Dialectical Behavioural Therapy (CBT)

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What is DBT?

Dialectical Behavioral Therapy (DBT) is a cognitive-behavioral treatment approach developed by Marsha Linehan in the late 1980s. It emphasizes the psychosocial aspects of treatment and combines standard cognitive-behavioral techniques with concepts of mindfulness, acceptance, and dialectical strategies. The term "dialectical" refers to the synthesis of opposites, particularly the balance between acceptance and change.

History of DBT

DBT was initially developed to treat individuals with borderline personality disorder (BPD) and chronic suicidal tendencies. Borderline Personality Disorder (BPD) is characterized by emotional instability, impulsive behavior, interpersonal difficulties, and a chronic pattern of self-harm or suicidal behavior. Marsha Linehan found that traditional cognitive-behavioral therapy (CBT) was insufficient for this population, leading her to integrate acceptance-based strategies. DBT was specifically developed to address these challenges, and over the years, extensive research has been conducted to evaluate its effectiveness in treating BPD.

Early Development

Linehan's work began with the adaptation of CBT to include techniques for acceptance and tolerance of distress. She recognized that a more compassionate approach was needed for individuals with BPD, who often experienced intense emotional pain.

Integration of Zen Principles

Linehan incorporated principles from Zen Buddhism, including mindfulness and acceptance, to create a more holistic approach. This integration marked a significant shift in therapeutic strategies, emphasizing both change and acceptance.

Expansion to Other Disorders

DBT was initially designed for individuals with BPD, but its applicability has expanded to include:

  • Borderline Personality Disorder (BPD)

  • Eating Disorders

  • Substance Abuse Disorders

  • Depression and Bipolar Disorder

  • Post-Traumatic Stress Disorder (PTSD)

  • Chronic Self-Harm and Suicidal Behaviors

Its principles have proven to be versatile and applicable across various clinical populations.

Components of DBT

DBT can be conducted either in individual therapy with a psychologist trained in DBT, or in a group therapy setting. DBT consists of several key components that work together to create a comprehensive treatment approach:

1. Individual Therapy - Individual therapy sessions focus on enhancing motivation and applying DBT skills to specific challenges and events in the patient's life.

2. Group Skills Training - Group sessions teach skills in four main areas: mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness. These skills are essential for managing emotions, relationships, and coping with distress.

Essential Skills

The skills taught in DBT are grouped into four main modules, each designed to address specific challenges and foster personal growth:

1. Mindfulness (Linehan, 2014)

Mindfulness involves being fully present and engaged in the current moment without judgment. It is the foundational skill in DBT, teaching individuals to observe, describe, and participate in their experiences without unnecessary criticism or avoidance. Techniques may include focused breathing, body scanning, and mindful eating. Mindfulness promotes self-awareness and emotional balance.

2. Distress Tolerance (Chapman et al., 2011)

Distress tolerance skills help individuals cope with painful emotions without resorting to destructive behaviors. These skills are particularly crucial for individuals prone to self-harm or impulsive actions. Techniques include:

  • Distraction: Redirecting attention away from distressing thoughts or feelings.

  • Self-Soothing: Engaging in comforting activities that engage the senses, such as listening to soothing music or taking a warm bath.

  • Improving the Moment: Using imagery, relaxation, or positive affirmations to create a sense of calm.

  • Acceptance: Practicing radical acceptance of the situation, recognizing that it exists without approving or rejecting it.

3. Emotion Regulation (Gross & Thompson, 2007)

Emotion regulation skills teach individuals to understand and manage their emotions. This includes:

  • Recognizing Emotional Triggers: Identifying situations or thoughts that trigger emotional reactions.

  • Reducing Emotional Vulnerability: Building a lifestyle that fosters emotional resilience, such as regular sleep and balanced nutrition.

  • Increasing Positive Experiences: Actively seeking out positive experiences and emotions.

  • Managing Extreme Emotions: Utilizing techniques to reduce the intensity of overwhelming emotions.

4. Interpersonal Effectiveness (Fruzzetti & Iverson, 2006)

Interpersonal effectiveness skills focus on assertiveness, empathy, and maintaining self-respect in relationships. These skills help individuals to:

  • Communicate Effectively: Expressing needs and feelings clearly and assertively.

  • Maintain Relationships: Balancing personal needs with the needs of others to foster healthy relationships.

  • Negotiate Conflicts: Using problem-solving and negotiation skills to resolve conflicts.

  • Respect Self and Others: Practicing respect for oneself and others, even in challenging interactions.

These essential skills form the core of DBT's therapeutic approach, providing individuals with practical tools to navigate life's challenges with greater resilience and wisdom.

Evidence of Effectiveness of DBT in Treating Personality Disorders

DBT's effectiveness in treating personality disorders, particularly BPD, has been well-documented:

Randomized Controlled Trials - Several randomized controlled trials (RCTs) have been conducted to assess the effectiveness of DBT in treating BPD. These studies have consistently shown that DBT is effective in reducing self-harm, suicidal behaviors, and hospitalizations among individuals with BPD (Linehan et al., 1991; Linehan et al., 2006).

Reduction in Suicidal Behavior - One of the most significant outcomes of DBT is its impact on suicidal behavior. Studies have shown that individuals undergoing DBT are less likely to engage in suicidal attempts and self-harm behaviors compared to those receiving other treatments or standard psychiatric care (Linehan et al., 1999).

Improvement in Emotional Regulation - DBT's focus on emotion regulation skills has been found to be particularly beneficial for individuals with BPD. Research has shown that DBT helps patients recognize and manage their emotions more effectively, reducing emotional instability and impulsivity (Neacsiu et al., 2010).

Enhancement of Interpersonal Relationships - DBT's interpersonal effectiveness skills training has been shown to improve interpersonal relationships for individuals with BPD. This includes better communication, empathy, and conflict resolution skills, leading to more satisfying and stable relationships (Stepp et al., 2008).

Long-term Outcomes - Studies have also examined the long-term outcomes of DBT for BPD. Findings suggest that the benefits of DBT extend beyond the duration of treatment, with sustained improvements in functioning, symptom reduction, and quality of life (Linehan et al., 2006).

Comparative Studies

DBT has been compared to other therapies, often showing superior outcomes in areas such as emotion regulation, interpersonal functioning, and overall symptom reduction (Kliem et al., 2010).

Meta-Analyses

Several meta-analyses have confirmed the robust effects of DBT across various studies, solidifying its standing as an evidence-based treatment for BPD (Panos et al., 2014).

The effectiveness of DBT in treating BPD is well-supported by empirical evidence. Its comprehensive approach, focusing on acceptance, change, and skill-building, has proven to be highly effective in addressing the complex challenges of BPD. The positive outcomes in reducing suicidal behavior, enhancing emotional regulation, improving interpersonal relationships, and demonstrating long-term benefits make DBT a leading treatment choice for BPD.

Conclusion

Dialectical Behavioral Therapy represents a significant advancement in the field of psychotherapy. Its unique blend of cognitive-behavioral strategies with mindfulness and acceptance principles offers a compassionate and effective approach to treating complex mental health conditions. The evidence supporting its effectiveness, particularly in treating personality disorders, underscores its value as a therapeutic approach.

Frequently Asked Questions

  • Dialectical Behaviour Therapy is an evidence‑based treatment designed to help people manage intense emotions, reduce impulsive behaviours, and build more stable and fulfilling relationships. DBT combines acceptance‑based strategies with practical skills, making it especially helpful for individuals who feel overwhelmed by their emotions or caught in recurring patterns of distress.

  • DBT was originally developed for people who feel emotions very intensely and may struggle with coping in ways that sometimes cause harm or distress, but it is now widely used for a range of difficulties, including: 

    • Borderline Personality Disorder (BPD)  

    • Intense emotional reactions  

    • Impulsivity  

    • Chronic feelings of emptiness  

    • Interpersonal conflict  

    • Anxiety and stress  

    • Trauma‑related symptoms

    Many people seeking DBT therapy in Sydney do so because they want a structured, compassionate approach to managing emotions and relationships

  • DBT focuses on four core skill areas:  

    • Mindfulness – staying grounded and aware in the present moment  

    • Distress Tolerance – coping with crises without making things worse  

    • Emotion Regulation – understanding and managing intense feelings  

    • Interpersonal Effectiveness – communicating clearly and maintaining healthy boundaries  

    A DBT Psychologist will tailor these skills to your personal history, emotional patterns, and goals.

  • DBT is based on Cognitive Behaviour Therapy (CBT) but goes further by integrating mindfulness, acceptance, and emotional regulation strategies. While CBT focuses on thoughts and behaviours, DBT places stronger emphasis on emotions, relationships, and tolerating distress.

  • Yes. Many clients access dialectical behaviour therapy in Sydney online, especially those who prefer the privacy and convenience of telehealth. Online DBT is effective and allows clients to practise skills in their everyday environment.

  • Not necessarily. While full DBT programs include individual therapy, group skills training, and phone coaching, many clients benefit from DBT‑informed individual therapy alone. At The Psychology Alley, DBT skills are integrated into personalised, depth‑oriented therapy—particularly for clients with BPD, trauma histories, or chronic emotion dysregulation.

  • DBT is often a medium‑ to long‑term therapy, depending on your goals and the complexity of your emotional patterns. Some people focus on learning core skills over several months, while others engage in longer‑term work to address deeper relational and identity‑based themes.

  • No. Although DBT is one of the most effective treatments for Borderline Personality Disorder, it is also helpful for anyone who:  

    • feels emotions intensely  

    • struggles with impulsive behaviours  

    • experiences unstable relationships  

    • finds it difficult to self‑soothe  

    • wants practical tools for emotional resilience

    Many clients seeking dialectical behaviour therapists in Sydney do not have a formal diagnosis.

  • A typical DBT session may include:  

    • Reflecting on recent emotional experiences  

    • Identifying triggers and patterns  

    • Learning and practising DBT skills  

    • Exploring underlying beliefs and relational themes  

    • Developing strategies for managing distress 

    Sessions are collaborative, structured, and grounded in compassion.

  • Look for a psychologist who:

    • Has experience working with BPD and emotion dysregulation  

    • Uses evidence‑based DBT principles  

    • Offers a warm, steady, and non‑judgmental therapeutic presence  

    • Understands the complexity of trauma and relational patterns  

    • Tailors therapy to your cultural and personal context

    At The Psychology Alley, DBT is offered within a thoughtful, culturally informed, and depth‑oriented therapeutic approach.

References

  • Chapman, A. L., Gratz, K. L., & Tull, M. T. (2011). The Dialectical Behavior Therapy Skills Workbook for Anxiety: Breaking Free from Worry, Panic, PTSD, and Other Anxiety Symptoms. New Harbinger Publications.

  • Fruzzetti, A. E., & Iverson, K. M. (2006). Mindfulness, acceptance, validation, and “individual” psychopathology in couples. In R. Baer (Ed.), Mindfulness-Based Treatment Approaches: Clinician's Guide to Evidence Base and Applications (pp. 168-191). Elsevier Academic Press.

  • Gross, J. J., & Thompson, R. A. (2007). Emotion Regulation: Conceptual Foundations. In J. J. Gross (Ed.), Handbook of Emotion Regulation (pp. 3-24). The Guilford Press.

  • Koerner, K., & Linehan, M. M. (2000). Research on Dialectical Behavior Therapy for Patients With Borderline Personality Disorder. Psychiatric Clinics, 23(1), 151-167.

  • Kliem, S., Kröger, C., & Kosfelder, J. (2010). Dialectical behavior therapy for borderline personality disorder: A meta-analysis using mixed-effects modeling. Journal of Consulting and Clinical Psychology, 78(6), 936-951.

  • Linehan, M. M. (1993a). Cognitive-Behavioral Treatment of Borderline Personality Disorder. Guilford Press.

  • Linehan, M. M. (1993b). Skills Training Manual for Treating Borderline Personality Disorder. Guilford Press.

  • Linehan, M. M. (2014). DBT Skills Training Manual (2nd ed.). Guilford Press.

  • Linehan, M. M., Armstrong, H. E., Suarez, A., Allmon, D., & Heard, H. L. (1991). Cognitive-behavioral treatment of chronically parasuicidal borderline patients. Archives of General Psychiatry, 48(12), 1060-1064.

  • Linehan, M. M., Comtois, K. A., Murray, A. M., et al. (2006). Two-year randomized controlled trial and follow-up of dialectical behavior therapy vs therapy by experts for suicidal behaviors and borderline personality disorder. Archives of General Psychiatry, 63(7), 757-766.

  • Linehan, M. M., Heard, H. L., & Armstrong, H. E. (1993). Naturalistic follow-up of a behavioral treatment for chronically parasuicidal borderline patients. Archives of General Psychiatry, 50(12), 971-974.

  • Neacsiu, A. D., Rizvi, S. L., & Linehan, M. M. (2010). Dialectical behavior therapy skills use as a mediator and outcome of treatment for borderline personality disorder. Behaviour Research and Therapy, 48(9), 832-839.

  • Panos, P. T., Jackson, J. W., Hasan, O., & Panos, A. (2014). Meta-analysis and systematic review assessing the efficacy of dialectical behavior therapy (DBT). Research on Social Work Practice, 24(2), 213-223.

  • Stepp, S. D., Epler, A. J., Jahng, S., & Trull, T. J. (2008). The effect of dialectical behavior therapy skills use on borderline personality disorder features. Journal of Personality Disorders, 22(6), 549-563.