7. Dialectical Behavior Therapy

Summary

Dialectical behavior therapy (DBT) is an approach to behavior therapy that is distinctive in its attention to, and intentional use of, dialectical processes of polarization, tension, and synthesis in its understanding of client and therapist behavioral patterns within the therapeutic relationship, in therapists' moment-to-moment choice of treatment strategies, and in case consultation and all other aspects of treatment. In all of these areas, the dialectical tension and synthesis most central in DBT is that between acceptance and change. DBT expands from standard behavioral and cognitive therapy change strategies to emphasize strategies that promote acceptance of clients by therapists and acceptance by clients of reality as it is. Methods for practicing increased mindfulness (meaning intentional nonjudgmental awareness) are viewed as a primary means for developing greater reality acceptance. This chapter describes the development and fundamental principles of DBT, its model of psychopathology, and its treatment structure and strategies, with emphases on the roles of mindfulness and acceptance strategies and on theoretical and technical similarities and differences from other CBT approaches. The chapter concludes with a summary of treatment outcomes reported in ten randomized controlled trials and discussion of possible mechanisms of action and directions for research.