Dialectical Behavior Therapy: Not Just for Borderline Personality

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.

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.

© Copyright 2015 GoodTherapy.org. All rights reserved. Permission to publish granted by Jeremy Schwartz, LCSW, therapist in Brooklyn, New York

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.

  • 15 comments
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  • Grant

    Grant

    March 24th, 2015 at 10:39 AM

    Seems as if it could be beneficial in many different areas.

  • Georgiana

    Georgiana

    March 24th, 2015 at 7:00 PM

    How can I get training in DBT? I live in NYC. Thank you!

  • anne

    anne

    June 6th, 2016 at 9:03 AM

    Hi Georgiana..I sometimes wish I lived in the US. Check out the genius and founder of DBT herself Prof Marsha Linehan at the University of Washington

  • Tollison

    Tollison

    March 25th, 2015 at 3:46 AM

    This makes perfect sense to me.
    If you give someone the skills that they need to cope with their anxiety, then you are giving them access to a whole new life
    You can’t bury the anxiety, and that is something that we will all feel from time to time
    but when you give someone the ability to have some skills to better cope when it arises, that is going to give them access to a brand new way of living

  • Rico

    Rico

    March 27th, 2015 at 2:36 PM

    giving me skills but to do what with? and what if that doesn’t work/\? then what?

  • Noelle

    Noelle

    March 28th, 2015 at 7:22 AM

    I am always so impressed when I see something on here that I have never even given any thought to before or that opens my eyes to something new and for me this article did just that. Keep up the great work and thank you for always providing new ways to enlighten your readers.

  • Jennifer

    Jennifer

    May 5th, 2015 at 6:16 PM

    I graduated from dbt in 2012.. from mental health systems in Edina, mn

  • Dawn D.

    Dawn D.

    September 12th, 2015 at 6:26 PM

    Thanks for this excellent synopsis of DBT. If you are interested in learning more about DBT, the website behavioraltech.org offers both online and in-person DBT training seminars.

  • Pat G.,LCSW

    Pat G.,LCSW

    December 11th, 2015 at 5:50 PM

    I have been using DBT skills for PTSD survivors for many years. Great skills to use while dealing with painful emotions.

  • Trudy

    Trudy

    December 22nd, 2015 at 9:05 AM

    Hello-i am looking for a therapist specializing in DBT in or near Rockymount NC as referral source

  • The GoodTherapy.org Team

    The GoodTherapy.org Team

    December 22nd, 2015 at 11:07 AM

    Dear Trudy,

    To search for a therapist in your area, please return to our homepage, https://www.goodtherapy.org/, and enter your zip code into the search field.

    Once you enter your information, you’ll be directed to a list of therapists and counselors who meet your criteria. From this list you can click to view our members’ full profiles and contact the therapists themselves for more information. You are also welcome to call us for assistance finding a therapist. We are in the office Monday through Friday from 8:00 a.m. to 4:00 p.m. Pacific Time; our phone number is 888-563-2112 ext. 1.

    Kind regards,

    The GoodTherapy.org Team

  • New Roads Behavioral Health

    New Roads Behavioral Health

    February 29th, 2016 at 8:41 PM

    We practice Dialectical Behavioral Therapy at our residential treatment facility in Utah. We’ve found it extremely effective for Borderline Personality Disorder, Depression and Substance Abuse. We treat a variety of clients and even the most severe cases respond very well to DBT. Our therapists were all trained at the Portland DBT Institute. Thank you for sharing this information!

  • Theresa

    Theresa

    July 10th, 2016 at 4:49 PM

    I like this idea if one thinks about it how one act or react when negative experiences happens in
    One life and how One perceive the events can cause major fear (anxiety) one lacks the inabilities to identify and find a solution to the problem these lack of skills could be the problems causing depression anxiety because of the frustration of not knowing how to identify the problems I believe fear over the inabilities to control the mind in a situation or find the solutions to a problem I believe relearned how to slow the mind and regroup everything that has happened could be the answer to a cure to several mental health disorders like depression if medication is needed because of the chemical inbalances of serotoning and dopamine then that’s a added learning objective understanding what one is going through can eliminate the fear reaction and learning to get a logical perspective to the negative life events is half the battle one knowing how to find the solution for their problem is the other half of beating a mental health emergency

  • Claire

    Claire

    July 15th, 2016 at 5:22 PM

    Reading these brings new ideas which are exciting to receive. Thank you. I wondered if this modality has ever been used with persons restraining emotions in sexuality. Say a woman , only able to climax alone. Woman suspects mother is being sexually obsessed with her but cannot assess memories. Again thank you for being a provocative and educative group.

    Claire D. LCSW-C, M.Ed.

  • m k

    m k

    July 31st, 2017 at 3:25 AM

    I have to thank you for the efforts you’ve put in writing this blog. I really hope to see the same high-grade
    blog posts by you later on as well. In truth, your creative writing abilities has encouraged me

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