Dialectical Behavior Therapy Guide [+DBT Recovery Worksheets]

How do you help someone change their behavior? How do you guide someone to change thought patterns and habits that have been ingrained in them for years or even decades? This is what behavioral therapists are tasked with, and one of the most common and research-backed ways they do this is with a technique called dialectical behavior therapy, or DBT.

In this article, you will learn about dialectical behavior therapy, a type of psychotherapy that teaches skills for managing intense emotions and tolerating distress.

You will learn how DBT works, the skills involved in DBT, and how this technique is different from cognitive behavioral therapy (CBT). You will also learn how DBT can be used as a meaningful part of addiction treatment and how to find a DBT provider.

Download our free DBT Worksheets for Recovery.

What is Dialectical Behavior Therapy?

Dialectical behavior therapy is a subset cognitive behavioral therapy that helps people change problematic ways of thinking and behaving.

While CBT focuses mainly on learning how to change negative thinking patterns and their subsequent behaviors, DBT emphasizes the value of learning to tolerate distressful emotions while you are simultaneously working to regulate them to solve behavioral problems.

The Origins of Dialectical Behavior Therapy

DBT was developed by Marsha Linehan, a psychologist and professor, in the 1980s. It was originally created as a therapy intervention to treat people with treatment-resistant borderline personality disorder, a complex mental health condition characterized by intense, unstable emotions, impulsivity, and struggles with relationships.

Starting in the 1990s, skills training expanded as research proved the techniques to be effective for treating other conditions including anxiety, depression, eating disorders, and substance abuse.

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The Core Philosophy of DBT

Dialectical behavior therapy’s core philosophy emphasizes validation and self-compassion rather than judgment. The goal of DBT therapy is to achieve balance between accepting emotional discomfort and moving to change unhealthy patterns that are contributing to it.

DBT involves the use of dialectics, or discussion and reasoning in an educational manner, between a client and their therapist. Skills training and practice play a major role in DBT therapy.

How Does DBT Therapy Work?

If you’re considering trying dialectical behavior therapy, what can you expect from your treatment sessions?

The Structure of DBT

DBT treatment programs typically involve four components:

1. Weekly individual counseling sessions
2. Group skills training sessions
3. Crisis counseling, using phone or text conversations with a therapist
4. Weekly consultation by the client’s therapist with clinical peers for support and advice

Each of these components plays an essential role in the therapeutic process.

Individual DBT Therapy

DBT individual therapy sessions allow clients to discuss specific issues and emotional challenges that they have recorded in diary form, as part of a standard DBT homework assignment.

The client and therapist prioritize the issues and analyze these accordingly, identifying triggers that lead to problematic behavior.

Then, together, client and therapist problem-solve using techniques from one or more of the four DBT core skills: mindfulness, distress tolerance, emotional regulation, and interpersonal effectiveness.

The client, having identified and labeled intense, distressing emotions, next strategizes with their therapist to find ways to reduce the impact of the emotions. They also practice how to appropriately express feelings, set boundaries, and communicate constructively, aiding in the reduction of stressful emotions.

DBT Group Therapy

Using discussion, worksheets, and role play, DBT group members practice DBT core skills using structured exercises. Situations catalogued in members’ weekly homework assignments provide examples for interactive activities.

Sharing experiences and support for one another in skills training groups helps members develop empathy and improve interpersonal communications.

Phone Coaching and Crisis Support

Unlike typical client-therapist relationships, DBT clients are allowed to reach out to their therapists via phone for short conversations to receive in-the-moment support for real life challenges. These conversations are typically 5 to 10 minutes and are meant to simply address the crisis at hand.

Call today to speak with someone, and learn if DBT is right for you.

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Tools Used in DBT Therapy

Dialectical behavior therapy techniques and tools include the following:

• Homework assignments are a key component in DBT therapy techniques. Homework reinforces skills learned in group practice and allows clients to apply them to real-world situations in daily life.
• Diary cards are used to track feelings and behaviors, DBT therapy techniques used, and resulting consequences. Clients rate their moods and check off skills used. Cards help clients recognize patterns and triggers. They also provide data to be discussed during individual therapy sessions.
• Boundary setting is an essential part of this therapy. DBT core skills modules help clients set boundaries by improving interpersonal communications, teaching assertiveness, and building self-respect.

DBT Therapy Techniques and Skills

Dialectical behavior therapists use particular techniques to guide you toward personal growth and improved mental health, and there are specific skills they teach you in the course of your treatment.

Understanding what these are can help you better know what to expect and whether DBT can help you.

The Four Core DBT Skills Modules

DBT focuses on teaching four types of emotional management skills: mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness.

Mindfulness

Mindfulness means placing one’s full attention on the present moment, instead of dwelling on past memories or regrets, or on future concerns. Being aware of presently occurring thoughts and feelings, without judging or trying to change them, fosters what is known in DBT as “wise mind.”

When using DBT wise mind, both your rational mind and emotional mind work together to help you make good choices, avoid impulsive reactions, and get in touch with your inner wisdom and intuitive guidance. DBT mindfulness techniques also help you recognize when boundaries are needed.

Distress Tolerance

DBT distress tolerance techniques teach skills for managing intense emotions rather than being overwhelmed by them. Being emotionally overwhelmed often causes you to react in an unhelpful way and causes a situation to worsen.

Examples of DBT therapy techniques for distress tolerance include:

1. Distractions, like counting or reciting affirmations
2. Self-soothing techniques like listening to music or taking a warm bath
3. The DBT “STOP” crisis technique:
   • Stop; don’t act impulsively.
   • Take a step back and distance yourself from the intensity of the situation.
   • Observe both internal thoughts and external circumstances.
   • Proceed mindfully.

The combination of these techniques can help you learn how to manage distress in a healthier and less destructive way.

Emotional Regulation

In dialectical behavior therapy, emotional regulation skills teach you how to understand and respond appropriately to negative or overwhelming emotions rather than being controlled by them. They teach the following steps:

1. Recognize and label your emotions. For example, emotions may be identified and labeled as “I am feeling angry.”
2. Refrain from acting on your immediate impulse and choose a more mindful and productive response, which would often be one that is opposite to your initial reaction.
   • For example, when angry, you might feel like yelling. Instead, mindfully choose to speak calmly.
3. Recognize that by replacing an impulsive choice with a more mindful, helpful one, you strengthen your emotional regulation skills and gain self-esteem.

Interpersonal Effectiveness

This DBT skill involves using healthy communication and setting boundaries.

The DBT therapy DEAR MAN acronym explains how to be assertive without damaging relationships:

• Describe the situation objectively, without blaming. For example, “I waited at the agreed upon restaurant. You didn’t come or call to cancel.”
• Express your feelings using “I messages,” such as, “I get worried when I don’t hear from you.”
• Assert your need or desire. For instance, “I need you to call if you are going to be late or are not able to meet.”
• Reinforce a positive outcome for your request being met. For example, “I’d feel less anxious and more understanding of your reason if you’d call.”
• Mindfully stay focused. In this example, if the other person deflects the conversation, gently steer it back to your request.
• Appear confident. For instance, speak clearly and maintain eye contact.
• Negotiate a compromise. For example, “We can try again tomorrow if you wish. What does your schedule look like?”

Download a free DBT Skills Worksheet.

DBT vs CBT Therapy

Because dialectical behavior therapy is based on cognitive behavioral therapy, there are similarities in theories and techniques. But there are also important differences when considering dialectical behavior therapy vs CBT.

Comparing DBT and CBT Approaches

• CBT focuses on changing negative thoughts to change behavior.
• DBT focuses on validating emotions while building coping skills.
• DBT emphasizes compassion, acceptance, and dialectical thinking.
• DBT incorporates mindfulness as an important component of skills training.

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DBT for Addiction and Substance Abuse

DBT is a common technique that’s used within addiction treatment. Dialectical behavior therapy for substance abuse uses DBT skills training to address cravings, triggers, and relapse prevention.

Why DBT Works in Addiction Recovery

There are countless psychotherapy techniques that are used, but not all of them are effective to treat substance use disorder. There are several factors that make DBT particularly effective for addiction recovery.

Skills That Foster Sustained Recovery

The skills training involved in dialectical behavior therapy for addiction is conducive to helping people better manage triggers that drive them to substance use:

• Mindfulness reduces impulsiveness and helps clients recognize triggers
• Distress tolerance helps clients cope with stress and cravings
• Emotional regulation allows the client to be less prone to powerful emotions that can trigger relapse
• Interpersonal skills help the client build support networks

All of this gives recovering individuals practical tools to build resilience and maintain abstinence.

Treating Co-Occuring Mental Health Conditions

DBT therapy for addiction is also effective in dealing with dual diagnosis conditions – the presence of substance use disorder along with one or more mental health conditions.

The use of mindfulness, DBT therapy wise mind, and emotional management are important tools for people with dual diagnosis to help them make good decisions and healthy choices. DBT’s focus on validation of personal experiences and emotions is especially helpful for individuals who have experienced trauma.

DBT treatment can be started at any point in addiction treatment, including detox if the patient is stable.

Who Benefits Most from DBT Therapy?

While Marsha Linehan originally developed dialectical behavior therapy for borderline personality disorder, it’s now effectively used in treatment for substance abuse and other conditions as well.

Other Conditions DBT is Used to Treat

Everyone’s needs in psychotherapy are different so a therapist determines the most effective techniques to use for each client and situation. Broadly, though, DBT is often used to treat:

• Depression
• Anxiety
• Eating Disorders
• PTSD

DBT is also useful in treatment for teens who are experiencing self-harm behaviors, suicidal behaviors, depression, anxiety, or other issues where symptoms of emotional dysregulation and distress tolerance are present. DBT for teens and adolescents is sometimes called DBT-A.

How Long Does DBT Therapy Last?

The duration of treatment and aftercare therapy for DBT can vary according to the severity of issues, the presence of co-occurring disorders, and other factors like client motivation and goals. But there are typical timelines.

DBT Treatment Duration and Aftercare

How long is DBT therapy? While you and your therapist can discuss expectations for your particular case, here are the fast facts about typical DBT treatment timelines:

• Standard DBT treatment programs typically last 6 to 12 months, but many last longer. DBT treatment involves long-term therapy because it takes time for DBT skills to become habituated.
• DBT clients often choose to continue DBT treatment in an aftercare environment.
• Aftercare for DBT often includes continued phone coaching and DBT support groups.

Finding DBT Therapy and Treatment Centers

If you believe DBT may be the best fit to treat your substance use disorder or other mental health condition, the most efficient way to begin your search for DBT treatment is often by obtaining a referral.

You could:

• Ask for a referral from your primary care provider or mental health therapist
• Call or visit your insurance provider’s website and ask for a DBT therapy referral
• Contact DBT support groups in your area and ask for referrals

This could allow you to directly find a therapist who specializes in DBT.

Where to Access DBT

DBT therapy is available at specialized dialectical behavior therapy treatment centers.

Dialectical behavior therapy can also often be accessed at:

• Rehab centers
• Mental health clinics
• Community mental health hospitals
• Psychiatric hospitals
• Private therapists’ offices

What to Ask When Choosing a DBT Provider

Finding the right fit in your DBT therapist is vital. When choosing a DBT provided, ask about:

• Training and experience, including access to peer consultation
• Types of DBT techniques they use (diary cards, homework assignments, etc.)
• Types of therapy components they offer (individual therapy, group therapy, phone coaching)
• Their schedule and whether they have availability that would coordinate with your schedule

Call now to connect with DBT therapy treatment centers near you.

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FAQs About DBT Therapy

Why DBT Matters for Recovery

DBT is a compassionate and effective tool for use in addiction recovery. It empowers recovering individuals to build healthier, more balanced lives. This technique can offer ample benefits:

• DBT is evidence-based treatment. DBT therapy effectiveness for treatment of substance abuse has been validated in studies reviewing DBT clinical programs.
• DBT for substance abuse teaches practical skills to help recovering individuals manage intense emotions that could trigger a relapse.
• DBT improves self-awareness, mindful reasoning, and decision-making.
• DBT helps people in recovery improve interpersonal relationships and create strong support networks.
• Continued use of DBT skills during aftercare helps clients sustain recovery successes.

Need something to help you stay on track? Download these FREE DBT Worksheets and get started today!

Need help finding DBT for your recovery? Call now for help.

800-996-6135

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