How does DBT differ from Cognitive Behavioral Therapy (CBT)?

CBT is present-focused and works with thoughts and behaviors to solve problems. DBT emerged because standard CBT was not fully effective for chronically suicidal individuals, and it synthesizes the core CBT principle of 'change' with a radical notion of 'acceptance.'

Who created DBT and why?

DBT was created by Marsha Linehan, who initially tried to apply CBT to chronically suicidal patients but realized it was insufficient. Her personal experiences, including her own struggles with mental health and a spiritual epiphany, led her to develop a system that balances change and acceptance for highly complex emotional dysregulation.

What are the core characteristics of Borderline Personality Disorder (BPD)?

BPD is defined by nine DSM criteria, with emotion dysregulation at its core. This includes intense, rapidly changing emotions, impulsivity, behavior dysregulation (e.g., substance use, self-harm), and chronic fears of abandonment. Individuals with BPD often have multiple co-occurring mental health conditions.

What is the mortality risk associated with Borderline Personality Disorder?

The mortality risk for BPD is very high, largely due to chronic self-injury and suicide attempts. Over 75% of individuals with BPD engage in self-injury or have made multiple suicide attempts, a significant risk factor even if there is no intent to die.

How does 'radical acceptance' work in DBT, especially for severe loss?

Radical acceptance means letting go of the refusal to accept a painful reality, such as a terminal diagnosis or the loss of a child. It involves actively and willingly choosing to acknowledge the present moment as it is, recognizing that rejection of reality often causes more suffering. It doesn't mean eliminating pain, but rather choosing not to add to it through resistance.

What is 'Wise Mind' in DBT and how does it relate to dialectics?

Wise Mind is the synthesis of 'emotion mind' (being controlled by emotions) and 'reasonable mind' (being controlled by facts and logic). It's not a compromise, but a new argument or statement that recognizes validity in both opposing sides to find a more effective path.

What are the five domains of skills deficits addressed by DBT?

DBT targets deficits in mindfulness (awareness of the present moment), interpersonal effectiveness (how to ask and say no effectively), emotion regulation (managing intense emotions), distress tolerance (handling distressing situations without making them worse), and self-management (doing things you don't want to do).

How can the 'DEAR MAN' skill help in difficult conversations?

DEAR MAN (Describe, Express, Assert, Reinforce, Mindful, Appear Confident, Negotiate) is a 7-step skill for interpersonal effectiveness. It helps you ask for something or say no in a way that increases the likelihood of a positive outcome by being clear, expressing feelings, and reinforcing benefits to the other person.

What is 'Opposite Action' in DBT and when is it used?

Opposite Action is an emotion regulation skill used to change an unwanted emotion when it doesn't fit the facts of the situation or is too intense. It involves engaging in the opposite of what emotional urges tell you to do (e.g., activating when sad, approaching when fearful, or engaging with family when wanting to isolate).

Can I benefit from DBT if I don't have a formal mental health diagnosis?

Absolutely. While DBT was developed for severe pathologies, its skills are applicable to everyone. Learning and applying DBT skills can significantly improve emotional regulation, interpersonal relationships, and distress tolerance, making life smoother even without a specific diagnosis.

Is formal meditation required for DBT?

While mindfulness is central to DBT, formal seated meditation (like 20 minutes daily) is not strictly required for clients or therapists. DBT emphasizes developing a 'mindfulness muscle' through various practices like mindful walking or yoga, and its skills are designed to be concrete and practical for any moment.

How can I find a well-trained DBT therapist?

Marsha Linehan's Linehan Board of Certification (LBC) provides certification for DBT therapists, which is a good starting point. A key question to ask potential therapists is if they are part of a weekly DBT 'consultation team,' as this shows commitment to the model's principles and ongoing professional development.

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219 ‒ Dialectical behavior therapy (DBT): skills for overcoming depression & emotional dysregulation

Peter Attia MD

Science & Technology4 min read157 min video

Aug 22, 2022|148,002 views|2,523|143

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TL;DR

DBT, a therapy for complex issues like emotional dysregulation, offers practical skills for managing emotions and improving relationships.

Key Insights

DBT is an evolution of CBT, specifically designed for complex mental health issues, particularly emotional dysregulation and self-harm.

Marsha Linehan developed DBT by integrating principles of change and acceptance, drawing inspiration from her own experiences and Zen Buddhism.

DBT addresses emotion dysregulation, interpersonal deficits, behavioral dysregulation, and distress tolerance through skills training.

Key DBT skills include mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness, with 'Opposite Action' and 'DEAR MAN' being notable techniques.

The concept of 'Wise Mind' in DBT synthesizes emotional and reasonable thinking, leading to balanced decision-making.

While DBT was developed for severe conditions, its skills are beneficial for anyone seeking to improve emotional management and relationships.

DBT emphasizes a skills-deficit model, suggesting that individuals with difficulties have not learned or have had effective behaviors discouraged.

Finding a qualified DBT therapist is crucial, and the Linehan Board of Certification (LBC) offers a way to verify credentials.

THE FOUNDATION OF DBT: FROM CBT TO COMPLEX NEEDS

Dialectical Behavior Therapy (DBT) originated as an adaptation of Cognitive Behavioral Therapy (CBT), initially developed to address complex mental health challenges, particularly among individuals struggling with suicidal ideation, self-harm, and borderline personality disorder (BPD). While CBT focuses on present thoughts and behaviors, DBT expands upon these principles to tackle more profound emotional dysregulation. This evolution was driven by the recognition that standard CBT approaches were insufficient for individuals with severe and persistent emotional distress, necessitating a more nuanced and skills-based therapeutic model.

MARSHA LINEHAN'S JOURNEY AND THE BIRTH OF DBT

DBT was created by Professor Marsha Linehan, who, after experiencing significant mental health struggles in her youth, including hospitalization and self-harm, embarked on a path to develop effective treatments. Her journey involved integrating her personal insights with existing behavioral therapies. She recognized the limitations of applying purely change-focused CBT to individuals with severe emotional dysregulation and began developing a dialectical approach that balanced acceptance of current reality with the need for change. This holistic development, influenced by her spiritual experiences and study of Zen Buddhism, formed the core of DBT.

THE CORE PRINCIPLES: DIALECTICS AND EMOTION DYSREGULATION

The 'dialectical' aspect of DBT refers to the philosophical principle of holding two opposing ideas simultaneously and finding a synthesis. In DBT, this is most evident in the core dialectic between acceptance and change. Therapists help individuals accept their current circumstances and emotions while also working towards changing maladaptive behaviors and emotional responses. DBT posits that many psychological difficulties, especially those associated with BPD, stem from emotion dysregulation, characterized by intense, rapidly changing, and hard-to-control emotions. This core issue can lead to other dysregulations in behavior, impulsivity, and interpersonal relationships.

KEY SKILL MODULES FOR EMOTIONAL MASTERY

DBT is structured around teaching specific skills across several domains. These include Mindfulness, which focuses on present-moment awareness without judgment; Distress Tolerance, offering strategies to cope with intense emotions and crises without making situations worse; Emotion Regulation, providing tools to understand, change, and prevent extreme emotions; and Interpersonal Effectiveness, teaching skills to assert needs, maintain relationships, and say no effectively. A fifth domain, Self-Management, emphasizes goal-setting and consistent behavior, sometimes integrated into other modules or presented as 'Walking the Middle Path' skills.

PRACTICAL APPLICATION: SKILLS LIKE DEAR MAN AND OPPOSITE ACTION

DBT employs practical, acronym-based skills to make complex concepts accessible. For instance, the 'DEAR MAN' skill guides individuals on how to effectively ask for something or say no assertively while maintaining self-respect and achieving their objective. 'Opposite Action' is a powerful emotion regulation technique that involves acting contrary to the urge that an unwanted emotion generates—for example, approaching a feared situation instead of avoiding it, or activating oneself when feeling depressed. These skills are designed to be practiced consistently, both in therapy and daily life, to build new behavioral patterns.

THE BROADER APPLICABILITY AND ACCESS TO DBT

While DBT was developed for individuals with severe emotional dysregulation and conditions like BPD, its skills have proven beneficial for a much wider population. Many people, even without a formal diagnosis, can improve their emotional management, interpersonal effectiveness, and overall well-being by learning and applying DBT principles. Given the high demand for mental health services, research is exploring stepped-care models, including self-help resources like books and videos, to make DBT more accessible. Finding a qualified DBT therapist is important, and resources like the Linehan Board of Certification can help verify credentials.

Mentioned in This Episode

●Software & Apps

●Organizations

●Books

●Concepts

●People Referenced

Common Questions

DBT is a form of talk therapy inspired by Cognitive Behavioral Therapy (CBT), specifically designed for individuals with complex mental health problems, often those who are suicidal, self-harming, or meet criteria for borderline personality disorder. It integrates principles of emotional regulation, mindfulness, distress tolerance, and interpersonal effectiveness.

Topics

Mental Health & Psychology Human Performance Mindset & Self-Improvement Emotional Regulation Distress Tolerance Interpersonal Effectiveness Mindfulness Practice Dialectical Thinking Borderline Personality Disorder Treatment Self-harm Prevention

Mentioned in this video

Concepts

Dialectical Behavior Therapy

A form of talk therapy inspired by Cognitive Behavioral Therapy, designed for individuals with complex mental health problems, originally for those who are suicidal or self-harming and may meet criteria for Borderline Personality Disorder.

Cognitive Behavioral Therapy for Insomnia

A specific application of CBT that has proved incredibly valuable for patients, focusing on modifying thoughts and behaviors to improve sleep.

borderline personality disorder

A complex mental health disorder defined by nine criteria in the DSM, characterized by dysregulation across emotional, behavioral, interpersonal, and self-image domains. It often co-occurs with other mental health problems.

Social Psychology

The field in which Marsha Linehan obtained her PhD, a lesser-known fact about her background, before she pursued clinical training.

Cognitive Behavioral Therapy

A class of talk therapy focused on present problems, working with thoughts and behaviors that contribute to issues, and characterized by a structured, active, problem-solving, and evidence-based approach.

Psychoanalysis

The dominant paradigm of therapy in the 1970s and 80s, which often involved talking about fears for months or years without necessarily improving them, in contrast to the quicker results sometimes seen with CBT.

Anorexia Nervosa

A psychiatric condition noted for having one of the highest mortality rates among psychiatric conditions.

Jeet Kune Do

A system of martial arts created by Bruce Lee, which took useful elements from over 30 other styles and discarded the useless, with a very particular goal, likened to Marsha Linehan's iterative approach to developing DBT.

Electroconvulsive Therapy

A treatment Marsha Linehan was exposed to as a teenager for her mental health struggles, used more liberally in the late 1960s than today.

Mindfulness

A central skill in DBT and a practice for recognizing thoughts and separating oneself from them; it's about being aware of the present moment without judgment. It is also one of the five domains of skills deficits addressed by DBT.

DEAR MAN

An acronym for Describe, Express, Assert, Reinforce, Mindful, Appear Confident, Negotiate, representing a 7-step skill in the interpersonal effectiveness module of DBT to help ask for something or say no effectively.

Mindfulness-Based Stress Reduction

A form of CBT for depression that teaches people to work up to seated meditation and requires therapists to also practice it.

Organizations

Stony Brook University

A premier place in New York during the 1970s and 80s for learning and applying behavior therapy, where Marsha Linehan received advanced training.

National Institutes of Health

A government organization from which Marsha Linehan sought research grants to study DBT, which at the time required identifying a specific disorder of interest.

Linehan Board of Certification

An organization founded by Marsha Linehan to certify DBT therapists, ensuring adherence to the treatment model and quality of care, created in response to concerns about non-DBT treatments being passed off as DBT.

Books

Radical Acceptance

A core DBT skill derived from Marsha Linehan's spiritual experience and Zen Buddhism, involving the complete and total acceptance of a moment, situation, or oneself exactly as it is, which can lead to joy and reduce suffering.

DBT Skills Training Manual

A workbook developed by Marsha Linehan as part of DBT treatment, which teaches skills to overcome deficits in mindfulness, interpersonal effectiveness, emotion regulation, distress tolerance, and self-management.

DSM

The Diagnostic and Statistical Manual of Mental Disorders, which in its third edition (around 1980) first defined the criteria for Borderline Personality Disorder as it is most well-known today.

People

Bruce Lee

A movie star and martial artist who created Jeet Kune Do, a system of martial arts which Peter Attia likens to Marsha Linehan's iterative development of DBT.

Aaron Beck

The figure associated with the beginning of CBT, who started developing his form of cognitive therapy in the 1960s after being trained as a psychoanalyst, focusing on changing how people thought about themselves and others.