Dialectical behavior therapy (DBT) provides patients with new skills that allow them to manage emotion triggers by trauma, and to decrease conflict in relationships. The therapy is geared toward providing therapeutic skills in four key areas.

The mastermind behind this therapeutic genius is Marsha Linehan, who was once a patient herself who benefited from this type of therapy. She was known to be suicidal and wished to end her life. Her story is unique. At 17 years old, she was confined in seclusion at a clinic in Hartford, Connecticut. She was placed in the room because she attacked herself by burning her wrists with cigarettes, cutting her arms, legs, and midsection wide open with sharp objects.

At a loss, physicians diagnosed Linehan with schizophrenia and began treating her accordingly. She was pumped full of Thorazine (chlorpromazine), Librium (chlordiazepoxide), and various other drugs. The cocktail of drugs was also met with hours of electroshock treatments in what they thought was going to treat the woman. It was agonizing for Linehan, who was described as one of the most disturbed patients in the hospital. After her discharge two years later, the doctors summarized her case as unique.

As she opened up to the public, she describes her story as a relentless quest to heal herself and those around her. Linehan went through troubling times, and her goal was to minimize to others what had been done to her. Twenty-six months of hospitalization is agonizing, but the damage she inflicted showed her need for help. The experience led to her developing DBT for those with a borderline personality disorder, a mental illness marked by mood instability, warped self-image, impulsiveness, and intense but unstable relationships.

DBT is employed for individuals afflicted with substance abuse disorders. As a result, DBT has become a significant source of hope in treating addiction.

The principles apply to those with drug or alcohol addictions, or those who struggle with co-occurring disorders such as bipolar disorder. DBT is sufficient in treating addictions because most of those who struggle with drug addiction also have a history of these mental health issues as well. Below, we will examine the effectiveness of DBT in residential treatment and learn about the core principles of the therapy.

The History of Dialectical Behavior Therapy

Dialectical behavior therapy evolved from Marsha Linehan’s effort to create a treatment for multiproblematic, suicidal women. Linehan studied the literature on effective psychological treatments for disorders such as anxiety, depression, and other emotion-related difficulties.

She assembled a package of evidence-based, cognitive-behavioral interventions that specifically targeted those exhibiting suicidal behaviors.

To start, the interventions were geared toward focusing on changing behaviors that many individuals criticized, misunderstood, invalidated, and consequently dropped out of treatment altogether.

After surviving many suicide attempts, Linehan moved to Chicago to live at a YMCA, where she had become an ardent Catholic. She began working and taking night classes at Loyola University. She had a moment, which she describes as an epiphany while praying at an on-campus chapel. The moment changed her life and allowed her to develop what we know today as DBT.

Linehan went on to earn her Ph.D. in social and experimental psychology in 1971. Once she entered into the field and worked with patients, she started to see the significance of acceptance, which is acknowledging reality, a foundational principle of DBT.

She created DBT as a means to adequately treat patients who feel compelled to hurt themselves; people often diagnosed with borderline personality disorder.

DBT incorporates core principles of cognitive behavioral therapy with radical acceptance and distress tolerance. Another key is mindfulness, a Buddhist belief.

The Core Principles of Dialectical Behavior Therapy

Dialectical behavior therapy is support-oriented, meaning that it is designed to help individuals identify and build on their strengths to develop self-confidence. The treatment is cognitive-based, which means it helps individuals identify patterns that make their lives more complicated.

Additionally, DBT is collaborative, meaning that it encourages individuals to work through their issues in collaboration with therapists. During the sessions, DBT will ask individuals to complete homework assignments, role-play new methods of interacting with others, and work on how to calm yourself when upset. Acquiring these tools is a significant portion of DBT, and they are taught in weekly lectures, reviewed in homework groups, and referred to in every group. The therapist seeks to help the person learn and apply these tools to everyday life.

The four key areas of DBT are:


The core of DBT is centered around mindfulness, and it helps patients to accept the emotions they feel when they challenge habits or beliefs, and by confronting upsetting or traumatic situations. While mindfulness is a derivative of Buddhist views, DBT does not contain any religious elements. Therapists will urge their patients to practice mindfulness in a way that they become much more self-aware of their environment.

Interpersonal Effectiveness:

This portion involves how patients interact with those around them and in their relationships. They are taught how to ask for what they need, how to say no, and how to deal with interpersonal conflict.

Distress Tolerance:

This involves tolerating, accepting, and finding meaning through the stress and interruptions in our lives. These can include stressful events such as the death of a relative, loss of employment, or illness. The person will be taught how to accept an event of this magnitude without judging the situation. The objective of distress tolerance is to develop the ability to be aware of an adverse event without it becoming overwhelming and challenging their inner peace.

Emotional Regulation:

Emotional regulation aims to teach those in recovery how to identify, regulate, and feel emotions without it overwhelming them to the point that it triggers impulsive behavior. For those who are suicidal or struggle with borderline personality disorder, this element teaches them to regulate the intense emotions they experience, such as anger, frustration, depression, and anxiety.

What Is Dialectical Behavior Therapy Used For?

Dialectical behavior therapy is used to treat various mental health conditions, such as borderline personality disorder, anxiety, depression, eating disorders, suicidal tendencies, and substance use disorders. In addition, it is powerful enough for any condition that a person wants to improve their mindfulness, distress tolerance, interpersonal effectiveness, and emotional regulation.

Why is Dialectical Behavior Therapy Effective?

Dialectical behavior therapy is mainly effective due to some individuals inability to cope with life. DBT preaches the required skills to function successfully in life. It offers real-life techniques to improve skills with clinical support, which allows people to continue improving their skills.

How Effective is Dialectical Behavior Therapy?

For those motivated to change, this form of therapy is highly effective. It has been proven so in several cases for those coming from diverse backgrounds in terms of gender, age, sexual orientation, and ethnicity. Extensive research has validated its effectiveness.

How Dialectical Behavior Therapy Works in Residential Treatment

Dialectical behavior therapy can be vital in residential treatment for people who want to adapt to new feelings of sobriety. Those who use addictive substances often mask their emotions for years at a time. Someone who doesn’t know how to deal with these emotions will likely turn back to drugs or alcohol to cope.

The purpose of residential treatment is to retrain the mind of someone who has been actively using drugs for long periods, and by implementing such practices, those can leave treatment, in essence, with a blank slate. They will have a new outlook on life that allows them to cope with the emotions and hardships of life that they were running from before treatment.

The creation of this therapy has been an essential portion of treating addiction and will continue to do so as more people struggle with addiction.

Why Dialectical Behavior Therapy is Effective in Residential Treatment

DBT has a high success rate in residential addiction treatment because the client will learn to articulate, envision, pursue, and sustain goals that are unique of their history of out-of-control behaviors, including substance abuse, and is able to deal with life’s everyday problems. DBT emphasizes to build a life worth living.

DBT is just one form of therapy; however, that is used to recover from drug or alcohol addiction. It should not be the only therapy that treats addiction. An established treatment provider will use a variety of techniques evidence-based therapies, which include 12-step programs.

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