Dialectical Behavior Therapy, better known as DBT, is a form of therapy that stems from Cognitive Behavioral Therapy (CBT) that combines mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness skills to help people cope with intense emotions and navigate healthy relationships. DBT was originally created by psychologist Marsha Linehan, to help treat chronic suicidality in people who have been diagnosed with Borderline Personality Disorder. Over time, DBT has shown to be helpful for people with various diagnoses including depression, anxiety, and bipolar disorders. The central tenet of DBT is to balance acceptance of life situations with efforts to change oneself and to develop a life worth living.
The Basics of DBT
To be able to achieve the goal of developing a life worth living, DBT requires one to go through the four modules. These modules are mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness. Let’s take a look into each of these modules and the skills that can be gained from them.
Mindfulness is the act of consciously focusing the mind on the current moment without judgment or attachment. A common form of mindfulness is meditation, where you focus on your breathing and body while calming your mind. The goal of mindfulness for most people is to reduce suffering, increase happiness, and experience reality as it is. Mindfulness is a key component of (DBT) because it can help you become more aware of your thoughts, feelings, and behaviors in the present moment, without judgment. This awareness is crucial for managing intense emotions, making more thoughtful decisions, and responding to challenging situations in healthier ways. By cultivating mindfulness, you can break the cycle of impulsive or reactive behaviors, improve emotional regulation, and develop a greater sense of control and acceptance over your experiences.
Distress Tolerance refers to one’s ability to be able to cope within a crisis situation. There are three goals of distress tolerance. These goals are to survive crisis situations without making them worse, to accept reality, and to become free of having to satisfy the demands of your own desires, urges, and intense emotions. Distress tolerance can help one to develop the skills to be able to sit with intense emotions without reacting impulsively, build resilience, and reduce your reliance on avoidance behaviors. By focusing on distress tolerance, you will develop the tools needed to weather emotional storms without making impulsive, potentially harmful decisions, and lead you to a more balanced and fulfilled life.
Emotion Regulation skills help you to be able to express your emotions in an effective way so that your true feelings are heard and understood. By practicing emotion regulation skills, you will learn to identify and understand your own emotions, decrease the frequency of negative emotions, reduce how vulnerable you are to your emotions, learn how to deal with difficult emotions without self-harm, and improve your ability to regulate your emotions. Mastering these skills allows you to be able to manage your emotional responses in ways that are more adaptive, less disruptive, and more aligned with your values. As a result, you will create a stable environment to make healthier decisions and improve your overall quality of life.
Interpersonal Effectiveness skills help you to be able to have healthy relationships with people in your life. These skills help you improve your communication and become more assertive without causing further rifts in relationships. Interpersonal effectiveness looks like communicating effectively with others, being able to set healthy boundaries and ask for what you need from others, knowing how to handle conflicts constructively, getting your needs met, and having others take your opinions seriously. These skills have the ability to help you improve your relationships and promote emotional stability, self-respect, and long-term well-being. Focusing on interpersonal effectiveness is essential to bolster personal growth and interpersonal harmony.
Who Benefits From DBT
DBT is a great form of treatment for a wide variety of people with a myriad of mental health conditions and emotional challenges. Originally, DBT was created primarily for adults with a borderline personality disorder diagnosis as this population typically has great difficulty managing their emotional reactions and tend to be very impulsive. Over the years though, DBT has expanded to include people of all genders, ages, and a variety of mental health diagnoses including depression, anxiety, bipolar disorders, ADHD, eating disorders, and PTSD.
As DBT gained popularity, clinicians began to wonder how to apply these skills to help children and teens. DBT-C was developed to help children find relief from their presenting problems and to reduce the risk of developing other mental health disorders in the future. This is done by helping children have a better relationship with the environment and a better relationship with their own self. Some of the goals of DBT-C are to help children develop a sense of self-love, a sense of safety, and a sense of belonging. DBT-C also incorporates parents in the treatment, which provides the support children need to overcome their obstacles.
As previously mentioned, DBT has become a treatment used for more than just borderline personality disorder. The skills that are taught within DBT are beneficial for anyone who has difficulties with emotion regulation, self-destructive behaviors, and interpersonal difficulties. Because of this, DBT has been found to be effective among all different types of people in a variety of clinical settings.
DBT vs RO-DBT
As clinicians began to use DBT to treat their patients, many began to realize that DBT does not work well for all of their clients. Clinicians noticed that a very specific subset of clients did not respond well to DBT due to their excessive self-control or overcontrol. One clinician in particular, Dr. Thomas Lynch, decided that in order to help this specific subgroup he would need to modify DBT. As a result, he developed Radically Open Dialectical Behavior Therapy (RO-DBT).
RO-DBT is based on similar principles as DBT, however it differs in several ways. Here are some of the common ways in which RO-DBT is different from traditional DBT.
Target population
- RO-DBT was created for over-controlled clients, meaning they direct more of their emotions inward or they do not allow their emotions to emerge at all. Common diagnoses for people who are over-controlled are anorexia nervosa, chronic depression, and OCD.
- DBT was developed for clients who are more under controlled, meaning they direct their emotions outward and appear to be disruptive to others. Common diagnoses for people who are under controlled are borderline personality disorder, substance abuse, and bipolar disorder.
Therapeutic Focus
- RO-DBT places an emphasis on external, or interpersonal, social signaling and social connectedness.
- DBT places an emphasis on internal, or intrapersonal, emotion regulation, impulse control, and distress tolerance.
Role of Biotemperment
- RO-DBT focuses on how biology influences our perception of others and how in return that affects our actions.
- DBT does not directly address or focus on the effect of one’s temperament.
Mindfulness Practices
- RO-DBT encourages clients to practice self-inquiry and cultivate healthy self-doubt along with focusing on flexible-mind responses that promote relaxation from rules and increase appropriate emotional expression.
- DBT encourages clients to experience nonjudgmental awareness of reality while operating out of Wise Mind and focusing on reducing mood dependent impulsivity.
Therapeutic Stance
- RO-DBT therapists take a less directive approach and encourage independent actions and thoughts.
- DBT therapists use external contingencies and take a more direct stance in order to stop dangerous and impulsive behaviors.
Radical Acceptance vs Radical Openness
- RO-DBT prioritizes radical openness which looks like actively seeking the things one wants to avoid in order to learn. This can include challenging one’s perceptions of reality, modeling humility, and a willingness to learn.
- DBT takes the radical acceptance approach which looks like accepting reality for what it is and turning suffering that cannot be tolerated into something that can be.
DBT Skills Groups in Tampa Bay
The most effective way to develop DBT or RO-DBT skills is for one to attend weekly individual sessions with a therapist who is trained in DBT as well as attend a weekly skills group. By doing both individual and group sessions, one is able to learn the variety of skills in depth in a skills group and then apply them to their own life in individual sessions. This becomes the most effective use of one’s time while in both a skills group and individual sessions.
In the Tampa Bay area there are a variety of groups that are offered for both DBT and RO-DBT skills. Here is a list of currently available groups for people of all ages.
| Group Name | Location | Population |
| RO-DBT Group | Integrated Care Clinic Virtual | Adults |
| DBT & RO-DBT Groups | Tampa Bay DBT | Teens and Adults |
| DBT Group | TBC for CBT | Teens and Adults |
| RO-DBT Group & RO-DBT Graduate Group | Radically Open Tampa | Adults |
DBT Therapists in Tampa Bay
If you have decided that DBT therapy would be helpful for you and you would like to start DBT therapy, finding the right therapist is important. One of the first things you should look for in a DBT therapist is that they are qualified to use DBT. The therapist should have gone through training to be able to effectively teach how to use each of the skills and guide you through applying those skills in your life.
