About DBT

What is DBT?

Dialectical Behavior Therapy (DBT) is a well researched and comprehensive treatment approach designed to help people who have difficulty regulating their emotions. Emotion dysregulation often results in a high degree of impulsive reactivity, self-destructive behaviors, and volatile relationships. DBT works by teaching clients to become more aware of their particular sensitivity to emotions such as anger, fear, shame and sadness. At the same time, it provides the skills necessary to tolerate these emotions and then begin to regulate them. DBT also teaches assertiveness skills to enable clients to effectively ask for what they want or say no to what they don't want while preserving relationships and their own self-respect.

Who can benefit from DBT?

Developed by Marsha Linehan, Ph.D., ABPP, at the University of Washington in the early 1990's, DBT was originally designed as an innovative and integrative treatment for suicidal and actively self-harming patients with a history of multiple psychiatric hospitalizations who met criteria for Borderline Personality Disorder (BPD). Because of its success in treating this patient population, DBT has gained in popularity and has been used to treat a broader range of patients who present with many of the characteristics listed below:

  • a tendency towards impulsivity and self-destructive behaviors
  • an unstable sense of self, including chronic feelings of emptiness
  • high emotional reactivity requiring a long time to calm down
  • a tendency to see others and the world in black or white terms
  • extreme sensitivity and a tendency to lash out in anger
  • unstable relationships, especially those involving intimacy
  • a pronounced fear of being abandoned
  • rapid mood changes with mixed anxiety and depression

How does DBT work?

DBT separates skills training from individual psychotherapy, requiring participants to attend a weekly skills training group in addition to being in ongoing weekly individual psychotherapy. As a unique and powerful way to further reinforce the skills taught in the skills training groups, telephone coaching is available between sessions to help generalize the use of skills. One of the key assumptions of DBT is that while we may not have caused all of our problems, we are the only ones capable and responsible for fixing them. This requires a continual willingness on the part of any DBT client to put in the hard work necessary for making the desired changes in order to create a life worth living.

At SFDBT we offer two separate programs: a Comprehensive DBT Programand a Skills Training Program. In our Comprehensive DBT Program clients are in weekly individual therapy with one of our SFDBT-affiliated therapists and in one of our weekly skills training groups. In addition, our SFDBT-affiliated therapists provide skills phone coaching and participate in our weekly consultation team meeting. In our Skills Training Program clients are in weekly individual therapy with a non-affiliated therapist of the client’s choosing while attending one of our weekly skills training groups.

DBT Skills Training

Our DBT skills training group is a seven-month long group where participants are expected to attend once weekly. The group is comprised of four modules (Core Mindfulness Distress Tolerance, Emotion Regulation, and Interpersonal Effectiveness).

  • Core Mindfulness Skills: Skills to increase being present and non-judgmentally aware in the moment 
  • Distress Tolerance Skills: Skills to manage difficult feelings without acting impulsively
  • Emotion Regulation Skills: Skills to prevent or decrease emotions or the intensity of emotions
  • Interpersonal Effectiveness Skills: Skills to manage effective communication with others

The Core Mindfulness skills are woven throughout each of the other three modules and is always the first module taught.  For example, in a two-month long period, we present two weeks of Core Mindfulness skills followed by 6-7 weeks (depending on the day of the group and the month) of the Distress Tolerance skills:

  • Two Month Section:
    2 weeks of Core Mindfulness skills
    6-7 weeks of Distress Tolerance skills 
  • Two Month Section:
    2 weeks of Core Mindfulness skills
    6-7 weeks of Interpersonal Effectiveness skills
  • Three Month Section:
    2 weeks of Core Mindfulness skills
    10-11 weeks of Emotion Regulation skills 

DBT assumptions about participants:

  • People in DBT are doing the best they can.
  • People in DBT want to improve.
  • People in DBT need to do better, to work harder, and be motivated to change.
  • The lives of suicidal individuals are unbearable as they are currently being lived.
  • People in DBT must learn new behaviors in all areas of their lives.
  • People cannot fail in DBT.

DBT assumptions about therapists :

  • All therapists, no matter how well trained, are fallible.
  • We make every reasonable effort to conduct competent and effective therapy.
  • We obey standard ethical and professional guidelines.
  • We are available for weekly therapy sessions, phone consultations, and provide needed therapy back-up.
  • We respect the integrity and rights of the patient.
  • We maintain confidentiality.
  • We meet regularly to obtain consultation and support to be effective in the work we do.

Targets of DBT treatment:

  • Decreasing high-risk suicidal and self-harming behaviors
  • Decreasing therapy interfering behaviors by either therapist or patient
  • Decreasing quality of life interfering behaviors
  • Learning and mastering behavioral skills for mood-independent life choices
  • Decreasing symptoms related post-traumatic stress, other anxiety, and depression
  • Enhancing and sustaining self-respect
  • Additional goals set by patient to create a life worth living

Stages of DBT treatment:

Stage One
  • Decreasing or eliminating life-threatening behaviors (suicide attempts, suicidal thinking, self-injury, homicidal and aggressive behaviors)
  • Decreasing or eliminating therapy-interfering behaviors (missing sessions, not doing homework, behaving in a way that burns others out)
  • Reducing or eliminating hospitalization as a way of handling crisis
  • Decreasing behaviors that interfere with the quality of life (eating disorders, not going to work or school, addiction, chronic unemployment)
  • Increasing behaviors that will enable the person to have a life worth living
  • Increasing behavioral skills that help to build relationships, manage emotions and deal effectively with various life problems
Stage Two
  • Continuing and building on Stage One skills
  • Targeting and decreasing symptoms of Post Traumatic Stress Disorder (PTSD) and other Anxiety or Depression related symptoms
Stage Three
  • Increasing love and respect for self and others
  • Affirming individual life goals
  • Solving ordinary life problems
Stage Four
  • Developing the capacity for freedom and joy
  • Creating a life worth living!