DBT has four primary modes of treatment delivery:
- Individual Psychotherapy:
Enhance Motivation with Individual Therapy
DBT individual therapy is focused on enhancing client motivation and helping clients to apply the skills to specific challenges and events in their lives.
Structure the Environment with Case Management in Individual Therapy
Case management strategies help the client manage his or her own life, such as their physical and social environments. The therapist applies the same dialectical, validation, and problem-solving strategies in order to teach the client to be his or her own case manager. This lets the therapist consult to the patient about what to do, and the therapist will only intervene on the client’s behalf when absolutely necessary.
- DBT Skills Training:The function of DBT Skills is to help enhance a client’s capabilities. There are four skills taught in DBT:
- Mindfulness: the practice of being fully aware and present in this one moment
- Distress Tolerance: how to tolerate pain in difficult situations, not change it
- Interpersonal Effectiveness: how to ask for what you want and say no while maintaining self-respect and relationships with others
- Emotion Regulation: how to change emotions that you want to change
- In-the-Moment phone coaching:Ensure Generalization with Coaching
DBT uses phone and other in-vivo coaching to provide in-the-moment support. The goal is to coach clients on how to use their DBT skills to effectively cope with difficult situations that arise in everyday life. Clients can call their individual therapist between sessions to receive coaching at the times when they need help the most.
- Consultation for Therapists:The DBT consultation team is essential to help therapists monitor their fidelity to the treatment, develop and increase their skills, and sustain their motivation to work with high-risk, difficult-to-treat clients.
Who Does DBT Help?
DBT was originally developed to treat chronically suicidal individuals diagnosed with borderline personality disorder (BPD), and it is now recognized as the gold standard psychological treatment for this population. In addition, research has shown that it is effective in treating a wide range of other disorders such as substance dependence, depression, post-traumatic stress disorder (PTSD), and eating disorders.
Skills training is one of four core components of DBT. As DBT has expanded beyond treatment for BPD, new sets of specialized skills have been developed for other disorders, including a module targeting emotion overcontrol, middle path skills developed originally for parents and adolescents but appropriate for many populations, skills for attention-deficit/hyperactivity disorder, and a set of skills specifically designed for individuals with addictions. Even when adapting DBT for other disorders, a DBT therapist still looks to the standard treatment model and adapts it only when necessary.
There is growing interest in teaching DBT skills to non-clinical populations. For example, DBT skills are widely taught in general mental health programs in community mental health, inpatient, acute care, forensic, and many other settings. Other groups are exploring how to incorporate DBT skills in school systems or how DBT skills could improve workplace productivity and morale.