Dialectical behavioral therapy treatment

In seeing many mental health conditions as disorders of emotion dysregulation, DBT is focused on emotions and how they feed ineffectual action patterns. Many elements of the therapy are aimed at teaching patients how to recognize, understand, label, and regulate their emotions and how to handle interpersonal situations that give rise to negative or painful emotions.

Each week, for individual therapy sessions, patients complete a diary “card” (often done via an app), a self-monitoring form that tracks individualized treatment targets relating to moods, behavior, and skills. Patients identify and rate the intensity of emotions they experience each day—fear, shame, sadness, anger, pain, suicide attempts, and more—and space is provided to discuss emotional experience in more detail if needed. In addition, using a checklist of skills—which also serves as a handy reminder to deploy them—patients note the frequency with which they engaged in positive practices, from self-soothing and radical acceptance to reducing vulnerability and acting in ways contrary to how they felt.

The information on the diary card lets the therapist know how to allocate session time. Life-threatening or self-injurious behavior takes priority, not surprisingly. After identifying the behavioral targets for a session, the therapist helps the patient engage in behavioral analysis, figuring out what led to a specific problem situation the patient encountered, including any underlying beliefs or attitudes that surreptitiously reinforce the behavior, and discussing the consequences of the patient’s actions. The therapist and patient discuss more skillful ways to solve emotional and life problems.

Because DBT is a demanding therapy to deliver even for experienced therapists, therapists typically work in consultation with a treatment team and regularly meet with a team. The team’s recommendations are often applied in individual therapy sessions.

While studies of DBT have documented improvement within a year of treatment, particularly in controlling self-harmful behavior, patients may require therapy for several years.