The overall goal in DBT is to create a life worth living – a life you really want. This involves learning and refining skills that change behavioral, emotional, and thinking patterns associated with problems in living – that is, those that cause misery and distress.

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What happens in DBT therapy?
Individual therapy within the DBT system is a lot like standard therapy. However, it will also include DBT-specific aspects, including talking about skills and checking in with where you are emotionally.  You will also identify your “target behaviors” – the things you do that are ineffective and tend to cause trouble for you. In your skills sessions, you will be learning about different things you can do to help you cope with stressful or crisis situations.

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What are the goals of DBT?
In DBT therapy, you will work on 4 specific areas of functioning. These include decreasing some behaviors and increasing others:

Behaviors to Decrease:

• Interpersonal chaos - Your relationships may feel chaotic, stressful and/or out of control

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• Out of control (“labile”) emotions and moods - You may feel like you're going crazy, or that you can't control yourself, or you may hear from others than you're out of control

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• Impulsive and/or reckless behavior - things you do that make the situation worse. These behaviors are called "target behaviors."

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• Confusion about yourself and your thinking (“cognitive dysregulation”), and “thinking traps” (cognitive distortions) that lead you to feel emotionally out of control or hopeless. Because of this confusion, you may behave in ways that damage your relationships and ability to cope effectively.

Behaviors to Increase: (DBT Skills modules)

• Interpersonal effectiveness skills – relating well with others and getting your needs met, while keeping your self-respect. This helps reduce the chaos many people feel in their relationships. You will learn how to balance your priorities with other people's demands and how to ask for something and say no effectively. You will also learn a structure for having difficult conversations.

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• Emotion regulation skills – feeling more in control emotionally and dealing with overwhelming emotions. You will learn to understand how emotions work, why we have emotions, and how to use mindfulness and coping tools to help you feel more in control of your emotions.

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• Distress tolerance skills – how to deal with overwhelming stressors, crisis situations, or other situations where you need coping skills. Using these skills helps reduce giving in to impulsive urges. The main idea here is to survive the situation - to get through it without making it worse.You will learn copings tools to use in crisis or overwhelmingly stressful situations. You will also learn "acceptance" skills, which will help you deal with the reality of situations rather than what should be, is fair, or what you think is right.

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• Core mindfulness skills – how to recognize the thinking traps you use the most, how to think dialectically, and how to be more aware of what’s going on around you. The idea here is that awareness of what’s going on leads to choices about how you handle it. Making active, conscious choices from a place of wisdom and understanding is one goal here.You will learn to describe rather than judge or evaluate a situation, and observe your reactions and your internal state. You will also learn to make choices from a place of inner wisdom ("wise mind"), participate in the world around you, and focus on what is effective to help you create the life you want.

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How long does all this take?
DBT is not a 6-week cure. These skills take time to teach, time to practice, and time to master. At a minimum, expect your DBT therapy to last about 6 months. This is the minimum amount of time to go through one full course of the DBT skills. Traditionally, the skills training is structured into 3 main modules, each lasting approximately 8-10 weeks,

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The first two to three sessions of a traditional module contain the core mindfulness skills, and the rest of the module is devoted to distress tolerance, emotion regulation, or interpersonal effectiveness skills. The reason we include the core mindfulness skills at the beginning of each module is because these skills are the base that everything else is built on. They are also a bit “slippery” – they can be more abstract than most of the skills and take some extra practice to get good at.

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