Definition
Dialectical Behavior Therapy (DBT) was developed by Marsha Linehan at the University of Washington. Its central premise is the fundamental "dialectic": radical acceptance of who one is right now and simultaneous change toward who one wants to be. DBT teaches four skill sets for managing intense emotional crises without acting in ways that worsen the situation.
How it's used
Standard DBT has four components: weekly individual therapy, weekly skills training group, between-session phone coaching, and therapist consultation team meetings.
DBT's four core skills are:
- Mindfulness: observing, describing, and participating in present experience without judging.
- Distress tolerance: surviving crises without worsening them (TIPP, ACCEPTS, IMPROVE techniques).
- Emotion regulation: identifying, labeling, and modifying difficult emotions.
- Interpersonal effectiveness: asking for what you need and saying no assertively (DEAR MAN, GIVE, FAST).
In individual sessions, the therapist works a hierarchy of targets: first suicidal or self-harming behaviors, then therapy-interfering behaviors, then quality-of-life-interfering behaviors, then skills development.
When to apply
DBT has the strongest evidence for borderline personality disorder (BPD), but has been adapted with good results for eating disorders, chronic depression, PTSD, substance abuse, and adolescents with suicidal behaviors. It is the first-line treatment recommended for BPD by most international clinical guidelines.
Historical origin
Marsha Linehan developed DBT from her own experiences with suicide attempts and her training in behavioral analysis and Zen practice. Her clinical trials at the University of Washington in the 1980s-90s were the first to demonstrate efficacy in reducing suicidal behaviors in BPD. Linehan's transparency about her own clinical history transformed stigma around mental illness in the mental health community.
How CauceOS supports it
CauceOS includes a DBT note template that records the skills worked in session, the position in the target hierarchy, and the current risk level. Alerts are configured to automatically detect language of suicidal ideation or self-harm (with the disclaimer of assistance, not diagnosis).
Related terms
- CBT — base from which DBT evolved
- ACT — shares emphasis on acceptance and mindfulness
- Crisis detection — critical tool when working with DBT population
References
- Linehan, M. M. (1993). Cognitive-Behavioral Treatment of Borderline Personality Disorder. Guilford.
- Linehan, M. M. (2015). DBT Skills Training Manual (2nd ed.). Guilford.
- Linehan, M. M. (2020). Building a Life Worth Living. Random House.