DBT Series: Introduction to Dialectical Behavior Therapy

Have you heard the phrase “Dialectical Behavior Therapy” or DBT and wondered what it is? Are you wondering if DBT could be a treatment options for yourself or your child/teen? You’re in the right place! This is the introduction to our DBT Series. Throughout this series, we’ll explore the theory behind DBT, the goals of DBT, the skills taught in DBT, and more! Follow along to learn all about DBT!

• What is Dialectical Behavior Therapy (DBT)?

  DBT is an evidence-based form of cognitive-behavioral therapy that focuses on helping youth and adults manage intense emotions, reduce self-destructive behaviors, and improve relationships. It was originally developed by Dr. Marsha Linehan to treat folks with borderline personality disorder, but it has since been adapted for many other conditions involving emotion regulation challenges, such as depression, anxiety, trauma-related disorders, and substance use concerns. 

  DBT helps people build the skills needed to tolerate distress, manage their emotions and behaviors, and interact more effectively with others. This approach combines principles of both acceptance and change. In practice, this means that people recognize their current circumstances and also work towards meaningful change. The term “dialectical” refers to the concept that two seemingly opposite ideas can both be true at the same time, such as “I am doing the best I can, and I can do better.” The dialectical perspective is especially important because many people with difficulties managing emotions can fall into an extreme way of thinking, like "people are all good or all bad." Extreme thinking patterns can cause emotions to intensify and become more difficult to cope with, which can in turn cause people to act in harmful ways to try to manage their emotions. In DBT, people learn to embrace both acceptance and change.

• Who is DBT for?

  DBT is for those of us who have trouble controlling emotions and behaviors (emotional and behavioral dysregulation). Folks who may be well-suited for DBT may often engage in impulsive or avoidant behaviors ("problem behaviors") that lead to harm, in an attempt to manage strong emotions. Examples of problem behaviors include suicidal behaviors, self-harm, aggressive behaviors, oppositional or argumentative behavior, property damage, substance use concerns, and risky sexual behaviors. DBT views problem behaviors as the result of a person’s attempt to cope with intense and difficult emotions, such as intense depression, anger, trauma, or general distress.

  DBT skills can be beneficial for a range of mental health concerns, problem behaviors, and diagnoses. Some of the common ones are:

  • Depression, Major Depressive Disorder (MDD)

  • Disruptive Mood Dysregulation Disorder (DMDD)

  • Post-Traumatic Stress Disorder (PTSD)

  • Anxiety, Generalized Anxiety Disorder (GAD)

  • Substance Use Disorders

  • Self-harm

  • Suicidal thoughts and behavior

  • Borderline Personality Disorder (BPD) symptoms (Note: BPD is typically not diagnosed in children and teens because their personalities are not stable. Symptoms of BPD are also common in other disorders, such as PTSD and depression).

• Why do some people have trouble controlling their emotions and behaviors?

  DBT uses the Biosocial Theory to understand emotion dysregulation. Some people have greater emotional vulnerability, meaning they have a high sensitivity to emotional triggers, they have an intense emotional response to triggers, and they are slow to return to baseline after encountering a trigger. They may feel their emotions go from 0 to 100 very quickly and then remain at 100 for a while. Triggers can be anything that makes us feel emotions, such as a bad grade on a test, an argument with a caregiver, or a reminder of a trauma or stressor. Emotional vulnerability is thought to be related to biological factors (for example, a temperamental predisposition) and can often be a trait recognized within families. Importantly, having greater emotional vulnerability is not a fault or failure!

  According to the Biosocial Theory, some folks who have greater emotional vulnerability and are in an emotionally invalidating environment are at an increased risk for becoming emotionally dysregulated over time. An invalidating environment is an environment where important people in a person’s life, such as parents/caregivers, siblings, or teachers, respond to emotions in ways that minimize, dismiss, or ignore them, even when unintentional. Instead of acknowledging or validating expressions of emotions, others' responses may punish or disregard the emotion. At the same time, the environment may unintentionally reinforce or reward problem behaviors that occur during emotional distress, increasing the likelihood that these behaviors and emotional responses will be repeated in the future. 

  For example, imagine a teenager who often feels frustrated about school and struggles to connect with classmates, frequently feeling misunderstood and left out [emotional vulnerability]. 

  When they try to share these feelings [message of distress], a parent might respond with comments like “it will get better,” “others have it worse,” or “just go make friends” in an attempt to cheer the teen up, put things in perspective, or problem-solve [invalidating environment]. While well-intentioned, these responses can unintentionally send the message that the teen’s emotions are unimportant, bad, or should be avoided. 

  Over time, the teen may stop expressing their sadness or insecurity directly. Instead, they might begin showing their distress in other ways, like through angry outbursts, shutting down, or even engaging in risky behavior [intensifying messages of distress]. These reactions often draw more attention, concern, or soothing from others, which can accidentally reinforce the very behaviors that signal distress. In this way, the environment begins to reward the behaviors that are problematic and disruptive, rather than the more vulnerable attempts to communicate emotions.

  It is very important to note that this pattern doesn’t stem from a single misunderstanding but from repeated experiences that shape how a person learns to manage and express emotions. Recognizing this cycle with compassion helps us respond in ways that validate the teen’s feelings, help them feel understood, and guide them toward healthier emotional expression.

• What are the DBT skills?

  DBT for older children and adolescents has five components: Mindfulness, Distress Tolerance, Emotion Regulation, Walking the Middle Path, and Interpersonal Effectiveness. (Note that DBT for adults typically does not include Walking the Middle Path). One thing that is interesting about this approach is that DBT-trained therapists apply the very same strategies their clients learn to their own lives! 

  • Mindfulness: people learn skills to increase their awareness of internal experiences (e.g., emotions, thoughts) and increase control over their attention.

  • Distress Tolerance: people learn skills to tolerate uncomfortable emotions, decrease impulsive and harmful behavior, and accept their reality.

  • Emotion Regulation: people learn skills to reduce negative or unhelpful emotions and increase positive and more desirable emotions.

  • Walking the Middle Path: people learn skills to reduce conflict such as validation, behavior change, and dialectical thinking (perspective taking).

  • Interpersonal Effectiveness: people learn skills to improve and maintain family and social relationships, set boundaries, and improve self-respect.

• Where can I learn more about DBT?

  We will be continuing our DBT Series to provide more information on DBT. You can also learn more about DBT from these trusted sources:

  https://my.clevelandclinic.org/health/treatments/22838-dialectical-behavior-therapy-dbt 

  https://www.psychologytoday.com/us/therapy-types/dialectical-behavior-therapy

At Richmond Family Psychology, Dr. Sarah Pittman specializes in teaching older children, teens, and their families emotion regulation skills using DBT-informed therapy. In addition, Dr. Pittman offers the following structured, time-limited DBT skills training services to older children, adolescents, and their families:

• DBT Individual Skills Training [Individual therapy], Length: about 24 sessions or about 6 months; 50-min session

• DBT Family Skills Training [Child or teen plus parent/caregiver(s)], Length: about 18 sessions or 4.5 months; 60-min session

• DBT Caregiver Skills Training [Parents/caregivers individually], Length: 6-12 sessions or about 2.5 months, 50-min sessions

Contact Dr. Pittman to learn more about DBT services in the Richmond area: 

Phone: 804-214-6414  | Email: spittman@richmondfamilypsychology.com

Ready to request an appointment? Click here!