What Is DBT Treatment Like?
DBT treatment generally consists of therapy in individual and group settings, practicing skills outside of sessions (e.g., “phone coaching,” homework), and working with a therapist who participates in a consultation team.
DBT begins with “pre-treatment” sessions with your therapist. Your therapist asks you about your background and your goals for therapy. You collaborate in developing a treatment plan.
Individual therapy focuses on the patient’s motivation to change, as well as adapting behaviors to be consistent with what the patient perceives to be a life worth living. This is done both in and out of the therapist’s office.
Each week, the patient must complete a self-monitoring form—sometimes called a “diary card”—that tracks treatment targets and daily mood ratings. The therapist uses it to prioritize session time, where behavior that is life-threatening gets the highest priority.
Behavior that disrupts DBT—like tardiness or skipping sessions—would be addressed next, followed by behavior that impacts quality of life. Behaviors that impact quality of life could include anything from arguing with loved ones to dangerous substance use to procrastination.
You and your therapist personalize your diary card based on your goals and revise it over time as you progress in therapy. The diary card helps create consistently productive individual therapy sessions.
Once behaviors and session time are prioritized, the provider and patient discuss causes and consequences of each behavior. This way patients can learn how to understand behavioral patterns, manage their emotions, and solve problems faster and with less stress.
The group therapy component of DBT is less like what you’d imagine a group therapy session to be. It’s more like a weekly class. It typically starts with a mindfulness exercise and a review of the past week’s homework. The session continues with a lesson on a new skill and activities or hands-on practice for that skill.
In DBT group therapy, new skills are learned, and patients have a chance to work on practicing these skills before they’re put into action out in the “real world.” Just like a class, there is weekly homework so the skills taught can be practiced in everyday life.
Many skills taught in DBT use acronyms to help with easier recall and use. One example is “DEAR MAN,” which teaches strategies for effective and assertive communication through the following:
- Appearing confident
Another example is the “STOP” skill, which is used in distress tolerance skill training. This can be helpful in accepting the reality of a situation when the circumstances are difficult or if there’s a strong urge to act impulsively or emotionally. STOP stands for:
- Take a step back
- Proceed mindfully
These are just a couple of the skills that can be learned in DBT, but there are many others taught that can help patients in many areas of their lives.
An important part of DBT is ensuring that patients can use the skills regularly in their daily lives. While patients get into a routine of completing their diary cards and homework assignments, it can still be hard to apply new skills independently—especially in highly stressful situations.
“Phone coaching,” an essential component of DBT, is designed for just that. Phone coaching helps patients apply skills when they are having trouble doing so in the moment. It involves the therapist being available by phone for support. Patients and therapists develop plans for when and how to use phone coaching.
Many DBT programs can last six months or longer because behavior changes, as well as the skills taught in DBT, take a while to become go-to thoughts and actions.
Standard DBT also includes a therapist team meeting. Several DBT therapists meet weekly to help one another problem-solve, adapt, and implement treatment when faced with unique clinical challenges—for example, if a patient is regularly skipping therapy sessions.
In the team meeting, therapists are encouraged to remain compassionate and nonjudgmental toward patients, especially when in difficult circumstances.
Support, encouragement, and monitoring for therapist burnout may also be provided in the team meeting. This allows for therapists to continue to learn from one another and ultimately provide the best care for you or your loved one.