DBT
Core Mechanism
Skills training (mindfulness, distress tolerance, emotion regulation, interpersonal effectiveness) + behavioral contingency management + dialectical validation reduces dysregulation
Ontology
Biosocial model: biological emotional vulnerability + invalidating environment → pervasive emotion dysregulation
Therapeutic Voice
"Right now your emotion mind is in the driver's seat. Can we find wise mind together?"
View of the Person
A biologically vulnerable being in transaction with an invalidating environment, needing both acceptance and change
Evidence
NICE: recommended for BPD. APA Div 12: Strong Research Support for BPD
30+ RCTs
Cochrane review (Storebø et al., 2020); DeCou et al. (2019)
Very strong evidence for BPD and suicidal behavior. Growing evidence for eating disorders, substance use.
Conditions
Epistemology
Blind Spots
Heavy skill emphasis can feel prescriptive; may not address underlying trauma directly; requires significant client commitment
Contraindications
Active psychosis, severe cognitive impairment limiting skills acquisition, clients unwilling to commit to the full treatment package (individual + group + phone coaching), antisocial personality disorder without emotional dysregulation
Training
DBT Intensive Training (2 parts, 5 days each). Consultation team required for comprehensive DBT. DBT-LBC certification optional
DBT-LBC certification optional
Intensive: 10 days + implementation between parts
$3K-6K for Intensive
Equity & Cultural Adaptations
Philosophical Roots
Zen Buddhism (mindfulness, radical acceptance); Hegel (dialectical synthesis of opposites); behaviorism (Skinner); biosocial model has no single philosophical ancestor
Related Modalities
Clinical Vignettes
See how DBT formulates these cases:
Test Yourself
What is the core dialectic in DBT?
Show answer
Acceptance AND change simultaneously — neither alone is sufficient.