What is dialectical behavior therapy DBT

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Dialectical Behavioral Therapy (DBT) was developed by Marsha Linehan (1993) for the treatment of patients with suicidal intentions and self-harming behavior in the context of a borderline disorder. The DBT understands this to be a disturbance in the regulation of emotions and tension: on the basis of an emotional vulnerability, difficulties can arise in regulating one's own emotions. In addition, if the environment does not validate (recognize) the feelings and behavior of those affected, this can lead to an intensification of the symptoms.

The DBT is designed specifically for the disorder and integrates a wide range of therapeutic strategies and techniques. In particular, recurring dysfunctional behavior patterns for coping with problems should be recognized, questioned and changed within the framework of the therapy. To this end, elements of the cognitive-behavioral and psychodynamic schools are combined.

An essential component of the DBT is the so-called skills training, which aims to build up skills for changing behavior, feeling and thought patterns and the interruption of dysfunctional patterns. The skills training consists of four different areas: mindfulness, stress tolerance, emotion regulation and interpersonal skills.

  • By the Mindfulness training a conscious perception and acceptance of the here and now is aimed for, whereby previous behavior and thought patterns are to be observed and questioned more closely.
  • By the Stress tolerance training The aim is to recognize and apply tension-regulating strategies, whereby phases of high stress are mastered and prevented.
  • Emotion-regulating measures aim at identifying, checking and regulating emotions.
  • In addition, the acquisition of interpersonal skills, such as the training of social skills, a more appropriate behavioral reaction in interpersonal conflicts and situations of tension.

The DBT strives for a balance between the acceptance of maladaptive behavior patterns as well as the simultaneous change of previous behavioral strategies. The therapist alternates between problem-oriented change strategies (behavior analysis, cognitive changes in dysfunctional thoughts) and accepting strategies (direct intervention in the environment), with the aim of creating an atmosphere that promotes development. This change is called dialectical strategy and is the core of the DBT. Furthermore, the recurring behavioral patterns are analyzed in more detail and the mechanisms for maintaining them, which are the most dysfunctional, are questioned. This takes place on different levels (physical, emotional, cognitive, behavioral).


  • Bohus, Haaf, Stiglmayr, Pohl, Bohme, Linehan (2000): Evaluation of inpatient dialectical-behavioral therapy for borderline personality disorder - a prospective study: Behavior Research and Therapy, v. 38, p. 875-887.
  • Bohus, Wolf: Interactive skills training for borderline patients. Manual for the CD-ROM for therapeutic work. Stuttgart: Schattauer
  • B√∂hme, Fleischhaker, Mayer-Bruns, Schulz: Dialectical-Behavioral Therapy for Adolescents (DBT-A) - therapy manual, self-published.
  • Fleischhaker, Schulz: Borderline personality disorders in adolescence, Springer.
  • Linehan, Schmidt, Dimeff, Craft, Kanter, Comtois (1999) Dialectical behavior therapy for patients with borderline personality disorder and drug-dependence: The American journal on addictions, v. 8, p. 279-292.
  • Linehan: Dialectical Behavioral Therapy of Borderline Personality Disorder, CIP Medien.