Types of Dialectical Behavior Therapy

Dialectical Behavior Therapy (DBT) is a structured, evidence-based therapeutic approach originally developed to treat individuals with borderline personality disorder (BPD). Over time, it has been adapted for various populations and conditions, resulting in multiple forms. Here’s an overview of the main types of DBT:

  • Purpose: Designed for adults with high emotional dysregulation, especially those with borderline personality disorder, chronic suicidal ideation, and/or self-harming and suicidal behavior.
  • Components:
    1. Individual Therapy: Weekly sessions focused on personal goals and problem-solving.
    2. Skills Training Groups: Weekly group sessions teaching mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness.
    3. Phone Coaching: On-demand support to apply DBT skills in real-life situations.
    4. Consultation Team: A support system for therapists to ensure effective delivery of DBT.
  • Key Features: Comprehensive and intensive, requiring a significant time commitment. Over 60 randomized control trials demonstrate effectiveness.

  • Purpose: Modified for adolescents struggling with emotional dysregulation, self-harm, suicidal behaviors, and family conflict.
  • Components:
    • Combines individual therapy with multi-family skills training groups.
    • Includes all the other features of standard DBT.
  • Unique Aspects: Actively involves parents or caregivers in the therapeutic process to create a supportive environment and teach family-wide skills.

  • Purpose: Adapted for preadolescent children with severe emotional and behavioral dysregulation, including early signs of anxiety, depression, or disruptive behavior.
  • Components:
    • Focuses on the parent-child relationship, with parents receiving intensive training in DBT skills.
    • Includes age-appropriate interventions for children to manage emotions and behaviors.
  • Key Features: Emphasizes parental involvement and modeling of DBT skills, as children often lack the capacity for abstract skill application.

  • Purpose: Developed to treat individuals with post-traumatic stress disorder (PTSD) within the DBT framework.
  • Components:
    • Combines DBT’s emotion regulation and distress tolerance skills with Prolonged Exposure (PE) therapy for trauma processing.
    • Includes exposure to trauma-related memories and situations to reduce avoidance and PTSD symptoms.
  • Unique Aspects: Ensures emotional stability through DBT skills before trauma-focused interventions begin.

  • Purpose: Specifically designed to treat disorders characterized by overcontrol, such as anorexia nervosa, obsessive-compulsive personality disorder, chronic depression, or perfectionism.
  • Components:
    • Focuses on building openness, flexibility, and emotional expression in individuals who struggle with excessive self-control and rigidity.
    • Teaches skills related to increasing social connectedness, openness to new experiences, and fostering spontaneity.
  • Key Features: Unlike standard DBT, which primarily addresses emotional dysregulation, RO-DBT targets overcontrol, which can contribute to social isolation, perfectionism, and maladaptive coping strategies. It emphasizes cultivating a sense of vulnerability and connection with others.

  • Purpose: An adaptation of DBT that integrates theory and interventions of Acceptance and Commitment Therapy (ACT) with DBT.
  • Components:
    • Integrates traditional DBT skills with a focus on understanding how contextual factors influence emotional responses and coping strategies.
  • Key Features: Offers a flexible, individualized approach that may be effective for clients navigating complex environmental or social dynamics, such as family systems, workplace stressors, or cultural expectations.
  • Caveats: Research is lacking on effectiveness with high-risk behaviors.

  • Purpose: Utilizes some principles and skills of DBT without implementing the full, formal structure of standard DBT.
  • Components:
    • May focus on core DBT skills like mindfulness, distress tolerance, emotion regulation, or interpersonal effectiveness.
    • May involve individual therapy without group training or omit other elements like phone coaching.
  • Key Features: Flexible and less intensive, making it accessible for clients who don’t require the comprehensive framework of standard DBT.
  • Caveats: No research support for effectiveness, may not be intensive enough for individuals engaging in self-harm or other high-risk behaviors.
    • No standard definition, clarify what this means with therapist.

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