Dialectical Behavior Therapy (DBT)

Dialectical Behavior Therapy (DBT)

The term ‘dialectical’ is derived from classical philosophy. Dialectical Behavior Therapy (DBT) was originally developed by Marsha Linehan for treating borderline personality disorder, and has subsequently been adapted for binge eating disorder. Typically clients with BPD, as defined in DSM-IV, are notoriously difficult to treat (Linehan 1993a). They often do not attend regularly, frequently fail to respond to therapeutic efforts and make considerable demands on the emotional resources of the therapist (particularly when suicidal and parasuicidal behaviors are prominent). The effectiveness of DBT has been demonstrated in many controlled studies across different research groups. Because of this success and due to similar behavior patterns, DBT is now being used in many settings as a viable therapy for the treatment of bipolar disorder.

How it works

Dialectical Behavioral Therapy (DBT) consists of two parts:

  1. Once-weekly psychotherapy sessions in which a particular problematic behavior or event from the past week is explored in detail, beginning with the chain of events leading up to it, going through alternative solutions that might have been used, and examining what kept the client from using more adaptive solutions to the problem:
    Both between and during sessions, the therapist actively teaches and reinforces adaptive behaviors, especially as they occur within the therapeutic relationship. . . the emphasis is on teaching patients how to manage emotional trauma rather than reducing or taking them out of crises. . . . Telephone contact with the individual therapist between sessions is part of DBT procedures.
    (Linehan, 1991) DBT targets behaviors in a descending hierarchy:

    • decreasing high-risk suicidal behaviors
    • decreasing responses or behaviors (by either therapist or patient) that interfere with therapy
    • decreasing behaviors that interfere with/reduce quality of life
    • decreasing and dealing with post-traumatic stress responses
    • enhancing respect for self
    • acquisition of the behavioral skills taught in group
    • additional goals set by patient
  2. Weekly 2.5-hour group therapy sessions in which interpersonal effectiveness, distress tolerance/reality acceptance skills, emotion regulation, and mindfulness skills are taught (see summaries of sample worksheets). Group therapists are not available over the phone between sessions; they refer patients in crisis to the individual therapist.

There are four modules in DBT group skills training:

  • Core Mindfulness Skills – These are derived from Buddhist meditation techniques to enable the client to become aware of the different aspects of experience and to develop the ability to stay with that experience in the present moment.
  • Interpersonal Effectiveness Skills – These focus on effective ways of achieving one’s objectives with other people: to ask for what one wants effectively, to say no and be taken seriously, to maintain relationships and to maintain self-esteem in interactions with other people (comparable to assertiveness training).
  • Emotion Modulation Skills – These skills are ways of coping with intense emotional experiences and their causes. They also allow for an adaptive experience and expression of intense emotions.
  • Distress Tolerance Skills – These include techniques for putting up with, finding meaning for, and accepting distressing situations if there is no conceivable solution at present.

DBT for Binge Eating Disorder Techniques

  1. Mindfulness training: Learning to fully experience thoughts, emotions, and action urges without attempting to suppress them or judge them, and without experiencing secondary emotions such as guilt or shame.
  2. Identifying the antecedents and consequences of emotions.
  3. Becoming aware of the bodily responses that accompany negative emotions.
  4. Understanding the relationship between cognitions and emotions, and modifying cognitions that evoke negative emotions.
  5. Learning adaptive methods of coping with negative emotions: relaxing, taking walks, socializing, taking a warm bath, listening to soothing music.
  6. Getting adequate sleep and reducing excessive exercise and the use of drugs and alcohol.
  7. Reducing negative emotions, for example by facing rather than avoiding feared situations, and by revealing rather than hiding feelings of shame.



Cognitive Behavioral Therapy

Cognitive Behavioral Therapy

Cognitive therapy is fairly new to the mental health field, but we can actually trace its development back in time 2,600 years to the Buddha and the great emphasis his followers place on watching – and eventually taming – one’s thoughts. There, the goal is eventual enlightenment. Here, we are speaking in relatively more modest terms of saving one’s own life – of watching how you think in certain situations, and making the appropriate adjustments.

What is CBT?

Cognitive-behavioral therapy is an action-oriented form of psychosocial therapy that assumes that maladaptive, or faulty, thinking patterns cause maladaptive behavior and “negative” emotions. (Maladaptive behavior is behavior that is counter-productive or interferes with everyday living.) The treatment focuses on changing an individual’s thoughts (cognitive patterns) in order to change his or her behavior and emotional state.

Cognitive therapy is a well-researched method of psychological treatment that can be effective for dealing with emotional and behavioral problems. It is a way of talking about:

  • How you think about yourself, the world and other people
  • How what you do affects your thoughts and feelings.

CBT can help you to change how you think (“Cognitive”) and what you do (“Behaviour)”. These changes can help you to feel better. Unlike some of the other talking treatments, it focuses on the “here and now” problems and difficulties. Instead of focussing on the causes of your distress or symptoms in the past, it looks for ways to improve your state of mind now.

It has been found to be helpful in:

  • Anxiety
  • Depression
  • Panic
  • Agoraphobia and other phobias
  • Social phobia
  • Bulimia
  • Obsessive compulsive disorder
  • Post traumatic stress disorder
  • Schizophrenia

How effective is CBT?

CBT has been shown in clinical trials to help ease symptoms of various health problems. For example, research studies have shown that a course of CBT is just as effective as medication in treating depression and certain anxiety disorders. There may be long-term benefits of CBT as the techniques to combat these problems can be used for the rest of your life to help to keep symptoms away. So, for example, depression or anxiety are less likely to recur in the future. There is good research evidence too to show that CBT can help to improve symptoms of some physical conditions such as rheumatoid arthritis.


Cognitive-behavioral therapy does not suit everyone and it is not helpful for all conditions. You need to be committed and persistent in tackling and improving your health problem with the help of the therapist. Those who don’t have a specific behavioral issue they wish to address and whose goals for therapy are to gain insight into the past may be better served by psychodynamic therapy. Patients must also be willing to take a very active role in the treatment process.

Cognitive-behavioral intervention may be inappropriate for some severely psychotic patients and for cognitively impaired patients (for example, patients with organic brain disease or a traumatic brain injury), depending on their level of functioning.