Dialectical Behavioral Therapy: What It Is, Components, Modules And Stages.

The DBT is a specific type of cognitive behavioral therapy developed in the late 1980s by psychologist Marsha M. Linehan to help better treat borderline personality disorder of personality . Since its development, it has also been used to treat other types of mental health disorders .

What is dialectical behavior therapy?

It is an evidence-based treatment therapy that helps people suffering from borderline personality disorder and has also been used to treat mood disorders, as well as for those who need to change behavior patterns that are not helpful, such as self-harm, suicidal idealization, and substance abuse.

This approach works to help people increase their emotional and cognitive regulation by learning about the triggers that lead to reactive states and helping to assess which coping skills to apply in the sequence of events, thoughts, feelings, and behaviors to help avoid reactions. unwanted, this therapy assumes that people are trying their best, but lack the skills necessary to be successful, or are influenced by positive or negative reinforcement that interferes with their ability to function properly.

It combines standard cognitive behavioral techniques for emotion regulation and reality testing with concepts of distress tolerance, acceptance and awareness derived largely from Buddhist meditative practice, is based on biosocial theory and is the first therapy which has been experimentally shown to be generally effective in treating borderline personality disorder . The first randomized clinical trial showed reduced rates of suicidal gestures, psychiatric hospitalizations, and treatment dropouts compared to standard treatment.

History of dialectical behavior therapy

It was developed in the late 1980s by Dr. Marsha Linehan and her colleagues when they discovered that cognitive behavioral therapy alone did not work as well as expected in patients with borderline personality disorder. Dr. and her team added techniques and developed a treatment that would meet the unique needs of these patients.

This therapy is derived from a philosophical process called dialectics, which is based on the concept that everything is made up of opposites and that change occurs when one opposing force is stronger than the other, or in more academic terms: thesis, antithesis and synthesis.

Specifically, the dialectic makes three basic assumptions:

  • All things are interconnected.
  • Change is constant and inevitable.
  • Opposites can be integrated to form a closer approximation of the truth.

Therefore, the patient and the therapist are working to resolve the apparent contradiction between self-acceptance and change in order to bring about positive changes in the patient.

Another technique offered by Linehan and his colleagues was validation, they found that with validation, along with the drive for change, patients were more likely to cooperate and less likely to experience distress at the idea of ​​change.

What are the components of dialectical behavior therapy?

The goal is to help clients build a life they consider worth living, where the client and therapist work together to set goals that are meaningful to the client. Often this means that they work on ways to decrease harmful behaviors and replace them with effective life-enhancing behaviors.

It has five components that work together and make up a standard program, this is different from many other psychotherapies that consist of only one mode or aspect of treatment (such as individual therapy), each component or mode of treatment is intended to fulfill a specific function.

Capacity enhancement : Provides opportunities for the development of existing skills. In treatment, four basic skill sets are taught: emotion regulation, mindfulness, interpersonal effectiveness, and tolerance for distress.

Generalization: Therapists use various techniques to encourage the transfer of learned skills in all settings. People in therapy can learn to apply what they have learned at home, at school, at work, and in the community. For example, a therapist may ask the person in treatment to talk to a partner about a conflict while using emotional regulation skills before and after the discussion.

Motivational improvement: Implement individualized behavioral treatment plans to facilitate the reduction of problem behaviors that can negatively affect quality of life. For example, therapists can use self-management tracking sheets so individual sessions can be tailored to address the most serious problems first.

Therapists’ Motivational Capacity and Enhancement: Because it is often provided to people experiencing chronic, severe, and intense mental health problems, therapists receive a great deal of supervision and support to avoid situations such as vicarious trauma or burnout . For example, treatment team meetings are held frequently to give therapists a space to provide and receive support, training, and clinical guidance.

Structuring the environment: A goal of therapy is often to ensure that positive and adaptive behaviors are reinforced in all environmental settings. For example, if an individual participates in multiple treatment programs within an agency, the therapist can ensure that each program is established to reinforce all positive skills and behaviors learned.

Dialectical Behavioral Therapy Modules


It is one of the central ideas behind all the elements, it is considered a foundation for the other skills that are taught because it helps people to accept and tolerate the powerful emotions they may feel when challenging their habits or exposing themselves to disturbing situations.

The concept of mindfulness and the meditation exercises used to teach it are derived from traditional Buddhist practice, although the version taught does not include any religious or metaphysical concepts. It is the ability to pay attention, without prejudice, to experience emotions and senses fully, but with perspective. Mindfulness practice can also be intended to make people more aware of their surroundings through their 5 senses: touch, smell, sight, taste, and hearing.



This is used to observe without judgment the own environment inside or outside of oneself, it is useful to understand what is happening in any given situation. He recommends developing a “Teflon mind,” the ability to let feelings and experiences pass without lingering in the mind.


This is used to express what one has observed with the ability to observe. It should be used without statements of judgment, this helps others know what one has observed. Once the environment or the inner state of mind has been observed with 5 senses, the individual can put words to the observations and thus better understand the environment.


This is used to fully focus and engage in the activity that one is doing.

Read more information about Mindfulness. (Required item)

Tolerance for distress

Many current approaches to mental health treatment focus on changing distressing events and circumstances such as dealing with the death of a loved one, loss of a job, serious illness, terrorist attacks, and other traumatic events. They have paid little attention to accepting, finding meaning and tolerating distress, this task has generally been approached through psychodynamic , psychoanalytic, gestalt or narrative therapies , together with religious and spiritual leaders and communities. Dialectical behavior therapy emphasizes learning to cope with pain skillfully.

Anguish tolerance skills are a natural development of mindfulness skills, they have to do with the ability to accept, in a non-evaluative and non-judgmental way, both oneself and the current situation. Since this is a non-judgmental stance, this means that it is not one of approval or resignation.

Distract yourself with Accepts

Sus siglas en ingles, Activities, Contribute, Comparisons, Emotions, Push away, Thoughts, Sensations.

This is a skill used to temporarily distract yourself from unpleasant emotions.

  • Activities: Use positive activities that you enjoy.
  • Contribute: Help others or your community.
  • Comparisons: Compare yourself to people who are less fortunate or the way you used to be when you were in worse shape.
  • Emotions: Make yourself feel something different by provoking your sense of humor or your happiness with the corresponding activities.
  • Zoom Out: Put something temporarily first in your mind.
  • Thoughts: Force your mind to think of other things.
  • Sensations: Do something that has a different intense sensation than what you are feeling, such as a cold shower or a spicy caramel.


This is a skill in which one behaves in a way that is comforting, caring, kind, and kind to oneself. It is used in times of distress or upheaval.

Full article on tolerance to distress. (Required item)

Emotional regulation

It recognizes and copes with negative emotions (eg anger) and reduces one’s emotional vulnerability by increasing positive emotional experiences. Dialectical behavior therapy skills for emotion regulation include:

  • Identify and label emotions.
  • Identify obstacles to changing emotions.
  • Reduce vulnerability.
  • Increase positive emotional events.
  • Increase attention to current emotions.
  • Take an opposite action.
  • Apply techniques of tolerance to distress.

Learn more about emotional regulation. (Required item)

Interpersonal effectiveness

The interpersonal response patterns taught in skills training are very similar to those taught in many interpersonal problem solving and assertiveness classes. They include effective strategies for asking for what is needed, saying no, and dealing with interpersonal conflict.

People with borderline personality disorder often have good interpersonal skills in a general sense. Problems arise in the application of these skills to specific situations, an individual can describe effective behavior sequences when talking about another person who is in a problem situation, but may be completely unable to generate or carry out a similar behavior sequence when analyzing your own situation.

The interpersonal effectiveness module focuses on situations where the goal is to change something (for example, request that someone do something) or to resist the changes that someone else is trying to make (for example, say no). The skills taught are intended to maximize the chances that a person’s goals in a specific situation will be met, while at the same time damaging neither the relationship nor the person’s self-respect. Click on interpersonal effectiveness for more information. (Required item)

What are the stages of dialectical behavior therapy treatment?

It is divided into four stages, which are defined by the severity of the client’s behaviors, and therapists work within this framework to help clients achieve their individual goals. There is no set time frame assigned to each stage; instead, a therapist and client will spend as much or little time as needed, according to the client’s goals.

Stage 1

The client is often miserable and their behavior is out of control: they may be trying to commit suicide, self-harm, use drugs and alcohol, and / or engage in other types of self-destructive behavior. When clients first begin treatment, they describe their experience of their mental illness as “being in hell.” The goal of Stage 1 is to move the client from being out of control to being in control of the behavior.

Stage 2

Clients may feel that they are living a life of quiet despair: their life-threatening behavior is under control, but they continue to suffer, often due to past trauma and invalidation, their emotional experience may be inhibited.

The goal of Stage 2 is to help the client move from a state of silent despair to one of full emotional experience, this is the stage where PTSD would be treated as part of the client’s diagnosis.

Stage 3

The challenge is to learn to live, define life goals, build self-respect, and find peace and happiness. The goal is for the client to lead a life of ordinary happiness and unhappiness.

Stage 4

For some people, a fourth stage is needed, finding a deeper meaning through a spiritual existence. Dr. Marsha Linehan has proposed a Stage 4 specifically for those clients for whom a life of ordinary happiness and unhappiness does not fulfill an additional goal of spiritual fulfillment or a sense of connection to a greater whole.

At this stage, the goal of treatment is for the client to move from a feeling of incompleteness to a life that involves a continuing capacity for experiences of joy and freedom.

What is special about dialectical behavior therapy?

The term “dialectical” comes from the idea that joining two opposites in therapy (acceptance and change) brings better results than just one. A unique aspect of accepting a patient’s experience is as a way for therapists to reassure them and balance the work required to change negative behaviors.

It has four parts:

  • Individual therapy  (Item required)
  • Group skills training
  • Telephone coaching, if necessary for crises between sessions
  • Consultation group for healthcare providers to stay motivated and discuss patient care

Patients agree to do homework to practice new skills, this includes filling out daily “journal cards” to track more than 40 emotions, impulses, behaviors, and skills, such as lying, self-harm, or self-respect.

Efficacy of dialectical behavioral therapy

Borderline personality disorder

It is the therapy that has been studied the most for the treatment of borderline personality disorder, and enough studies have been done to conclude that it is helpful. A 2009 Canadian study compared treatment with dialectical behavior therapy against general psychiatric management. A total of 180 adults, 90 in each group, were admitted to the study and treated for an average of 41 weeks, statistically significant decreases in suicidal events and non-suicidal self-harm events were observed. Read more about borderline personality disorder. (Required item)


In a Duke University study on the comparative treatment of depression with antidepressant medications and dialectical behavior therapy, a total of 34 chronically depressed people over 60 years old were treated for 28 weeks, six months after treatment, they were observed statistically significant differences in remission rates between groups, with a higher percentage of patients treated with antidepressants and dialectical behavior therapy in remission. Full article on depression.

Georgia Tarrant
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Hello, how are you? My name is Georgia Tarrant, and I am a clinical psychologist. In everyday life, professional obligations seem to predominate over our personal life. It's as if work takes up more and more of the time we'd love to devote to our love life, our family, or even a moment of leisure.