What it is: Dialectical behavior therapy (DBT) aims to teach people how to manage strong, unpleasant emotions by simultaneously accepting them and changing them. “Acceptance is an active process—it’s not resignation, it’s just noticing,” says Jenny Taitz, Psy.D., director of the Dialectical Behavior Therapy Program at the American Institute for Cognitive Therapy.
The treatment involves learning and practicing four skills. The first is mindfulness: “being in the present without judgment,” as Taitz puts it. The second, interpersonal effectiveness, involves learning how to better relate to others—to assert yourself, for example, in a straightforward and non-confrontational way. Third: emotion regulation to help calm overwhelming feelings. “A big part of that is learning to label your emotions, describe emotions, let go of judgments about emotions,” Taitz says. And fourth: distress tolerance—using self-soothing skills instead of impulsive behaviors to cope with a crisis.
“The purpose of DBT is not to feel better, but it’s to build a life worth living,” Taitz says.
How it works: Clients in DBT participate in a five-month-long training group that aims to teach the four central skills. It’s more like a class than a therapy group: there’s even homework! There’s a lot to learn, so DBT practitioners often recommend taking the course twice.
At the same time, clients meet one-on-one with a DBT therapist, which is usually mandatory for participation in the group. Clients bring in a diary card with a list, on the top, of target behaviors they’re working on and emotions they’ve tracked over the past week. On the bottom half of the card, they list skills they’re using to try to manage their emotions. “It’s fairly structured according to goals,” Taitz says, but she emphasizes that there’s room for spontaneity—it’s not regimented in a week-by-week sort of way.
Finally, clients are encouraged to call their therapists for coaching as the need arises. “The purpose of phone coaching is to help a person generalize the skills they use in real time,” Taitz says.
Who it fits: Dialectical behavior therapy was initially developed to treat suicidal and self-harming patients, but it’s expanded to treat anyone who struggles with what Dr. Taitz called “emotion dysregulation.” People who fall into this category experience, in comparison to other people, “emotions that are more intense, they last longer, they’re slower to return to baseline,” Taitz says.
Shown to treat: Borderline personality disorder, eating disorders (especially binge eating and bulimia), treatment-resistant depression, and substance abuse.
Duration: Typically one year. The training group is an hour and a half, once a week; individual therapy sessions are 45 minutes, once a week; and phone calls are 10-15 minutes, as needed.
Where to find a dialectical behavior therapist: The Behavioral Tech website: behavioraltech.org.