These patterns can harm relationships and functioning across all settings. They may often result in suicidal behavior and/or a diagnosis of borderline personality. Certified practitioners of DBT offer acceptance and support to people in therapy. Many of the people they work with have conditions described as “difficult to treat.” They work to develop techniques for achieving goals, improving well-being, and effecting lasting positive change. In one study of DBT, as the participants developed more effective skills to manage their emotions, their substance use decreased too. Researchers believe this happened because their emotional coping skills increased and they had less of a need to use substances to numb their emotions.
Researchers and treatment developers have applied DBT to a variety of patient populations, but the preponderance of RCTs has focused on persons (mainly women) with BPD.3 The following section includes a brief review of the well-controlled RCTs that have evaluated DBT. Often, when people are overwhelmed with emotions, they may deal with the distressing feelings in ways that help them feel better in the moment. This can include substance abuse to numb the feelings or some type of immediate self-destructive action.
How long will I need dialectical behavior therapy?
In their sample of 41 clients, the total cost decrease was nearly a quarter of a million dollars. Interestingly, the authors also concluded that the cost of providing DBT treatment was not statistically different (actually, about $400 less) than the average outpatient costs from the year before DBT. Stages are defined by the severity of the client’s behaviors, and therapists work with their clients to reach the goals of each stage in their progress toward having a life that they experience as worth living.
DBT is a comprehensive and multifaceted therapy designed to help patients cope with extreme emotional suffering and, often, self-injurious behavior. Many patients seeking DBT have undergone other forms of therapy without experiencing significant improvement. DBT is a complex treatment modality that makes many demands of therapists and requires extensive training to be administered in the way it was developed and tested. In addition to keeping patients present-focused, it slows down emotional reactivity, affording people time to summon healthy coping skills in the midst of distressing situations. DBT can help individuals to recognize intense emotions, how to accept some of them as a part of life, and how to change ones that lead to negative actions. Through DBT, individuals learn how to accept themselves for who they are and develop tools for dealing with difficult emotions and managing stress.
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To date, there have been nine published randomized controlled trials and five controlled trials of DBT (view all publications). Two of these trials (carried out in our research clinic) specifically targeted highly suicidal women with BPD, and we are in the midst of a third trial targeting the same population. In our first study, results favoring DBT were found in each DBT target dialectical behavioral therapy area. In our second study, we compared DBT to a much stronger control condition, treatment by non-behavioral community experts (TBE). In comparison to TBE, DBT reduced suicide attempts by half, had less medically severe self-injurious episodes, lower rates of treatment drop-out, and fewer admissions to both emergency departments and inpatient units due to suicidality.
Many therapists believe that the treatment for borderline personality disorder, in particular, can often take several years. To that end, at both Adult and Adolescent Services, Yale offers high quality DBT treatment across levels of care, allowing patients and their families to be matched to treatments that best fit their needs. Additionally, offering DBT services across levels of care also supports patients in maintaining their treatment gains and meeting individualized goals.
In what order should DBT skills be learned?
In another study, after the first year of DBT treatment, 77% of the patients no longer met the criteria for a borderline personality diagnosis. Once a week, you talk with your therapist to learn how to apply DBT skills to specific challenges and situations in your own life. Another critical goal of DBT is to address behaviors that pose a life-threatening risk, such as suicidal thoughts, suicide attempts, and self-harm. In this module, you learn the skills to create healthy relationships while taking care of yourself.
In a study of depressed elderly patients who met criteria for a personality disorder,15 investigators compared an adapted version of DBT plus antidepressant medications to medications only. Findings indicated that a larger proportion of DBT patients were in remission from depression at post-treatment and at the six-month follow-up period. Research has found that beyond BPD, dialectical behavior therapy has been shown to help reduce suicidal behavior in adults.
Those in standard DBT attend therapy and a skills training group weekly. The groups are designed to help those in treatment develop behavioral skills through group work and homework assignments. These assignments allow people to practice learned skills in day-to-day life.
The main goal of therapists who use dialectical behavior therapy (DBT) is to strike a balance between validation (acceptance) of who you are and your challenges and the benefits of change. Your therapist will help you learn new skills to improve emotion regulation. Dialectical behavior therapy (DBT) is a type of talk therapy (psychotherapy).
Preliminary data suggest that DBT may have promise in reducing binge-eating and other eating-disordered behaviors. On the one hand, the most conservative clinical choice would be to limit DBT to women with BPD. On the other hand, DBT is a comprehensive treatment that includes elements of several evidence-based, cognitive-behavioral interventions for other clinical problems. The four DBT skills (mindfulness, distress tolerance, interpersonal effectiveness, and emotion regulation) are taught in separate group skills training modules. The standard DBT training schedule begins with two weeks of mindfulness training followed by five- to seven-week training modules in distress tolerance, interpersonal effectiveness, and emotion regulation. A two-week module of mindfulness training is interspersed between each five- to seven-week module.
- In deciding whether to use DBT or other treatments for a particular patient, one key deciding factor is the research data on the treatment with patients that are similar in terms of problem areas, diagnoses, or characteristics to the patient in question.
- By Nancy Schimelpfening
Nancy Schimelpfening, MS is the administrator for the non-profit depression support group Depression Sanctuary.
- Dialectical is a term that quite literally means integrating opposites – finding a balance between what needs to change and what can be accepted as is.
- Environments that lack solid structure and stability can intensify a person’s negative emotional responses.
- However, CBT primarily focuses on learning ways to change unhelpful thoughts and behaviours.
- Perhaps more importantly, the study demonstrated that utilization of high-cost inpatient services decreased by 50% and length of stay by 69%.
DBT is a form of cognitive behavioral therapy (CBT) that was first developed in the 1980s by psychologist Marsha Linehan, PhD, at the University of Washington in Seattle, according to the Association for Behavioral and Cognitive Therapies (ABCT). Most definitions revolve around criteria for PTSD with the addition of several other domains. While The APA may not recognize CPTSD, the WHO has recognized this syndrome in its 11th edition of the International Classification of Diseases (ICD-11).
