Dialectical Behavior Therapy

What Is Dialetical Behavior Therapy?

Therapist and Patient in a Counseling Session
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What Is Dialectical Behavior Therapy?

Dialectical behavior therapy (DBT) is a type of cognitive behavioral therapy. Its main goal is to teach the patient skills to cope with stress, regulate emotions and improve relationships with others.

DBT is derived from a philosophical process called dialectics. Dialectics is based upon the concept that everything is composed of opposites and that change occurs when one opposing force is stronger than the other, or in more academic terms: thesis, antithesis and synthesis.

History of Dialectical Behavior Therapy

DBT was developed in the late 1970s by Dr. Marsha Linehan and colleagues when they discovered that cognitive behavioral therapy alone did not work as well as expected in patients with borderline personality disorder. Dr. Linehan and her team added additional techniques and developed a treatment which would meet the unique needs of these patients.

The Three Fundamentals of Dialectical Behavior Therapy

1. Cognitive Behavioral Therapy

Learning new behaviors -- which can be anything a person thinks, feels or does -- is a crucial part of DBT. There are four main strategies that are used to change behavior: skills training, exposure therapy, cognitive therapy, and contingency management.

  • Skills Training - Attending skills groups, doing homework assignments and role playing new ways of interacting with people.
  • Exposure Therapy - Exposing oneself to feelings, thoughts or situations which were previously feared and avoided.
  • Cognitive Therapy - Recognizing and reassessing patterns of negative thoughts and replacing them with positive thoughts that more closely reflect reality.
  • Contingency Management - Identifying how maladaptive behavior is rewarded and how adaptive behavior is punished and using this knowledge to modify behavior in a positive way.

    2. Validation

    For patients with borderline personality disorder, the process of cognitive behavioral therapy can cause a great deal of distress. The push for change feels to them as if it invalidates the emotional pain they are feeling. Linehan and her team found that by offering validation along with the push for change, patients were more likely to cooperate and less likely to suffer distress at the idea of change. The therapist validates that the person's actions "make sense" within the context of his personal experiences without necessarily agreeing that they are the best approach to solving the problem.

    3. Dialectics

    Dialectics makes three basic assumptions: (1) all things are interconnected (2) change is constant and inevitable and (3) opposites can be integrated to form a closer approximation of the truth. In DBT, the patient and therapist are working to resolve the seeming contradiction between self-acceptance and change in order to bring about positive changes in the patient.

    What Is Dialectical Behavior Therapy Used For?

    DBT is designed for use by people who have urges to harm themselves, such as those who self-injure or who have suicidal thoughts and feelings.

    It was originally intended for people with borderline personality disorder, but has since been adapted for other conditions where the patient exhibits self-destructive behavior, such as eating disorders and substance abuse.


    "DBT Resources: What is DBT?" Behavioral Tech, LLC. 2003. Behavioral Tech, LLC. Accessed: November 6, 2007.

    Petry, Nancy M. "Contingency Management in Addiction Treatment." Psychiatric Times. February 2002. CMP Healthcare Media, LLC. Accessed: November 6, 2007.

    Sanderson, C. J. "Dialectical Behavior Therapy Frequently Asked Questions." Behavioral Tech, LLC. 2003. Behavioral Tech, LLC. Accessed: November 6, 2007.

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