Dialectical Behavior Theory

Laura R. Simpson

Dialectical behavior therapy (DBT) is a therapeutic methodology initially developed by Marsha M. Linehan in the late 1970s to treat individuals with borderline personality disorder (BPD). As its name suggests, DBT is grounded in a dialectical perspective of reality and experience. That is, the world is in continuous change and ever shifting, and individuals are constantly in transition. An individual's knowledge base and coping skills developed from life experience provide the frame of reference for reacting to challenges, and the consequences of those reactions affect knowledge of self, others, and the world. This ongoing cyclical relationship between what the individual knows and does is often destructi ve and leads to ongoing dysfunctional relationships, difficulty coping with stressors, or chronic frustration. Dialectical behavior therapy combines customary cognitive-behavioral techniques for emotion regulation and reality testing with concepts of mindful awareness, distress tolerance, and acceptance predominantly derived from Buddhist meditative practice (Linehan, 1993a).

Dialectical behavior therapy is the first therapy that has been empirically proven to be successful for treating BPD. Specifically, individuals with self-injurious behaviors such as cutting, suicidal thoughts, gestures, and even attempts have shown positive response to this therapeutic intervention (McMain, Korman, & Dimeff, 2001). Research indicates that DBT is also effective treating other mental health problems, such as depression, bipolar disorder, posttraumatic stress disorder (PTSD), anxiety, eating disorders, or alcohol and drug problems (Feigenbaum, 2007; Katz, Gunasekara & Miller, 2002; Lynch, Chapman, Rosenthal, Kuo, & Linehan, 2006; Lynch & Cheavens, 2008; McMain et al., 2001; Quinn, 2009; Swales, Heard, & Williams, 2000).

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