulation, and interpersonal effectiveness. Individual sessions allow them to work out their specific problems and discuss how best to use the skills they have acquired in a group. Finally, emergency phone consultations, while subject to certain boundaries, allow DBT patients to receive timely assistance when their coping skills prove insufficient for dealing with the situation at hand. Usually, DBT takes at least one year and can often last two years or more.
DBT Skills
Clients learn practical skills in four key areas
Mindfulness
Distress Tolerance
Emotional Regulation
Interpersonal Effectiveness
Elements of DBT can also be used by individual therapists in non-clinical settings. While this would not be considered DBT in a true sense, it is common for mental-health professionals to combine interventions and conceptualizations from different modalities to fit their clients’ unique needs. After all, a degree of destructive behavior, difficulties with self-acceptance and emotional control, along with chronically low self-esteem, affect the lives not only of people with BPD, MDD, or bipolar disorder. Less severe versions of such problems are exactly what brings many people into therapy in the first place.
So, how does a therapist choose when to use CBT versus DBT-like treatments? It mostly depends on whether the client is responsive to the idea that he or she can manage emotions by controlling his or her thinking. If so, CBT interventions will likely be a more straightforward solution. If, on the other hand, the client’s emotions appear overwhelming and he or she doesn’t believe that rational thinking is sufficient to control them, DBT’s paradoxical approach of change through acceptance may be worth exploring.