Dialectical behavior therapy primarily is used for people battling suicidal thoughts and self-injurious behaviors. This form
of treatment involves four components: individual psychotherapy, group skills training, phone coaching and ongoing support
from a team of therapists.
DBT is a modified form of cognitive behavioral therapy, a psychotherapy used to help people deal with a range of mental health
problems, including depression, suicidal thoughts and substance use disorders. However, DBT differs from CBT in that
DBT encourages clients to learn to accept stressing thoughts, feelings and behaviors rather than reject them. Therapists
aim to help clients find a balance between acceptance and change to overcome their problems.
Nanci Stockwell of Advanced Recovery Systems describes dialectical behavioral therapy and the skills that are developed during DBT.
Over the years, DBT has been altered to address
substance use disorders
. Multiple studies show that this updated approach, called DBT-SUD, can reduce drug use in
people with borderline personality disorder, a mental disorder characterized by unstable relationships, distorted self-image
and impulsiveness. Although research involving the impact of DBT on drug use is limited, additional research could indicate
DBT’s effectiveness in treating other substance-using populations.
The History of DBT
In the 1970s, Dr. Marsha Linehan developed DBT after she attempted to use CBT to treat adult women who had battled suicidal
ideation, suicide attempts and self-harm.
Linehan and a team of researchers investigated the effectiveness of standard CBT on women with suicidal thoughts caused by
psychological pain, a symptom of borderline personality disorder. She found the therapy technique wasn’t always effective,
partially because of its focus on rejecting painful thoughts.
“So then [Linehan] had this brilliant epiphany,” Dr. Alec Miller, professor in the Department of Psychiatry and Behavioral
Sciences at the Albert Einstein College of Medicine, told the Child Mind Institute. “[She blended] the acceptance strategies
of mindfulness with the change technologies of CBT to create this dialectical behavior therapy.”
Linehan altered standard CBT by integrating strategies of acceptance. This allowed therapists to explain that the problematic
thoughts many people harbored were okay. Through this modification to CBT, clients could learn to trust themselves.
Researchers combined elements of acceptance and change to create dialectical strategies, which helped therapy sessions run
DBT and Substance Abuse
After developing DBT, Linehan led a study to determine whether the approach was effective in treating women battling borderline
personality disorder and
Researchers compared participants who engaged in DBT with a control group who received standard treatment. Those who were
receiving treatment during the pretreatment evaluation were permitted to stay with their psychotherapists during the
study. Others entered alternative substance abuse or mental health programs.
The results showed that DBT was more effective than standard treatment in treating people with borderline personality disorder
and a substance use disorder involving opioids,
, amphetamines, sedatives, hypnotics and anti-anxiety medications. Researchers found that DBT clients showed
reduced substance abuse, and they were more likely to continue therapy than those in traditional treatment.
A 2015 study published in the journal Addictive Behaviors used DBT in conjunction with cultural, spiritual and traditional
practices to treat 229 adolescents at an
inpatient rehab facility
. The results showed 96 percent of adolescents improved or recovered from their substance
use disorders over time.
Another 2015 study, published in Current Opinion in Psychology, reviewed multiple reports about the use of DBT-SUD in individuals
with borderline personality disorder and multiple drug dependencies.
DBT-SUD is a modified version of dialectical behavior therapy that incorporates substance abuse prevention strategies to
help individuals overcome addiction. Through this approach, therapists use problem-solving techniques to discuss the
importance of harm reduction and a realistic approach to relapse avoidance.
Researchers concluded that DBT-SUD has shown promise in treating drug disorders among women with borderline personality disorder,
and it may be helpful in treating other drug-using populations.
Interested in how DBT can help with your addiction?We have programs designed specifically for you.
What Are the Stages of DBT?
Before engaging in dialectical behavior therapy, a health care professional generally explains the process of this substance abuse treatment
approach. The therapist and client collaborate to develop realistic goals to be achieved during each of the four stages
During stage one of DBT, individuals strive to gain control over their reckless behaviors, which could include heavy drinking
or drug abuse. Those entering this level of therapy often have a history of self-harming, suicidal thoughts or mental
Stage one is designed to help people overcome these behaviors and achieve stability. It also aims to decrease behaviors that
interfere with therapy. Through this stage, clients learn to increase their ability to manage stress and effectively
interact with others.
Those in stage two of DBT have learned to manage their behaviors, but their emotional health remains an issue. They often
suffer in silence. Upon entering this level of therapy, people may experience drug or
, have symptoms of an eating disorder or engage in nonsuicidal self-injury.
During the second stage, clients develop goals to be achieved during therapy. These targets are contingent on the severity
of existing problems and the relationships between them. Individuals also learn self-validation techniques and how to
maintain focus and control emotional stress.
Stage two aims to relieve traumatic stress. A therapist may help someone with post-traumatic stress disorder and alcohol
dependence through interventions that involve behavioral analyses, exposure therapy and techniques to improve self-validation
People in stage three of DBT often have problems with achieving happiness. In response, therapists help clients increase
self-respect and self-esteem, identify life goals and recognize a normal balance of happiness and unhappiness.
Many people have trouble achieving a sense of connectedness, joy and freedom. Stage four of DBT uses long-term psychotherapy
to help individuals overcome these feelings and live a life of spiritual fulfillment.
What Skills Are Taught in DBT?
Dialectical behavior therapy incorporates four skills intended to help people overcome their distressing thoughts and unhealthy
behaviors. Each set of skills has its own unique characteristics that help clients better understand their emotions.
Mindfulness is a mental state characterized by being aware and accepting of the present moment, including our thoughts, feelings
and environment. Mindful people focus on the moment without judgement.
This skill teaches clients to control their thoughts and to avoid letting their minds dictate their lives. They can use this
knowledge to maintain a positive state of mind, to better understand their emotions and to effectively accept stress
rather than push it away.
Individuals who regulate their thoughts and feelings during tough times often make wise choices. Others react to highly stressful
situations in a hostile manner, which may lead to regrettable decisions. Distress tolerance teaches people to make sound
decisions in difficult moments.
Through this module, therapists teach crisis survival skills to clients. This information helps distressed individuals avoid
exhibiting antagonistic behaviors that could exacerbate problems. They learn to tolerate stress rather than change it.
Interpersonal effectiveness teaches clients to deal with others in healthy, effective ways. People develop an understanding
of how to ask for something and say no when necessary. In doing so, individuals learn how to handle difficult situations
and improve communication and relationships.
Emotion regulation helps people understand and control their emotions. This set of skills teaches clients to better understand
and express their emotions in order to alleviate psychological pain. The approach allows clients to avoid feeling overwhelmed
by their thoughts.
The Effectiveness of DBT for Co-Occurring Disorders
Studies indicate that dialectical behavior therapy, like CBT, has neurobiological effects on the brain.
A 2014 study published in the Journal of Psychiatric Research tested the effect DBT had on individuals with borderline personality
disorder, an illness that has been linked to depression, and drug and alcohol abuse. In the study, researchers took MRI
scans of patients as they viewed unpleasant, neutral and pleasant photographs. Scans were conducted before and after
The study found that DBT reduces activity in the amygdala, a part of the brain that is often disturbed in people with borderline
personality disorder. By reducing amygdala activity, DBT improves emotional behavioral health.
DBT and Suicidal Behaviors
DBT was developed to treat people with symptoms that include self-harm. Over the years, several studies have tested this
on people with such behaviors.
In a 2016 study funded by the American Foundation for Suicide Prevention, Dr. Anthony Ruocco and colleagues investigated
DBT’s effect on brain activity by evaluating 29 borderline personality disorder patients with self-harming behaviors.
Participants underwent brain image scanning while completing a computer task before and after DBT therapy.
Ruocco saw a change in brain activity after DBT treatment, and the therapy reduced self-harm behavior. After treatment, patients
showed increased activity in the prefrontal cortex, a part of the brain that controls emotional and behavioral health.
DBT helps individuals respond to difficult emotions in a more adaptive way. This form of treatment has also proven to reduce
suicidal episodes and psychiatric hospitalizations, according to a report by Yale University.
DBT and PTSD
Borderline personality disorder and PTSD share symptoms such as emotional avoidance, impulsive behavior and the development
of relationship problems. This suggests that DBT could be used to treat PTSD.
A 2013 study published in the journal Psychotherapy and Psychosomatics tested the effectiveness of DBT-PTSD in treating people
with borderline personality disorder and PTSD caused by childhood sexual abuse. DBT-PTSD blends elements of DBT and trauma-specific
The results showed that this treatment approach greatly improved the PTSD symptoms in many participants.
DBT has been used to treat
people with PTSD
prior to more specific treatment approaches such as exposure therapy. DBT uses elements of mindfulness
to help these individuals develop emotional regulation and distress tolerance.
DBT and Symptoms of Depression
A 2007 study published in the Journal of the American Academy of Child & Adolescent Psychiatry tested DBT methods on adolescents
. Nine of 10 patients completed treatment. At the conclusion of therapy, patients saw a decrease
in self-injurious behavior, suicidality and symptoms of
“Dialectical behavior therapy may offer promise as an approach to the psychosocial treatment of adolescent bipolar disorder,”
the study authors concluded.
A study published in the journal Behavior Therapy studied the efficacy of DBT in women veterans with borderline personality
disorder. Researchers found DBT to be effective in reducing thoughts of hopelessness, depression and angry outbursts.
The findings suggested that DBT can be effective in treating other groups of patients, including those without suicidal or
self-injurious behavior. In a randomized clinical trial cited by the study authors, researchers found that DBT is more
effective than treatment as usual for drug-dependent women with borderline personality disorder.
DBT and Eating Disorders
This treatment method works for people
suffering from eating disorders
as well. A 2001 study found that DBT significantly decreased
symptoms of bulimia
among women. These symptoms include binge and purge behaviors.
A 2006 study on DBT found this method of treatment helpful for people suffering from substance use disorders, binge eating
or depression. Researchers also found that this treatment method helped reduce suicide attempts, emergency
room visits and parasuicidal behavior such as self-harm.
A 2013 study published in Behaviour Research and Therapy tested the efficacy of DBT on people with binge eating disorder.
More than 88 percent of these individuals were women, and the average age of participants was about 43 years old.
After treatment, individuals who received DBT reported having fewer binge-eating episodes in the past month than study participants
on a wait list for treatment with DBT. DBT clients also reported having an improved quality of life six months after
Does DBT Work for Children and Teens?
Dialectical behavior therapy has been used to help people overcome a variety of issues ranging from substance abuse to mood
. But does this therapy work for children and adolescents? A 2011 study answered affirmatively.
The report, published in the journal Child and Adolescent Mental Health, used DBT on children aged 8 to 11 who experienced
symptoms of depression,
and suicidal thoughts. After treatment, children reported having better healthy coping skills. They also
showed decreases in depressive symptoms, suicidal ideation and other unhealthy behaviors.
“These promising preliminary results suggest that continued development of DBT for children with more severe clinical impairment
is warranted,” the authors concluded.
Health care professionals often use individual therapy, group skills training, weekly consultation team meetings and family
therapy when treating teens with DBT. This allows parents and adolescents to learn together and share feedback.
also are encouraged to call their therapists when in crisis.
Dr. Jill Emanuele, a clinical psychologist at the Child Mind Institute, said DBT for teens focuses on eating properly, getting
enough sleep, taking medications and avoiding substance use. Adolescents also learn to recognize and manage suicidal
Finding DBT Treatment
Many independent therapists, organizations and institutions in the United States use dialectical behavior therapy to treat
teens and adults with borderline personality disorder. The Linehan Institute offers workshops, books and webinars designed
to teach people more about DBT.
rehab centers throughout the country
have incorporated dialectical behavior therapy into their evidence-based treatment
strategy. It is particularly helpful for those who have trouble managing emotions and intrusive thoughts.
Matt Gonzales is a writer and researcher for DrugRehab.com. He graduated with a degree in journalism from East Carolina University and began his professional writing career in 2011. Matt covers the latest drug trends and shares inspirational stories of people who have overcome addiction. Certified by the Centers for Disease Control and Prevention in health literacy, Matt leverages his experience in addiction research to provide hope to those struggling with substance use disorders.
- American Foundation for Suicide Prevention. (n.d.). Does Dialectal Behavioral Therapy (DBT) Actually Change the Way the Brain Works? Retrieved from https://afsp.org/dialectal-behavioral-therapy-dbt-actually-change-way-brain-works/
- Appalachian State University. (n.d.). Stages of Treatment for Dialectical Behavior Therapy. Retrieved from http://www1.appstate.edu/~hillrw/DBT%20Website/stages.html#top
- Beckstead, D.J. et al. (2015, December). Dialectical behavior therapy with American Indian/Alaska Native adolescents diagnosed with substance use disorders: combining an evidence based treatment with cultural, traditional, and spiritual beliefs. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/26240942
- Bogart, D. (2016, April 26). Putting the Brakes on Emotional Reactions: Dialectical Behavior Therapy in the Treatment of Borderline Personality Disorder. Retrieved from https://campuspress.yale.edu/exploringmentalhealth/putting-the-brakes-on-emotional-reactions-dialectical-behavior-therapy-in-the-treatment-of-borderline-personality-disorder/
- Carey, B. (2011, June 23). Expert on Mental Illness Reveals Her Own Fight. Retrieved from http://www.nytimes.com/2011/06/23/health/23lives.html?pagewanted=all&_r=0
- Chapman, A.L. (2006, September). Dialectical Behavior Therapy. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2963469/
- DBT Skills Group of New Jersey. (n.d.). The Four Skill Modules. Retrieved from http://www.dbtskillsgroupnj.com/four-skill-modules/
- Friedman, F.B. (2009, October 16). ABCs of DBT: Dialectical Behavior Therapy in a Nutshell. Retrieved from http://il.nami.org/ABCs%20of%20DBT.pdf
- Garey, J. (n.d.). DBT: What Is Dialectical Behavior Therapy? Retrieved from https://childmind.org/article/dbt-dialectical-behavior-therapy/
- Goldstein, T.R. et al. (2007, July). Dialectical Behavior Therapy for Adolescents With Bipolar Disorder: A 1-Year Open Trial. Retrieved from http://www.sciencedirect.com/science/article/pii/S0890856709621705
- Goodman, M. et al. (2014, October). Dialectical behavior therapy alters emotion regulation and amygdala activity in patients with borderline personality disorder. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4263347/
- Harvey, P. (2012, April 14). Using DBT Skills To Reduce Emotion Dysregulation And Reactivity In Children/Adolescents And Parents. Retrieved from https://www.adaa.org/sites/default/files/Harvey%20131.pdf
- Koons, C.R. et al. (2001). Efficacy of Dialectical Behavior Therapy in Women Veterans With Borderline Personality Disorder. Retrieved from https://depts.washington.edu/brtc/files/Koons%20et%20al%202001.pdf
- The Linehan Institute. (n.d.). Get Clinical Training. Retrieved from http://behavioraltech.org/training/options.cfm
- The Linehan Institute. (n.d.). What is DBT? Retrieved from http://behavioraltech.org/resources/whatisDBT.cfm
- Linehan, M.M. et al. (1999). Dialectical Behavior Therapy for Patients with Borderline Personality Disorder and Drug-Dependence. Retrieved from https://pdfs.semanticscholar.org/2a24/1a7f38383a2608ea343f4571ade6345197fa.pdf
- Masson, P.C. et al. (2013, November). A randomized wait-list controlled pilot study of dialectical behaviour therapy guided self-help for binge eating disorder. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/24029304
- Mayo Clinic. (2015, July 30). Borderline personality disorder: Definition. Retrieved from #
- National Alliance on Mental Illness. (2013, February). Dialectical Behavior Therapy Fact Sheet. Retrieved from https://www2.nami.org/factsheets/DBT_factsheet.pdf
- National Institute of Mental Health. (n.d.). Borderline Personality Disorder. Retrieved from https://www.nimh.nih.gov/health/statistics/prevalence/borderline-personality-disorder.shtml
- Perepletchikova, F. et al. (2011, May 1). Adapting Dialectical Behaviour Therapy for Children: Towards a New Research Agenda for Paediatric Suicidal and Non-Suicidal Self-Injurious Behaviours. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3105788/
- Safer, D.L., Telch, C.F. & Agras, W.S. (2001, April 1). Brief Report: Dialectical Behavior Therapy for Bulimia Nervosa. Retrieved from http://ajp.psychiatryonline.org/doi/full/10.1176/appi.ajp.158.4.632
- State of California Department of Developmental Services. (n.d.). DBT Part 2: Behavioral Skills. Retrieved from http://www.dds.ca.gov/HealthDevelopment/docs/day2/Dialectical_Behavior_Therapy/DBT_Behavioral_Skills_Pt2.pdf
- Stotts, A.L. & Northrup, T.F. (2015, April 1). The Promise of Third-Wave Behavioral Therapies in the Treatment of Substance Use Disorders. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4674809/
- The University of California, Berkley. (n.d.). Mindfulness. Retrieved from http://greatergood.berkeley.edu/topic/mindfulness/definition
- Wagner, A.W. (n.d.). Applications of Dialectical Behavior Therapy to the Treatment of Trauma-Related Problems. Retrieved from https://www.adaa.org/sites/default/files/Wagner_MC.pdf