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Dialectical behavioral therapy (DBT) is an effective combination of cognitive and behavioral therapies. The goal of DBT is to transform negative thinking patterns and destructive behaviors into positive outcomes.
The effectiveness of DBT has been shown to help people diagnosed with an eating disorder regulate their emotions, build self-management skills, reduce anxiety and stress, and control destructive eating behaviors.[1] DBT is a researched-based way to establish coping mechanisms to implement in environments that may elicit old, destructive patterns of eating.
How Did DBT Begin?
The Linehan Institute was founded by Dr. Marsha Linehan, professor of psychology at the University of Washington. The Institute conducts cutting edge research on DBT and found that DBT was originally effective for people diagnosed with Borderline Personality Disorder (BPD). DBT proved to help people experiencing severe suicidal thoughts and difficulty managing emotions.
The success of DBT on the BPD population has led to its ongoing research and success with people diagnosed with eating disorders. This is due to the fact that DBT helps patients establish coping mechanisms to reduce anxiety in situations and environments that elicit the stress response associated with food.[2] Anxiety levels increase when people recovering from an eating disorder are put in environments that trigger old responses. DBT can help to shift negative and impulsive thinking into positive self-talk and mindful eating behaviors.
How Does DBT Work?
DBT is used for people with severe cases of eating disorders. DBT is used to create a controlled environment for individuals to have the opportunity to practice regulating their emotions and managing their behaviors associated with the particular disorder.
DBT incorporates a combination of group and individual therapy sessions that seek to teach the individual valuable self-management skills in daily life.
Individual Therapy Sessions. Individual sessions are extremely valuable for creating behavioral plans and goals for mindful eating. Patients have the opportunity to work with psychologists, therapists, and eating disorder specialists to create an individualized behavior plan to implement in the person’s daily life. These sessions offer an empowering experience for the individual because they help to establish self-compassion and purpose in the person’s life beyond the disorder.
Individuals have the opportunity to examine a deeper meaning of their lives through the DBT process of recovery. They will set goals for themselves, incorporate activities they enjoy, and mindfully understand their process of struggle. Therapists work alongside individuals to empathize with their journey and to ensure self-compassion and mindfulness are a part of the recovery process. A positive self-identity is created in these sessions in which the person establishes self-compassion, acceptance, and an increased sense of self-worth and purpose.
Group Therapy Sessions. Group sessions provide essential life skills to individuals. These sessions help to teach self-management skills such as mindful eating in group environments. These sessions also cultivate group support and aid the individual in understanding how his/her journey is shared amongst others.
Interpersonal relationships are strengthened by guided group sessions. Individuals have the opportunity to connect with people who are experiencing a similar journey and this cultivates an understanding of the shared human experience.
Coaching. One of the most helpful features of DBT is that it is not exclusive to individual and group therapy sessions. If an individual is struggling in between sessions, coaches are available by phone to help the person through any painful moment. Individuals can speak to therapists, psychologists, and eating disorder specialists if they have any questions on how to implement a particular management skill or self-soothing technique.
How Skills Learned from DBT Can Help People Recovering from Eating Disorders:
The skills learned from DBT can easily be incorporated into a person’s everyday routine. The individual learns the deeper meaning and purpose behind each skill. The person has the understanding that these skills are essential for self-growth and a healthful human being.
The following skills learned in DBT will help the individuals redefine their identity and lead a more healthful life:
Mindfulness: DBT helps individuals establish techniques for mindful eating and acceptance of the present moment. Patients will keep a diary and reflect on their moments of difficulty and success on their journey.
Distress Tolerance: Individuals will learn how to cope with situations that cause stress and anxiety by reframing their thoughts, implementing self-soothing techniques, and understanding the present moment.
Interpersonal Effectiveness: DBT helps individuals learn how to establish what they want and how to assess their needs while maintaining self-respect and healthy relationships with others.
Emotional Regulation: DBT seeks to aid individuals in how to understand, adapt, and change their emotions to improve their mindset and take positive actions.
The Success of DBT on Eating Disorder Patients
Research conducted by the Linehan Institute on groups of people with bulimia nervosa, binge-eating disorder, and anorexia have shown the skills learned from DBT to be highly effective. In the studies, self-injury, negative thoughts about self-image, and binge-eating behavior have decreased amongst patients. In addition, the research has also shown that patients were less likely to restrict their eating behaviors and have continued to improve in follow-up sessions.[3]
DBT transforms negative mental thoughts and behaviors into an understanding of the person’s journey. The skills learned from DBT sessions prompts people to react to stressful situations in more productive, positive ways. DBT is essential in eating disorder recovery because it provides whole-bodied treatment for the mind, body, and soul and ultimately helps to establish mindfulness and self-compassion.
Greta Gleissner is the founder of Eating Disorder Recovery Specialists, a nationwide network of eating disorder treatment specialists that provide meal coaching and recovery skills such as CBT, DBT, ACT, MI, etc. EDRS work alongside treatment programs, teams, and families to provide transitional aftercare support for post-residential treatment clients.
To find a therapist, please visit the Psychology Today Therapy Directory.
Overview
What is dialectical behavior therapy (DBT)?
Dialectical behavior therapy (DBT) is a type of talk therapy (psychotherapy). It’s based on cognitive behavioral therapy (CBT), but it’s specially adapted for people who experience emotions very intensely.
Cognitive behavioral therapy (CBT) is a type of talk therapy that helps people understand how thoughts affect emotions and behaviors.
“Dialectical” means combining opposite ideas. DBT focuses on helping people accept the reality of their lives and their behaviors, as well as helping them learn to change their lives, including their unhelpful behaviors.
Dialectical behavior therapy was developed in the 1970s by Marsha Linehan, an American psychologist.
What is dialectical behavior therapy (DBT) used for?
Dialectical behavior therapy (DBT) is especially effective for people who have difficulty managing and regulating their emotions.
DBT has proven to be effective for treating and managing a wide range of mental health conditions, including:
- Borderline personality disorder (BPD).
- Self-harm.
- Suicidal behavior.
- Post-traumatic stress disorder (PTSD).
- Substance use disorder.
- Eating disorders, specifically binge eating disorder and bulimia.
- Depression.
- Anxiety.
It’s important to note that the reason DBT has proved effective for treating these conditions is that each of these conditions is thought to be associated with issues that result from unhealthy or problematic efforts to control intense, negative emotions. Rather than depending on efforts that cause problems for the person, DBT helps people learn healthier ways to cope.
How do I find a DBT therapist?
A therapist can be a psychiatrist (a medical doctor who can prescribe medications), psychiatric nurse, psychologist, social worker or family therapist.
Finding the right therapist is often a time-consuming task, and DBT therapy isn’t any different. Try not to become discouraged. Talk to people you trust to give you a referral for a therapist who uses dialectical behavior therapy, whether it’s your primary healthcare provider or a friend or family member.
You can also search for therapists online through local and state psychological associations.
Be sure that any therapist you’re interested in seeing is a state-certified and licensed mental health professional and that they treat your area of concern (for example, eating disorders, borderline personality disorder, self-harm, etc.).
Most therapists’ websites list the conditions and problems they treat. If you have questions, call or email the therapist’s office before you choose.
It may be helpful to ask a potential DBT therapist the following questions:
- What is the nature of your training in DBT?
- Do you provide comprehensive DBT or a modification? If not comprehensive DBT, why not?
- Do you belong to a DBT consultation team?
- What’s your policy on phone calls and emails during the week?
- How much time will you initially ask me to commit to for the entire therapy process?
Procedure Details
How does dialectical behavior therapy (DBT) work?
The main goal of therapists who use dialectical behavior therapy (DBT) is to strike a balance between validation (acceptance) of who you are and your challenges and the benefits of change. Your therapist will help you learn new skills to improve emotion regulation.
The structure of dialectical behavior therapy can vary some from therapist to therapist, but, in general, DBT involves these four types of sessions:
- DBT pre-assessment.
- Individual therapy.
- Skills training in groups.
- Telephone crisis coaching.
DBT pre-assessment
Your therapist may offer an assessment before starting DBT. They’ll determine how suitable DBT is for you by asking you questions and explaining how DBT works. If you decide that DBT is the right therapy for you, they’ll ask you to commit to the treatment and the length of treatment.
Individual DBT therapy
Individual DBT therapy involves weekly sessions with your therapist. Each session lasts about 40 minutes to 60 minutes.
Individual DBT therapy sessions have the following goals:
- To help keep you safe by reducing suicidal and self-harming behaviors, if applicable.
- To limit behaviors that get in the way of productive therapy.
- To help you reach your goals and improve your quality of life by addressing what’s blocking your progress, such as mental health conditions or relationship issues.
- To help you learn new skills to replace unhelpful behaviors.
Your therapist will likely ask you to keep a diary to track your emotions and actions and to look for patterns of behavior. You’ll bring this diary with you to your sessions so you and your therapist can decide what to work on for each session.
DBT skills training in groups
In these sessions, your therapist will teach you skills in a group setting. This isn’t to be confused with group therapy, in which you discuss your problems with others. Think of it more like a teaching and learning session in a classroom setting.
DBT skills aim to help enhance your capabilities in day-to-day life. The four skills your therapist will teach include:
- Mindfulness: This is the practice of being fully aware and focused in the present instead of worrying about the past or future.
- Distress tolerance: This involves understanding and managing your emotions in difficult or stressful situations without responding with harmful behaviors.
- Interpersonal effectiveness: This means understanding how to ask for what you want and need and setting boundaries while maintaining respect for yourself and others.
- Emotion regulation: This means understanding, being more aware of and having more control over your emotions.
Telephone crisis coaching
DBT often involves telephone crisis coaching to support you in your daily life. This means you can call your therapist at certain times for support between sessions.
Examples of when you may need to call your therapist include:
- When you need help with an immediate crisis, such as wanting to self-harm.
- When you’re trying to use the DBT skills you learned but want some advice on how to do it.
However, your therapist will set clear boundaries about when you can call them, such as during an agreed-upon range of time during the day.
Crisis coaching functions on an as-needed basis. The calls are usually brief, and they shouldn’t replace the work of individual or group sessions.
Risks / Benefits
What are the benefits and risks of dialectical behavior therapy (DBT)?
Dialectical behavior therapy (DBT) has been proven to help people with their mental health conditions in several studies. For people with borderline personality disorder, in particular, DBT results in:
- Less self-harm behavior and anger.
- Fewer days of inpatient hospitalization.
- Less drug and alcohol misuse.
- Improved depressive symptoms.
However, DBT isn’t for everyone, and it can be very difficult. DBT is more likely to work for you if you:
- Are committed to making positive changes.
- Are ready to fully commit to therapy and do homework assignments.
- Are ready to focus mostly on your present and future, rather than your past.
- Feel able to do some sessions in a group with others.
Recovery and Outlook
How long will I need dialectical behavior therapy?
Dialectical behavior therapy (DBT) usually takes at least six months to a year. However, each person is unique, and mental health conditions are complex. You shouldn’t expect to be completely free of symptoms or no longer have problematic behaviors after one year of DBT.
Many therapists believe that the treatment for borderline personality disorder, in particular, can often take several years.
Try not to get discouraged by how long it may take to be able to better manage your emotions and have a better quality of life. The important thing is that you’re seeking help. Any progress is good progress.
When to Call the Doctor
When should I see my healthcare provider or therapist while doing DBT?
It’s important to go to all of your scheduled individual DBT therapy sessions and group skill training sessions.
If you’re experiencing a crisis, such as feeling suicidal, and can call your therapist, do so.
If your therapist is unavailable, call the National Suicide Prevention Lifeline at 1.800.273.8255. Someone will be available to talk with you 24 hours a day, seven days a week. You can also call 911 or go to the nearest emergency room.
A note from Cleveland Clinic
Dialectical behavior therapy (DBT) is an effective treatment to help people who experience very intense, negative emotions. Although it may be difficult and time-consuming to find the right DBT therapist for you, it’s important to keep trying. The sooner you can start therapy — and stay committed to it — the sooner you’ll have an improved quality of life.
