Building a Life Worth Living with DBT
Dialectical Behavior Therapy (DBT) is a well-researched and comprehensive treatment approach designed to help people who have difficulty feeling in the driver's seat of their emotions. Emotion dysregulation often results in a high degree of impulsive reactivity, self-destructive behaviors, and painful relationship patterns. DBT works by teaching clients to become more aware of their particular sensitivity to emotions such as anger, fear, shame and sadness. At the same time, it provides the skills necessary to tolerate these emotions and then begin to feel more in the driver's seat. DBT also aims to build client's relationship with self and reduce shame via self-validation. This in turn helps connect with new intrapersonal skills to enable clients to effectively ask for what they want or say no to what they don't want while preserving relationships and their own self-respect.
The Bio-Social model of DBT suggests that people who have experienced invalidating environments as children, combined with biological predisposition to heightened emotional experiencing to the environment and emotions, often experience higher levels of emotion reactivity, sensitivity, and slower return to baseline.
With higher emotional arousal, the common impact is engagement in behaviors that are ineffective and worked in the short term (e.g., avoidance, substance abuse, self-injury, interpersonal conflicts, negative thoughts about oneself and others). When ineffective behaviors dominate, it’s hard to develop a solid sense of Self. DBT Supports with learning ways to connect with yourself and cope in ways that serve you in the short and long term, thus building the life that you want to live.
For a helpful summary explaining what DBT is, please view this short video created by psychologist Esme Shaller, Ph.D. and the University of California, San Francisco’s Young Adult and Family Center.
Benefits of Dialectical Behavior Therapy (DBT)
The benefits of Dialectical Behavior Therapy (DBT) are extensive and well-supported by research. By learning and practicing skills, people can see real, positive changes in their lives, such as:
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Feeling more in the driver's seat of emotions – Feel less overwhelmed and more in charge of how you react.
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Psychological flexibility and less rigidity in thinking patterns- moving away from black and white thinking
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More aligned and values driven ways to handle stress – Learn tools to get through tough times without making things worse.
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Stronger relationships – Communicate more clearly and build deeper, healthier connections with others.
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Less harmful behaviors – Reduce impulsive actions like self-harm or substance use and improve overall mental well-being.
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Access to making behavior changes that stick
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More self-understanding and self-acceptance – Learn to see yourself with more kindness and less judgment. We are kicking shame out here folxs!
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These changes help create a more balanced, confident, and fulfilling life.
What is involved in a comprehensive DBT Program?
Often times there are folxs who are starting DBT who have had some experience with DBT language, tools or skills. One of the things that I sometimes hear is, "I have done DBT before and it didn't work for me." Upon leaning in with curiosity and conversation about the experience in DBT, it is often discovered that the treatment was not a comprehensive DBT program. This can make a world of difference in person's experience. Comprehensive DBT Programs deliver all 4 modes of treatment as they were researched in the evidence-based studies for efficacy. The modes of treatment are then delivered by an intensively trained DBT therapist who values adherence to the modality, is engaged in yearly continuing education, and meets on a weekly DBT Consult Team with other intensively trained DBT therapists.
The Four Modes of Treatment in Comprehensive DBT include:
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Individual Therapy- weekly sessions that are structured to meet your unique Life Worth Living goals
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DBT Skills Group- Learning new skills is an essential component of treatment, and this happens in the context of a group format. The structure of skills group and therapy together helps to maximize learning experience. Check out the DBT Groups page for more information.
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Phone Coaching- These are brief 5-10 minute phone conversations when clients need extra support using or generalizing a skill in the moment where rubber is hitting the road. There is so much that happens in life outside of the therapy room; coaching helps with the integration of skills that we are learning.
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Consultation Team- Individual DBT therapists and skills group leaders meet as a team to ensure treatment adherence and to provide the highest quality of care. My consultation team meets weekly online and is comprised of Lisa Cline LCSW, Kelly Sonnenfeld PhD, and the folks over at Lake West DBT. Kelly, Lisa, and I are all in the same suite and provided comprehensive care within in our groups, and parent coaching. If you are engaged in DBT with me, you will likely meet at least one of them! Lake West is another comprehensive DBT Program who is adherent to the DBT modality, we meet online weekly and get together in person once a year.
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DBT Consult Team
Research
Dialectical Behavior Therapy (DBT) is one of the most well-researched and evidence-based treatments for emotional dysregulation and related mental health conditions. Developed by Dr. Marsha Linehan in the 1980s, DBT was originally created to treat individuals with Borderline Personality Disorder (BPD). Since then, research has demonstrated its effectiveness for a wide range of emotional and behavioral challenges.
Who is DBT For?
DBT has been found to be effective in treating the following conditions: Borderline Personality Disorder co-occurring with Suicidal and self-harming behaviors Substance use disorders Post Traumatic Stress Disorder High irritability Cluster B Personality Disorders Attention Deficit Disorder PTSD related to childhood sexual abuse Major Depressive Disorder Bipolar Disorder Transdiagnostic Emotion Dysregulation Suicidal and Self Harming Adolescents Binge Eating Disorder Bulimia Nervosa
Treatment Outcomes
73% reduction in psychiatric hospitalizations — This reflects a major shift from inpatient care to community-based treatment, reducing the burden on hospital systems and improving patient stability. 50% decrease in suicide attempts — DBT’s focus on emotion regulation, distress tolerance, and interpersonal effectiveness directly addresses risk factors for suicidal behavior. Annual savings of over $8,000 per patient in mental health costs — These savings come from reduced hospitalizations, fewer emergency visits, and lower use of crisis services, indicating strong cost-effectiveness
Acceptance and Change in DBT: The Core Dialectic
A dialectic is the idea that two seemingly opposite things can both be true at the same time. In Dialectical Behavior Therapy (DBT), this means balancing acceptance and change—accepting yourself and your emotions as they are, while also working to change behaviors that cause suffering.
For example, you can accept that you're doing the best that you can and want to continue to improve. You can validate your emotions while also recognizing that acting on them impulsively might not help. Folxs who resonate with a mental health diagnosis like Borderline Personality Disorder, PTSD, mood disorders, or anxiety often struggle with black-and-white thinking. This is a way of viewing the world where things are seen as either all good or all bad, a success or a failure, right or wrong, with no middle ground. This type of thinking can create intense emotional pain, feeling like there is a lack of options, reinforces shame cycles, reinforces feeling stuck, and lead to difficulty handling life’s challenges. DBT therapists use dialectics to help people move away from black-and-white thinking (like “I’m either good or bad” or “I have to be perfect or I’m a failure”) and toward a more balanced and flexible perspective.
Additionally, the lens that I hold in therapy is that all behaviors, even the behaviors that one is trying to change, have a function. They are not all good or all bad. Many target behaviors that folx come to therapy wanting to impact (self-harm, suicidality, substance abuse/misuse, avoidance, disassociation, conflict) all serve a function that meets a need. The goal of our work is to identify what is the valid function of that behavior and how do we meet that need in a way that does not amplify suffering or make things worse. For example, maybe I am not opening my text messages because I feel overwhelmed when thinking about responding to them. As a result, I have less friends reaching out to me. We would validate that overwhelm makes sense when there are a lot of unread messages and what are the skills that we can learn to soothe that anxiety and attend to my value of connection so that I feel more rooted moving into that task. Acceptance and change!
