With a multitude of psychotherapeutic modalities available to consumers, it is often confusing to know which approach is appropriate for which psychological difficulties. Dialectical behavior therapy (DBT) is a form of cognitive behavior therapy (CBT) that was originally developed by Dr. Marsha Linehan for the treatment of borderline personality disorder (BPD). DBT has since been applied to a wide range of behavioral disorders of affect regulation, namely, to the treatment of any unhealthy behaviors people turn to manage their emotions (e.g., eating disorders, alcohol and drug abuse, cutting, internet addiction, pornography addiction, gambling, etc.).

1. By Dr. Abigail McNally

2. Dialectical Behavior Therapy (DBT)
for the Nonprofessional
With a multitude of psychotherapeutic modalities
available to consumers, it is often confusing to know which
approach is appropriate for which psychological
difficulties. Dialectical behavior therapy (DBT) is a form of
cognitive behavior therapy (CBT) that was originally
developed by Dr. Marsha Linehan for the treatment of
borderline personality disorder (BPD). DBT has since been
applied to a wide range of behavioral disorders of affect
regulation, namely, to the treatment of any unhealthy
behaviors people turn to manage their emotions (e.g.,
eating disorders, alcohol and drug abuse, cutting, internet
addiction, pornography addiction, gambling, etc.).

3. Dialectical Behavior Therapy (DBT)
for the Nonprofessional
While many unhealthy behaviors may be treated indirectly
by other approaches, such as psychodynamic
psychotherapy or interpersonal psychotherapy, DBT is
particularly effective when behavioral dysregulation is
severe, addictive, and/or when the patient has a volatile,
fragile, or shame-infused sense of self. DBT embraces a
non-judgmental perspective; the treatment is guided
throughout by a core assumption that the patient’s
problematic behavior exists for an adaptive, functional
reason (it serves an important emotional purpose that
must be understood and validated before alternative
healthier means for accomplishing the same goal are
learned).

4. Dialectical Behavior Therapy (DBT)
for the Nonprofessional
At its theoretical foundation are the behavior change
strategies of CBT. Namely, techniques to alter behaviors
and/or to alter cognitions (thoughts) are used to help alter
how the patient feels. In addition to change-based
strategies, however, the “dialectical” addition to DBT
includes an equal focus on acceptance-based strategies.
Based in Buddhist meditative philosophy, acceptance work
focuses patients on the importance of accepting what
simply is in the here and now rather than fighting it or
trying to change it (e.g., a patient overwhelmed by anxiety
is helped to observe, describe, and accept the anxiety non-
judgmentally and allow it to be as it rises and falls naturally
as do waves on the shore).

5. Dialectical Behavior Therapy (DBT)
for the Nonprofessional
Formal DBT with BPD or otherwise chronically
suicidal patients includes a weekly individual therapy
session for honing in on a patient’s target behaviors, a
weekly DBT group session for learning and practicing
skills, and a weekly consultation team session for the
therapist. Informal DBT, or DBT-informed
psychotherapy, weaves skills-based work in affect
regulation into an on-going interpersonally oriented
psychotherapy.

6. About the Author
An expert in the use of DBT-informed psychotherapy
and psychoanalytic treatment methods, licensed
psychologist Dr. Abigail McNally maintains a private
practice in Cambridge, Massachusetts. Dr. McNally’s
specialties include borderline personality disorder,
trauma/PTSD, and eating disorders. She holds a Ph.D.
in Psychology from Boston University and is the
former Director of Psychology Training at Two Brattle
Center, PC.