Is dbt just for borderline personality disorder

Deborah C. Escalante

Depressed Young Woman Talking To CounselorMarsha Linehan’s groundbreaking introduction of dialectical behavior therapy (DBT) through her 1993 treatment and skills training manuals has brought effective therapy to many people living with the symptoms of borderline personality. Linehan worked with women who had histories of suicide attempts, self-harm, frequent experiences of crisis, and difficulty managing intense emotional states. She found that the people she worked with in therapy experienced standard cognitive behavioral therapy as invalidating due to its consistent emphasis on changing thoughts, emotions, and behaviors.

Dialectical behavior therapy is a type of cognitive behavioral therapy that is based on a balance between acceptance of where a person is right now together with the need to push for change to help the person have more effective relationships and manage emotional states. The “dialectical” in its name refers to a philosophy in which seemingly opposing ideas can exist at the same time. We’re constantly balancing needs, values, and ideas that may appear to be opposites. Our task is to find the synthesis in these differing ideas.

A key component of dialectical behavior therapy is skills training, which includes the teaching and application of skills in mindfulness, emotion regulation, interpersonal effectiveness, and distress tolerance.

Mindfulness practice is nothing new—it is a core component of many religious traditions—but increasingly we are able to study and measure its brain benefits.

In the years since Linehan released her first treatment and skills training manuals, DBT has been tried and tested in many settings, including with people who do not have borderline personality but who are living with other mental health conditions such as depression, anxiety, and addictions.

The skills training and treatment model of DBT is applicable to people living with a range of mental health conditions. Practicing mindfulness helps people with and without mental health conditions to improve well-being, attention to the present moment, and increasing positive emotional experiences while decreasing negative emotions and distress. This is why people with depression, bipolar, anxiety, eating disorders, and other mental health conditions may benefit from mindfulness practice and the other skills that form dialectical behavior therapy.

DBT for Depression

Dialectical behavior therapy offers skills specifically designed for people dealing with depressive feelings. DBT empowers people with depression to add positive emotional experiences to their lives in order to have better relationships and experience more joy. DBT includes evidence-based behavior activation skills to give people concrete tools to use when feeling depressed. By knowing what works, people with depression can take charge of their lives and do what they need to feel better.

DBT for Bipolar

People with bipolar often benefit from therapy to help them learn skills for tolerating distress and managing intense emotions. There is such an overlap between the symptoms of borderline personality and bipolar that some experts have proposed that borderline personality be considered part of the bipolar spectrum. People with bipolar often benefit from help managing stressors that can increase vulnerability to depression and mania.

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DBT for Anxiety

Dialectical behavior therapy gives people skills to live in the present moment and to observe, alter the intensity of, and change feeling states. People with anxiety benefit from being able to tolerate intense feelings and modify behaviors in order to create new emotional experiences. Mindfulness skills in DBT give people with anxiety the tools to set aside worries about the past or future in order to address what is happening in their lives right now.

DBT for Addictions

The new DBT skills manual, published in 2014, includes a section on skills for tolerating distress in people with addictions. Linehan includes in this category not only people with addictions to alcohol and other drugs, but also people who are addicted to gambling, sex, shopping, and more. The skills are based on a philosophy of dialectical abstinence, which uses the understanding that harm reduction and abstinence are both important and can coexist on an individual’s path to recovery.

DBT for Eating Disorders

People with eating disorders benefit from skills to regulate intense emotions and to pick up on trigger emotions that lead to behaviors that cause problems. DBT views food restriction and binging and purging as attempts to manage painful feelings. The skills training component of DBT offers new skills to regulate these difficult feelings.

Dialectical behavior therapy is based on learning theory and is not diagnosis-specific. People with a wide range of problems have found DBT helpful. If you think DBT may be for you, don’t delay in seeking out a therapist trained to offer this effective evidence-based treatment.

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The preceding article was solely written by the author named above. Any views and opinions expressed are not necessarily shared by GoodTherapy.org. Questions or concerns about the preceding article can be directed to the author or posted as a comment below.

DBT was designed to treat borderline personality disorder, but it can be used for many other conditions.

The world is filled with contrasts — up and down, happy and sad, stillness and movement.

Dialectical behavior therapy (DBT) embraces this dichotomy and helps individuals strike a balance between accepting themselves as they are while acknowledging that change is necessary.

During DBT, individuals learn to manage their emotions and relationships through mindfulness, emotional regulation, distress tolerance, and interpersonal effectiveness.

Techniques like individual and group therapy, homework, and skill building guide them to embrace their reality.

Treating a wide variety of mental health conditions, DBT builds on cognitive behavioral therapy to address the needs of people with a higher sensitivity to emotional situations.

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What is DBT?

Dialectical philosophy finds truth in multi-perspectives. It tells you that you’re OK just as you are in this moment. At the same time, it helps you build skills that will change the way you think, feel, and behave.

First developed by Dr. Marsha Linehan in the late 1980s, DBT was intended for people living with borderline personality disorder. She found that previous treatments focused solely on change wasn’t helpful for people living with this condition — but neither was only acknowledging their pain.

Dialectical behavior therapy takes into consideration that some people react more intensely to emotional situations within interpersonal relationships and teaches skills to help manage emotions, like:

  • mindfulness
  • emotional regulation
  • distress tolerance
  • interpersonal effectiveness

Borderline personality disorder is characterized by intense emotions, lack of stability in relationships, black and white thinking, and an unstable self-image. People with borderline personality disorder tend to have higher rates of self-injury and suicide.

Research suggests that DBT helps reduce suicide behaviors and lowers hospitalizations for people living with borderline personality disorder.

But DBT doesn’t only help there. It can help no matter if you’ve been diagnosed with a mental health condition or not, and it can also help with other conditions.

DBT for post-traumatic stress disorder (PTSD)

Post-traumatic stress disorder (PTSD) can develop after experiencing a traumatic event, such as an accident, war, natural disaster, or violent assault.

Similar to people with borderline personality disorder, individuals with PTSD can have trouble managing their emotions. Sometimes they have issues with depression, panic attacks, and anxiety — all of which might put them at higher likelihood for suicide or self-harming behaviors.

In DBT, you’re taught skills to help regulate your emotional responses and reduce self-harming behaviors.

In a 2020 study of women with childhood-abuse related PTSD, researchers observed participants over 15 months. The participants received both cognitive processing therapy and dialectical behavior therapy.

Symptoms improved more in those who received DBT (58%) versus those who received CPT (41%).

DBT for depression

People with depression often experience changes in mood, and similar to borderline personality disorder, have an increased chance of suicide or self-harm behaviors.

Research has shown that DBT is effective for treating depression.

In a 2017 study exploring the effectiveness of DBT’s emotional regulation and mindfulness skills on preventing depression relapse, researchers found that symptoms of depression were reduced. However, more research is needed to determine if it could help prevent relapse.

A 2020 study found that adolescents who received inpatient DBT had a significant decrease in their symptoms over a short amount of time compared with the usual treatment of group therapy, individual therapy, and medication, if needed.

DBT for anxiety

Anxiety disorders involve strong feelings of fear, anxiety, or worry that at times can interfere with day-to-day life. This can sometimes lead to issues at home, at work, and in relationships.

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DBT for anxiety focuses on teaching skills to cope with these feelings and manage emotions. Research has found that DBT can successfully reduce anxiety symptoms.

A 2016 study suggests that developing DBT skills and psychological flexibility — the ability to stay in the moment — might also help improve symptoms of anxiety.

DBT for eating disorders

One goal in treating eating disorders, such as anorexia nervosa, binge eating disorder, and bulimia nervosa, is to limit the frequency of episodes. DBT may help do that.

DBT has been shown to be particularly helpful for treating binge eating disorder. Research suggests it can help reduce binge eating behaviors for a short period.

A 2017 review pointed out that though 89% of participants stopped binge eating by the end of a 20-week treatment with DBT, only 56% of them continued to not binge eat 6 months after the end of treatment.

DBT for suicide and self-harming behaviors

DBT was originally intended to treat chronically suicidal behaviors and thoughts in people with borderline personality disorder.

Research has found that DBT helps to reduce suicidal behavior in adults.

In a 2019 long-term effectiveness study, researchers looked at treatments for adolescents with repeated suicidal and self-harming behaviors. At the 3-year follow-up, adolescents who received DBT reported a more significant and larger long-term reduction in self-harm behaviors than those who didn’t receive DBT.

Another study found that DBT reduced suicide attempts in teens after treatment and at the 1-year follow-up.

DBT for substance use disorder

DBT has shown promise as a stand-alone treatment for substance use disorder.

In a 3-month study, more than 100 individuals with substance use disorder and co-occurring substance use disorder with another mental health condition received only DBT in an outpatient program. Participants in the study showed improvements in the number of consecutive days of abstinence.

A study in 2015 showed that 98% of the American Indian/Alaska native adolescents who had substance use disorder self-reported they were either “recovered” or “improved” after treatment with DBT.

DBT for bipolar disorder

People with bipolar disorder experience changes in mood, behaviors, and thoughts. Suicidal thoughts are common in people living with bipolar disorder, especially during depressive episodes.

Though DBT isn’t one of the firstline therapies for bipolar disorder, experts are exploring how to adapt DBT skills for treating bipolar disorder.

Older research suggests that DBT improves symptoms of bipolar disorder I or II in people ages 18 or older. However, the improvements weren’t significant enough to recommend DBT as a standard treatment.

Newer research suggests that DBT using adapted materials for bipolar disorder might be a helpful intervention. Five experts interviewed in the study reported using DBT to treat bipolar disorder, but more research is needed to confirm this therapy is effective.

Let’s recap

Through skills like mindfulness, emotional regulation, and distress tolerance, DBT offers the tools you need to manage intense emotions and cope with stress.

In DBT, you can learn to embrace the present while welcoming change.

If you think you may benefit from DBT, you can use the Behavioral Tech’s directory or the American Psychology Association locator to find a therapist that specializes in this type of therapy.

You can also reach out to your primary doctor or a mental health professional for recommendations.

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