Dialectical Behavior Therapy (DBT) is an evidence-based psychotherapy effective for both youth and adults. It was originally developed in the 1970s by American psychologist Dr. Marsha Linehan, who sought to create a treatment that could help individuals with borderline personality disorder and chronic suicidality. DBT is particularly helpful for individuals struggling with emotional dysregulation, relationship difficulties, low self-esteem, and impulsive or self-destructive behaviors, such as non-suicidal self-injury. Beyond borderline personality disorder, research supports DBT’s effectiveness in treating a range of conditions, including substance use disorders, major depressive disorder, anxiety, bipolar disorder, eating disorders, post-traumatic stress disorder.
Some patients may choose to participate in a comprehensive, full-model DBT program, such as the one offered by the DBT Center of San Diego for adolescents and adults. These programs often last a minimum of six months and include individual therapy, group skills training, and coaching. However, not all patients can commit to such intensive programs. Many still benefit from learning and applying DBT skills within individual or group therapy settings. Primary care providers and caregivers can also learn some DBT skills to teach or reinforce during brief encounters with youth.
DBT is organized into four core skill areas: mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness.
Mindfulness. Mindfulness is the foundation of DBT. It involves becoming aware of one’s thoughts, emotions, and sensations in the present moment without judgment. For example, a simple mindfulness exercise is to sit comfortably for five minutes and observe a small object using all five senses. Notice your thoughts and feelings as they arise and let them pass without judgment. Over time, practicing mindfulness can help individuals become more aware of internal experiences they might otherwise overlook.
Distress Tolerance. Distress tolerance skills help individuals manage intense or overwhelming emotions in healthy ways. These skills are especially valuable for people who rely on self-injurious behaviors to cope with distress. One useful technique is TIPP, which stands for Temperature, Intense exercise, Paced breathing, and Progressive muscle relaxation.
– Temperature: Cool your body down, for instance by splashing cold water on your face.
– Intense exercise: Engage in brief physical activity, such as running or doing jumping jacks.
– Paced breathing: Try diaphragmatic breathing. Inhale through your nose for four counts and exhale through your mouth for six.
– Progressive muscle relaxation: Tense and relax your muscles from your feet up to your head.
After practicing TIPP, many people feel calmer and more in control, reducing the urge to act impulsively.
Emotion Regulation. Emotion regulation skills teach individuals to identify, understand, and change unhelpful emotional patterns. A practical strategy involves breaking down an emotional experience into parts:
– Describe the situation
– Identify what triggered it
– Name your primary and secondary emotions
– Notice your urges and actions
– Reflect on the outcomes
By examining emotions in this structured way, individuals can gain insight into their reactions and develop more adaptive coping responses.
Interpersonal Effectiveness. Interpersonal effectiveness skills help individuals build and maintain healthy relationships, set boundaries, and communicate assertively. A commonly used tool is DEAR MAN:
– Describe the situation
– Express your feelings and opinions
– Assert your needs clearly
– Reinforce the benefits of your request
– Mindful: Stay focused on your goal
– Appear confident: Maintain a calm, steady tone and body language
– Negotiate: Be willing to compromise when appropriate
Using DEAR MAN can help individuals express themselves effectively while maintaining respect for both themselves and others.
There are many other DBT skills beyond these examples, all aimed at improving emotional and interpersonal functioning. As with any skill, consistent practice is essential. Individuals should rehearse DBT skills several times a week until they feel natural and easy to use. For primary care providers and caregivers, even learning a few of these tools can make a significant difference in supporting youth mental health.
AUTHOR:
Dr. Kristen Kim, MD
Child, Adolescent and Adult Psychiatrist
Vista Hill Foundation