Dialectical Behavior Therapy (DBT): A Brief Overview

by Tom Horvath, PhD, ABPP

Dialectical Behavior Therapy (DBT) is an approach to psychotherapy designed for individuals who are highly emotionally sensitive, who struggle with depression and anxiety, and who may at times become suicidal. DBT tools, which focus on distress tolerance, interpersonal effectiveness, emotion regulation, and mindfulness, can be helpful to anyone. You can remember these 4 categories as DIEM, as in carpe diem (seize the day).

DBT is part of the larger family of CBT (cognitive behavior therapy). Marsha Linehan, a psychology professor emeritus at the University of Washington, Seattle, developed DBT as a result of coping with her own emotional problems. Linehan, born in 1943, revealed in her late 60’s the personal connection to her professional work.

Distress tolerance is the capacity to wait, despite stress, without acting impulsively. Interpersonal effectiveness allows one to deal with conflict while maintaining self-respect. Emotional regulation is based on understanding, identifying, observing, and releasing emotions. Mindfulness is the capacity to “go inside” and observe thoughts and feelings without immediately acting on them.

What does it mean to be highly emotionally sensitive? Most of us at times feel overwhelmed by emotion, but for some being overwhelmed is often more frequent, severe, and long lasting. Highly emotionally sensitive individuals may have had upbringings that were invalidating, chaotic, or traumatic. They may now seek an unrealistic level of control over their environments, and to behave perfectly, in an unrealistic effort to prevent future emotional problems.

As you consider how much effort to put into learning DBT (information and self-help material about Dialectical Behavior Therapy is easily available), consider questions such as the following: How emotionally over-reactive am I? Has my excessive emotional reactivity improved over my lifetime, or I am still having significant difficulty? Do I have good role models for managing emotional reactivity? Of the four categories of DBT skills (distress tolerance, interpersonal effectiveness, emotion regulation, and mindfulness), which is the most challenging for me? To what extent have I attempted to exert unrealistic control over my environment, or to be perfect? How difficult (invalidating, chaotic, or traumatic) was my upbringing?

With practice, all of us can improve our DIEMs!