Dialectical Behavior Therapy

(DBT) is a well-researched, comprehensive treatment for people who have intense emotions they are unable to manage in constructive ways. When people struggle with intense emotions, the results can be impulsive or emotion-based actions that cause pain and problems in their lives and the lives of those around them. These behaviors can be raging, self-harm, depression, suicide attempts, self-harm, substance abuse, eating disorders, being emotionally numb, over-shopping, or gambling. Individuals with these problems are often diagnosed with borderline personality disorder. However, they may have other mental health diagnoses as well.

How does DBT work?

DBT works by teaching participants to become more aware of their emotions, especially ones such as anger, shame, and sadness. It offers alternative ways to manage feelings, deal effectively with painful situations, and improve relationships. It teaches skills necessary to tolerate these feelings and then begin to regulate them. DBT therapy is provided through a compassionate treatment relationship that builds on the clients’ inherent strengths, understands the person’s emotional sensitivity, and offers powerful and concrete methods to build a life that feels worthwhile and meaningful.

Who developed DBT?

Dialectical behavior therapy (DBT) was developed by psychologist Marsha M. Linehan and her team at the University of Washington in Seattle. Dr. Linehan saw the pain and suffering that individuals with intense emotions experienced and vowed to find a solution. DBT was the result of extensive and rigorous research leading to important outcomes for her clients.

How is therapy balanced?

DBT balances change techniques from cognitive-behavior therapy with acceptance strategies from Zen practice.

What are change strategies?

Changes strategies focus on learning to change one’s own emotional experiences or change environmental situations that amplify emotional experiences. These strategies include problem-solving, skills training, developing more effective thinking, behavioral activation, and exposure therapy.

What are acceptance strategies?

Acceptance strategies teach new ways of responding that work paradoxically. Through acceptance of events, situations, emotions, and/or thoughts, a new relationship can be built with our experiences. It is through these new relationships that change paradoxically occurs. It is only through acceptance that change may arise.

The primary acceptance skill is mindfulness, which involves learning to focus attention, and being able to accept things for what they are, including thoughts, emotions, and other people, without getting caught up in judgments, assumptions, or interpretations. While you are working to make changes, it is often necessary to tolerate some distress, so you learn coping skills as well. You develop ability to better tolerate emotional pain and accept yourself, your past, and your current life.

Why both Acceptance and Change?

Using both acceptance and change strategies, DBT asks both client and therapist to find the balance between accepting reality as it is, and maintaining a strong commitment to change. DBT therapists work to provide treatment in a way that is warm and validating, while at the same time offering enough challenge and guidance to stimulate behavioral change and reduction of harmful behaviors. The goal is to help clients create a life worth living.

Since first being developed, DBT has been modified as a treatment for other complex and challenging mental disorders that involve emotional dysregulation, such as dual diagnoses, PTSD, eating disorders and severe mood disorders

What about addressing PTSD?

Many of our clients have experienced traumatic events throughout their life. These events can set a trajectory to developing Post-traumatic Stress Disorder. This is a normative response to traumatic events when our emotional resources are overcome by the trauma we experience. At STLCFD we offer an opportunity to address both PTSD and other difficulties in living such as depression, anxiety, or other mood disorders as DBT is comprehensive. You will work with your therapist to decide on the best course of action based on your goals.

At STLCFD we utilize a therapy call Prolonged Exposure Therapy, which is an extremely effective treatment developed by Edna Foa, Ph.D and her treatment team at the University of Pennsylvania’s Center for Treatment and Study of Anxiety.


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  • This is not a crisis hotline. In the case of an emergency, please contact Behavioral Health Response by calling (800) 811-4760.