Dialectical

Behavior
Therapy (DBT)
Lupe Espinoza, Chayanne Ramirez, Elaine Young
 Brief History
How did this approach develop? Who were
the prominent figures in its development?

Theory of Change
Strategies
How does counseling or psychotherapy
What techniques or strategies are used?
work? How do people change?

Role of Therapist Research on Efficacy

How does the therapist relate to the What is the strength of the
client? What is his or her role? evidence for this approach?

Evaluation
What are the strengths and limitations of this
approach with children in schools?
 Jamboard Activity:
Please share two nuggets of knowledge
throughout the presentation!

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Brief History
 Dialectical Behavior Therapy

DBT Development Prominent Figures

● a comprehensive cognitive ● The first clinical trials were ● Marsha Linehan

focused on treating ○ Professor of Psychology at the
behavioral treatment for University of Washington
complex, difficult to treat chronically suicidal who
■ Retired in 2019
mental disorders also met criteria for ○ Original developer of DBT
● a modular and hierarchical borderline personality ○ Hospitalized at 17 years old
treatment consisting of a disorder (BPD) ○ Linehan developed DBT as a
combination of individual ○ a population known result of her own
psychotherapy, group skills, transformation that occurred in
for being at risk for 1967, while she prayed in a
training, telephone coaching, suicide small Catholic chapel in
and a therapist consultation ● Trial and error effort Chicago
team ○ Driven by clinical
experience

(Dimeff & Linehan, 2001; Fassbinder et al., 2016; Linehan & Wilks, 2015)
Theory of Change
How do people change?
Cognitive Behavioral Biosocial Theory Dialectical Theory
Therapy (CBT)
● Emotional ● There is no absolute
● Influence on DBT Dysregulation truth or relative truth
● Strong therapeutic ● Impulsivity ● Reality is comprised of
alliance ● Impulsive
internal opposing truths
● Identify extreme and Behaviors
and the integration
absolute thought
○ Thesis
patterns and test
their validity ○ Antithesis
● Behavioral ○ Synthesis
Activation ● Continuous state of
change
Role of Therapists
How does the therapist relate to the client?
 Types of Roles
Navigator Cheerleader Collaborator
Helping the client navigate Motivating clients to change Recognizing the client as
through the processes by validating their situation as autonomous and that the
unbearable. therapeutic relationship is real
and collaborative

Teacher Juggler Validator

Grounded in DBT skills, Juggle various techniques Validate clients to motivate
continuously practicing and and strategies. Being flexible change, and understand
learning, understand cognitive with changes that occur various levels of validation
behavioral theory & language, throughout sessions. Prioritize and how it helps clients
teach clients skills issues and discussions in
sessions.
 Additional Roles
● Utilize assessment tools to identify the client’s behaviors and establish
a treatment plan.

● Assess the client’s target behaviors and goals.

● Treat highest target behaviors with priority.

● Utilize progress monitoring throughout the client’s duration of service

in order to have an accurate conceptualization and intervention plan.
 DBT & SFBT Comparison
DBT therapists have an instructional approach to counseling the
client, through dialectical conversations, teaching mindfulness
strategies (acceptance), and helping clients acquire skills to
change behaviors.

On the other hand, SFBT tends to be a more collaborative

approach. Where the client is the expert and acquire the
strengths and skills to reach their goals.
Strategies
 Strategies

Modules Functions

● Mindfulness 1. Enhances behavioral capabilities

● Emotion Regulation 2. Improves motivation to change (by modifying
● Interpersonal Effectiveness inhibitions and reinforcement contingencies)
3. Assures that new capabilities generalize to the new
● Distress Tolerance
environment
4. Structures the treatment environment in the ways
Major Components essential to support client and therapist capabilities
5. Enhances therapist capabilities and motivation to
● DBT skills training group treat clients effectively
● DBT individual psychotherapy
● DBT telephone coaching
● DBT therapist consultation team
(Carson-Wong et al., 2018; Linehan, 1993; McCauley et al., 2018)
Research on Efficacy
What is the strength of the evidence for
this approach?
 Brief DBT Skills Programs DBT STEPS-A
(Stand-alone treatment) ● Reduced depression, anxiety
● Reduced youth’s likelihood to and social stress
engage in risk-taking behavior ● Improvements in emotional
● Decreased depression and symptoms and internalizing
other outcome variables problems
● Decreases in suicidal ideation, ● Students with trauma →
manic symptoms and increased use of positive
emotional dysregulation coping skills
● 28% reported an increase in ● Decreased emotional
effective coping skills reactivity and impairment
 Evaluation
What are the strengths and limitations of this
approach with children in schools?
 DBT-STEPS A Program
This program is delivered over the academic year (30 weekly classes) and teaches skills to
adolescents in the areas of distress tolerance, emotion regulation, interpersonal effectiveness
and mindfulness. This is not a therapy program.

The DBT STEPS-A curriculum is delivered by teachers to the student population. If a risk is
identified, a student can be referred to specialist services.

Strengths: Limitations:
● Identifying students who need mental ● Training teachers (takes time)
health services. ● Lack of research of efficacy in different
● Teaching all students effective skills. school settings/populations
● Reducing mental health stigma and ● For middle and high schools only
addressing issues to the universal
student population.
(Flynn et al., 2018).
 Other Limitations
Training/Certification Education Setting Limitations:
● Not all school counselors or school ● Bringing DBT into the therapeutic
psychologists will be certified DBT process with students require
therapists, which can affect fidelity of planning, organization
DBT practices. (consultation teams), and multiple
● More research is needed for training sessions with students, in order to
therapists, implementing DBT across provide best practices.
diverse populations and settings, ● Lack of research for efficacy within
and adhering to DBT principles. schools.
 References
Carson-Wong, A., Hughes, C. D., & Rizvi, S. L. (2018). The effect of therapist use of validation strategies on change in client
emotion in individual dbt treatment sessions. Personality Disorders: Theory, Research, and Treatment, 9(2), 165.
Chapman, A. L. (2006). Dialectical behavior therapy: Current indications and unique elements.
Psychiatry (Edgmont), 3(9), 62.
Dimeff, L., & Linehan, M. M. (2001). Dialectical behavior therapy in a nutshell. The California Psychologist, 34(3), 10-13.
Fassbinder, E., Schweiger, U., Martius, D., Brand-de Wilde, O., & Arntz, A. (2016). Emotion regulation in schema therapy and
dialectical behavior therapy. Frontiers in psychology, 7, 1373.
Flynn, D., Joyce, M., Weihrauch, M., & Corcoran, P. (2018). Innovations in Practice: Dialectical behaviour therapy - skills
training for emotional problem solving for adolescents (DBT STEPS-A): evaluation of a pilot implementation in Irish
post-primary schools. Child and Adolescent Mental Health, 23(4), 376–380. https://doi.org/10.1111/camh.12284
Goldstein, T. R., Fersch-Podrat, R. K., Rivera, M., Axelson, D. A., Merranko, J., Yu, H.,... & Birmaher, B. (2015). Dialectical behavior
therapy for adolescents with bipolar disorder: results from a pilot randomized trial. Journal of child and adolescent
psychopharmacology, 25(2), 140-149.
Linehan, M. M. (1993). Dialectical behavior therapy for treatment of borderline personality disorder: implications for the
treatment of substance abuse. NIDA research monograph, 137, 201-201.
Linehan, M. M., & Wilks, C. R. (2015). The course and evolution of dialectical behavior therapy. American journal of
psychotherapy, 69(2), 97-110.
 References

Lynch, T. R., Chapman, A. L., Rosenthal, M. Z., Kuo, J. R., & Linehan, M. M. (2006). Mechanisms of
change in dialectical behavior therapy: Theoretical and empirical observations. Journal of
clinical psychology, 62(4), 459-480.
MacPherson, H. A., Cheavens, J. S., & Fristad, M. A. (2013), Dialectical behavior therapy for
adolescents: Theory, treatment adaptations, and empirical outcomes. Clinical child and
family psychology review, 16(1), 59-80.
McCauley, E., Berk, M. S., Asarnow, J. R., Adrian, M., Cohen, J., Korslund, K., ... & Linehan, M. M. (2018). Efficacy of dialectical
behavior therapy for adolescents at high risk for suicide: a randomized clinical trial. JAMA psychiatry, 75(8), 777-785.
Panos, P. T., Jackson, J. W., Hasan, O., & Panos, A. (2014). Meta-Analysis and Systematic Review Assessing the Efficacy of
Dialectical Behavior Therapy (DBT). Research on Social Work Practice, 24(2), 11. https://doi.org/DOI:
10.1177/1049731513503047
Rizvi, S. L., & Sayrs, J. H. R. (2020). Assessment-Driven Case Formulation and Treatment Planning in Dialectical
Behavior Therapy: Using Principles to Guide Effective Treatment. Cognitive and Behavioral Practice, 27(1),
4–17. https://doi.org/10.1016/j.cbpra.2017.06.002
Sayrs, J. H. R., & Rizvi, S. L. (2020). Behavioral Assessment in DBT. Cognitive and Behavioral
Practice, 27(1), 1–3. https://doi.org/10.1016/j.cbpra.2019.06.004
 References
Spina, N. (2020). Use of a Modified DBT-STEPS-A Curriculum with Early Adolescents: Changes in Perceived DBT Skills Use,
Dysfunctional Coping, and Blaming Others
Wayne, K. R. (2018). Using Dialectical Behavior Therapy to Improve School Performance of High School Students.
Zapolski, T. C., & Smith, G. T. (2017). Pilot study: Implementing a brief DBT skills program in schools to reduce health risk
behaviors among early adolescents. The Journal of School Nursing, 33(3), 198-204.