Dialectical Behavioural Therapy (DBT)

Dialectical behavioral therapy is a type of cognitive behavioral therapy, a version of talk therapy. Cognitive behavioral therapy tries to identify and change negative thinking patterns and pushes for positive behavioral changes.

The term “dialectical” comes from the idea that bringing together two opposites in therapy,  acceptance and change, brings better results than either one alone. It teaches patients skills to cope with, and change, unhealthy behaviors and can be used to treat suicidal and other self-destructive behaviors. DBT is adapted to help manage problems that threaten a person’s safety, relationships, work, and emotional well-being.

Patients agree to do homework to practice new skills. This includes filling out daily “diary cards” to track emotions, urges, behaviors, and skills.

Principles include

Support-oriented: It helps a person identify their strengths and builds on them so that the person can feel better about him/herself and their life.

Cognitive-based: DBT helps identify thoughts, beliefs, and assumptions that make life harder: “I have to be perfect at everything.” “If I get angry, I’m a terrible person” & helps people to learn different ways of thinking that will make life more bearable: “I don’t need to be perfect at things for people to care about me”, “Everyone gets angry, it’s a normal emotion.

Collaborative: It requires constant attention to relationships between clients and staff. In DBT people are encouraged to work out problems in their relationships with their therapist and the therapists to do the same with them. DBT asks people to complete homework assignments, to role-play new ways of interacting with others, and to practice skills such as soothing yourself when upset. These skills, a crucial part of DBT, are taught in weekly lectures, reviewed in weekly homework groups, and referred to in nearly every group. The individual therapist helps the person to learn, apply and master the DBT skills.

Skills taught

  • Distress tolerance: Feeling intense emotions like anger without reacting impulsively or using self-injury or substance abuse to dampen distress.
  • Emotion regulation: Recognizing, labeling, and adjusting emotions.
  • Mindfulness: Becoming more aware of self and others and attentive to the present moment.
  • Interpersonal effectiveness: Navigating conflict and interacting assertively.

Possible uses

  • less frequent and less severe suicidal behavior
  • shorter hospitalizations
  • less anger
  • less likely to drop out of treatment
  • improved social functioning
  • Attention-deficit/hyperactivity disorder (ADHD)
  • Binge eating disorder
  • Bipolar disorder
  • Bulimia
  • Generalized anxiety disorder
  • Major depressive disorder (including treatment-resistant major depression and chronic depression)
  • Post-traumatic stress disorder
  • Substance use disorder

Further readings and resources
CAMH: DBT Information
Clinic 308: Group and individual therapy program
PsycheHUB:DBT explanatory video
PsychCentral: Component of DBT
WebMD: DBT comprehension
West Island DBT Centre