Dialectical Behavior Therapy
Also known as: DBT
Linehan's CBT extension adding mindfulness, distress tolerance, and emotion regulation.
Dialectical Behavior Therapy was developed by Marsha Linehan at the University of Washington in the 1980s and presented in her 1993 Cognitive-Behavioral Treatment of Borderline Personality Disorder. DBT integrates cognitive-behavioral techniques with mindfulness practices drawn from Zen Buddhist tradition, organized around the dialectic between acceptance and change — both fully accepting clients as they are, and committing to behavioral change. The standard treatment package combines weekly individual therapy, weekly skills-training group covering four modules (Mindfulness, Distress Tolerance, Emotion Regulation, Interpersonal Effectiveness), as-needed phone coaching for skills application in crisis, and weekly therapist consultation team. DBT was originally developed for chronically suicidal women diagnosed with borderline personality disorder, where it produces among the largest treatment effects in psychotherapy research, and has been adapted for substance use disorders, eating disorders, PTSD, and adolescent populations.
Core components
- Dialectic of acceptance and change
- Four skills modules: Mindfulness, Distress Tolerance, Emotion Regulation, Interpersonal Effectiveness
- Standard treatment package: weekly individual therapy + weekly skills group + phone coaching + consultation team
- Stages of treatment (1: behavioral stability, 2: emotional processing, 3: ordinary problems in living, 4: incompleteness/joy)
- Biosocial theory of borderline personality disorder
- Wise Mind concept
Primary use case
First-line treatment for borderline personality disorder; treatment of chronic suicidality and self-harm; adaptations for substance use disorders, eating disorders, PTSD, complex trauma, and adolescent populations; integration in psychiatric inpatient programs and intensive outpatient programs.
Common criticisms
- Standard four-mode package is resource-intensive and difficult to deliver in many community-mental-health contexts
- therapist training requirements are substantial (intensive training plus consultation team)
- skills-only adaptations show smaller effects than full DBT
- limited evidence on which components account for which outcomes (dismantling studies are scarce)
- the integration of Buddhist mindfulness with behavioral therapy raises questions about cultural appropriation when implemented without acknowledgment
- treatment-resistant subgroups within BPD remain a clinical challenge
- cost and access disparities limit who can receive full DBT.
Lineage
- Child of
- Cognitive Behavioral Therapy
- Siblings
- Cognitive Behavioral Therapy, Acceptance and Commitment Therapy, Schema Therapy
- Derived from
- Cognitive Behavioral Therapy