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Dialectical Behavior Therapy, or DBT, is a form of Cognitive Behavioral Therapy that focuses on solving behavioral problems by incorporating dialectical processes and acceptance-based strategies. It is best suited to the needs of patients suffering from intense emotional distress that prevents them from experiencing a good quality of life.

DBT was developed by American psychology researcher and author, Marsha Linehan. She created the therapy as a result of her struggles with schizophrenia and suicidal thoughts at a young age. She was institutionalized for her mental illness until the age of 18.

Convinced that CBT left a gap that needed to be filled, Linehan developed DBT at the University of Washington years later. DBT consists of four key skill areas and main components: interpersonal skills training, distress tolerance, emotional regulation, and mindfulness training.

DBT treatment can be delivered in many ways, typically consisting of individual therapy sessions and/or DBT skills groups. For example, while some patients may complete individual therapy sessions without attending any skills group, others might opt for group sessions without individual therapy.

An individual therapy session consists of a one-on-one session with a DBT therapist. This ensures that the patient’s therapeutic needs are attended to. Over the course of the treatment, the therapist will also help the patient apply DBT skills on a daily basis, appropriately address daily struggles that occur, and stay motivated.

DBT skills groups, on the other hand, encourage members to learn and practice skills with each other while they are led by a DBT therapist. Members provide mutual support and listen as others share their experiences.

Therapists in a group session teach skills and lead members in group exercises. Each member is assigned homework, which often involves practicing mindfulness exercises.

Group sessions are typically completed within six months. Weekly sessions are conducted with each one lasting around two hours. The exact length of each session depends on the needs of each member.

To build a life worth living, which is the main goal of DBT, client and therapist first sit down and make plans. They then set their goals and expectations.

There are five components in a standard DBT treatment program: a) a skills group, b) individual therapy, c) skills coaching, d) case management, and e) a consultation team. This section will provide an overview of the standard program.

Led by a therapist group leader, group sessions for teaching and learning behavioral skills happen every week and last about 2.5 hours. They are run like a class, and homework assignments are given so that patients can practice their newfound skills.

Twenty-four weeks are required for the entire skills curriculum, and this can be repeated to create a 1-year program. Depending on the situation and the needs of the patients, a shorter subset of this curriculum can also be taught.

The purpose of this skills group training is to improve clients' capabilities so they can effectively deal with the problems and challenges that arise in their daily lives. They learn from these four skills modules:

Of these four skills modules, mindfulness and distress tolerance belong to the acceptance strategy of DBT; interpersonal effectiveness and emotion regulation belong to the change strategy.

The purpose of an individual psychotherapy session is to improve the motivation of each patient. Personal issues and struggles are talked about, with the therapist encouraging the patient in the light of DBT's focus on acceptance and change. Skills learned in group sessions are also reinforced. Furthermore, a real relationship of mutual help between therapist and patient is formed; the therapist becomes a true partner in the process, not just a teacher or observer.

Like with the skills group training, an individual therapy session happens every week and runs concurrently with it.

DBT patients can call their therapists at any time of the day, to ask for advice whenever problems arise. The goal of skills coaching is to train patients to practice and apply the skills they are learning in their lives.

This is about helping patients manage their own lives. The therapist advises on the things to be done but intervenes only when necessary.

The therapists themselves are part of a consultation team, in which they are given support for the work they are doing. This way, they will stay motivated and competent. This kind of emotional support is especially needed for difficult cases.

Clients who choose to undergo Dialectical Behavior Therapy often have several behavioral problems to be treated, not just one. The therapist will then have to prioritize problems according to the following hierarchy: (1) threat to life, (2) interference to therapy, (3) interference to quality of life, and (4) the need to learn new skills. For example, suicidal thoughts of a patient will be dealt with first, before alcohol abuse.

Lastly, there are 3 to 4 stages of treatment for DBT. Stage 1 corresponds to the initial life of the patient being out of control. Stage 2 corresponds to continued silent suffering after some control has already been achieved. Stage 3 corresponds to the challenge of living life: setting goals, gaining self-respect, finding happiness. And Stage 4, which is needed only by some, corresponds to finding a deeper fulfillment and completeness through spirituality of some kind.

So, does it really work? The answer is a resounding yes. DBT is a treatment based on evidence, and research has shown that it is indeed effective against the mental health illnesses it is used on, which are many. It is also found to be effective on people of diverse backgrounds (in terms of age, gender, sexual orientation, and race), and it's already been implemented in more than 25 countries.