Dialectical Behavior Therapy

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DBT was developed by Marsha Linehan. Since the development there has been significant research to show its efficacy in the treatment of emotion dysregulation and Borderline Personality Disorder. It is most often considered for those with suicidal and self-harming behaviors. However, has been expanded to support those with addiction, trauma, eating disorders and treatment resistant depression. The treatment started with adults and has since expanded to adolescents and even children. 

Essentially, DBT assists in stabilizing the dysregulation. You can imagine it as going into the emergency room for treatment to address any serious conditions that are impacting right now. Today’s feelings and actions need specific interventions to assist with regulation. This is achieved via DBT specific interventions (i.e. diary card, Behavior Chain Analysis, Dialectical interventions, Acceptance principles, Coaching calls… just to name a few). 

Stage 1 DBT (aka Comprehensive DBT or “fidelity” DBT): 

This applies to both Adolescents (13 years +) and Adults (18 years +)

1) Weekly individual sessions with a DBT clinician

2) Weekly DBT skills class

3) Coaching calls to contact therapist for in the moment skills coaching

4) Therapist attends a weekly DBT consultation team meeting

Comprehensive DBT consists of weekly individual therapy, weekly skills group, daily diary card and coaching calls (prn). Depending on age, the therapy may last between 6-12 months. A successful completion is dependent on length of time in treatment, reduction of targets (or symptoms), and a mutual agreement with therapist that treatment is complete. 

*Everyone starts in pre-treatment stage which consists of 3-5 individual sessions. 

What are the benefits of DBT?

It works. *Want the most recent research on DBT? Check out: Efficacy Trials – Behavioral Tech

DBT Research Updates – Behavioral Tech

*Investing in DBT means investing in you. It also reduces long term mental health care costs. Dialectical Behavior Therapy and Mental Healthcare Costs – Behavioral Tech

Once stabilized, other treatment considerations are made (i.e. trauma interventions, completion of therapy, any other treatment modality) to assist the client in the continuation of building their life worth living. 

Have you graduated DBT Stage 1 (aka, comprehensive DBT)? Regardless if you completed it recently or years ago, it is quite an accomplishment. Congratulations! 

While the structured and time intensive work is completed in stage 1, there can still be additional goals moving forward. Stage 2 work is self-paced and more flexible than first stage. 

Once the behaviors settle (regulate) and a person is able to achieve behavioral control, they can be left with emotional distress. While DBT does not “cure” emotional vulnerability, it often lessens the suffering that co-occurs. However, some will notice a feeling of ‘quiet desperation’ following Stage 1. 

Stage II focuses on:

long term emotion regulation; 

living life with emotional vulnerability; 

processing emotional trauma(s) and/or chronic traumatic invalidation; 

targeting the Dialectical Dilemmas more fully; 

continuing to build and secure a life worth living; 

integrating other treatment options (i.e. EMDR, sensorimotor, neurotherapy *add links). 

Add this 16-week virtual course to help support your teen. This course is most effective for teens experiencing:

• Emotional reactivity
• Perfectionism
• Avoidance of responsibilities
• Upsetting worries
• Feeling hopeless
• Struggles within friendships
• Impulsivity
• Recent upsetting event(s)

In this course your teen will learn: 

• To improve communication skills that benefit relationships
• Regulate emotions 
• Build tolerance to stressful events
• Find balance between extreme states 
• Increase awareness

These benefits are based off of the DBT Modules: Core Mindfulness, Interpersonal Effectiveness, Emotion Regulation, Distress Tolerance, Walking the Middle Path. 

In the recent years, DBT has completed research on targeting trauma while receiving Stage 1 DBT. This was based off the research that shows relapse rates are higher if symptoms of PTSD were occurring at the time of DBT. This makes so much sense. If the trauma is not directly treated, people will experience initial relief, yet will be more prone to relapse over time. The current research that has been completed has combined DBT with Prolonged Exposure.

At Still Move Counseling, we offer a different combination with EMDR. So, if you are exploring options for attending to trauma(s) with a different method it can be vital for a therapist to understand DBT. The collaboration and DBT reinforcement are a couple examples of the many benefits you will receive. 

Want to know more about EMDR as a way to address trauma?  

DBT skills are lifelong skills. And yet, it is extremely easy to fall out of practice without the weekly support and reminders. Need a therapist who “speaks the language”? Or looking for a refresher on skills? Sometimes big adjustments require brief, DBT-informed therapy.
 *Therapist will assess need for comprehensive DBT or DBT informed therapy during initial evaluation. 

Our team also has two Nationally Certified DBT Providers from the Linehan Board. More about the certification: The overarching aim of the DBT-Linehan Board of Certification is to provide to the public at large and to relevant stakeholders a source that clearly identifies providers and programs that reliably offer DBT in a way that conforms to the evidence-based research.  Clinicians demonstrate that they have the requisite knowledge and skills to deliver DBT with adherence to the model as developed by Dr. Linehan and colleagues.  DBT Programs demonstrate having the necessary components and organization to deliver DBT with fidelity to the model.  A roster of certified clinicians and programs is available.