INFORMATION ON DIALECTICAL BEHAVIOR THERAPY

What is Dialectical Behavior Therapy (DBT)?

Dialectical Behavior Therapy (DBT) is an evidence based treatment developed at the University of Washington by Marsha Linehan, Ph.D., ABPP.  DBT was originally created for individuals who were suicidal or self harming; however, DBT has been used more broadly to help people with difficulty regulating emotions. This may manifest in a number of ways including:

·       very intense emotions that feel uncontrollable

·       intense anger or irritability

·       moving from one emotion to another quickly

·       feeling overwhelmed by emotions

Additionally, DBT addresses the following:

·       chaotic or tumultuous interpersonal relationships

·       impulsive behaviors such as excessive spending, substance abuse, unsafe sex, or binge eating

·       recurrent suicidal or self harm behaviors, threats, or gestures

·       chronic suicidal thoughts

·       fears of abandonment

·       difficulty knowing oneself or confusion about identity

·       feelings of emptiness

·       paranoia or feeling suspicious of others

·       dissociation or feeling as if a person is not really present

·       behaviors interfering with therapy such as non compliance with homework, non-attendance etc.

Comprehensive or full fidelity DBT is compromised of multiple components:

·       Individual therapy 

·       Skills Training (most often in a group skills class which includes teaching skills in mindfulness, interpersonal effectiveness, distress tolerance, emotion regulation, and middle path)

·       Phone or text coaching by your provider

·       Consultation team for the provider where she consults with other providers regarding how to best provide care for her clients

·       Diary cards (daily tracking by clients regarding emotions and behaviors that will lead to treatment gains based on goals)

** Sometimes providers will say they offer DBT; however, they only provide certain components (i.e. incorporate a few skills into treatment, but do not offer phone coaching or have a consultation team).  Not everyone needs all components of DBT; however, for certain diagnoses and problems, all components are necessary to ensure the highest likelihood of treatment success.  At CBH, Dr. Kleiber will do a thorough assessment of your presenting problems and goals and tailor a treatment program to fit your needs and difficulties.

What to expect:

·       A typical course of DBT is between 6-12 months; although many clients continue individual DBT after graduating from skills training.  That being said, DBT is time limited.  It is the job of Dr. Kleiber is to essentially work herself out of a job by helping you build the skills needed to attain your goals, first with the therapist and then independently.  

·       DBT teaches skills in a number of domains to build a life worth living.  Skills include: Mindfulness, meaning the ability to stay in the present moment, nonjudgmentally.  Mindfulness skills are foundation of the program and all other skills taught.  Distress tolerance, meaning the ability to get through life's crises without making the situation worse, as well as accept when things cannot be changed.  Emotion regulation, or the ability to stabilize emotions over time, change the emotions that you would like to change, and experience emotions as controllable and not overwhelming.  Interpersonal effectiveness, meaning the ability to ask for things and say no effectively, and maintain and build relationships and self respect.  Finally, middle path, which focuses on creating a balance in life and using contingencies to increase the behavior that you do want and decrease the behavior that you do not.

·       DBT is active and present focused.  Dr. Kleiber will focus on your current goals to help you build a life worth living.   This means that she will ask you to actively participate in sessions.  Additionally, Dr. Kleiber will assign homework/practice between sessions to help you bring the skills you learn in the therapy room into the real world.

·       DBT balances acceptance and change.  Dr. Kleiber will help you make changes in your life by assessing and creating a plan to meet your goals and discover what is currently getting in the way of achieving them.  At the same time, she will be supportive and validating and help you be more accepting of yourself overall.  

Other information:

Overview of DBT

o   Link to video (youtube) by the Young Adult & Family Center at the University of California San Francisco

o   Link to Linehan Institute (website) overview of DBT

Real life experience with DBT

o   Link to New York Times (article) by William Lippincott.  The author's account of going through DBT.

o   Linehan Institute (website) Real Life Stories showing experiences with DBT

Cost effectiveness of DBT

o   Links to an article and website (article 1 and website) regarding the cost effectiveness of DBT by Behavioral Tech, LLC. 

Research regarding DBT

o   Link to publications by Marsha Linehan's laboratory's publications regarding DBT (website)