Behavior Therapy and Cognitive Behavior Therapy are types of treatment that are based firmly on research findings. These approaches aid people in achieving specific changes or goals.
Changes or goals might involve:
A way of acting: like smoking less or being more outgoing;
A way of feeling: like helping a person to be less scared, less depressed, or less anxious;
A way of thinking: like learning to problem-solve or get rid of self-defeating thoughts;
A way of dealing with physical or medical problems: like lessening back pain or helping a person stick to a doctor’s suggestions.
Behavior Therapists and Cognitive Behavior Therapists usually focus more on the current situation and its solution, rather than the past.
They concentrate on a person’s views and beliefs about their life, not on personality traits.
Behavior Therapists and Cognitive Behavior Therapists treat individuals, parents, children, couples, and families.
Replacing ways of living that do not work well with ways of living that work, and giving people more control over their lives, are common goals of behavior and cognitive behavior therapy.
HOW TO GET HELP:
If you are looking for help, either for yourself or someone else, you may be tempted to call someone who advertises in a local publication or who comes up from a search of the Internet.
You may, or may not, find a competent therapist in this manner.
It is wise to check on the credentials of a psychotherapist.
It is expected that competent therapists hold advanced academic degrees.
They should be listed as members of professional organizations, such as the Association for Behavioral and Cognitive Therapies or the American Psychological Association.
Of course, they should be licensed to practice in your state.
You can find competent specialists who are affiliated with local universities or mental health facilities or who are listed on the websites of professional organizations.
You may, of course, visit our website (www.abct.org) and click on "Find a CBT Therapist"
The Association for Behavioral and Cognitive Therapies (ABCT) is an interdisciplinary organization committed to the advancement of a scientific approach to the understanding and amelioration of problems of the human condition.
These aims are achieved through the investigation and application of behavioral, cognitive, and other evidence-based principles to assessment, prevention, and treatment.
Dialectical Behavior Therapy (DBT) is a type of cognitive-behavioral therapy.
DBT was originally developed in the 1980s by Marsha Linehan, a psychologist at
the University of Washington. Although initially intended to help chronically suicidal
individuals diagnosed with borderline personality disorder (BPD; please
refer to the accompanying fact sheet for information on BPD), DBT has since
been adapted for and used to effectively treat a number of other psychological
problems. The central dialectic within DBT is to balance acceptance of the person
exactly as s/he is in this moment with intense efforts to change the person’s life
to increase adaptive functioning and decrease maladaptive behavior. The overarching
goal of treatment with DBT is to help individuals develop, as Dr. Linehan
would say, “a life worth living.”
What Does DBT Involve?
Since DBT was developed for individuals with severe and persistent suicidality
[for more information on suicide, see ABCT’s fact sheet on suicide], it tends to
involve greater commitment on the part of therapists and clients alike to work
towards developing a satisfying and meaningful life so suicide does not appear to
be a good alternative to living.
In its standard, outpatient form, DBT has four major components:
1. Weekly individual (one-to-one) therapy
2. Weekly skills-training sessions, usually in the form of groups
3. As-needed consultation between client and therapist outside of sessions
4. Weekly therapist consultation meeting in which DBT therapists meet to discuss their DBT cases
Individual therapy occurs at least once a week. The content of the therapy session
generally revolves around targeting a high-priority event that occurred within the
past week, helping the individual identify all the factors that led up to and followed
the event (via a process called “behavioral analysis”) and then determining
and practicing new ways of responding in the similar situations. The skills-training
component of DBT involves teaching the individual specific skills designed to
help improve their life in four major areas: mindfulness, emotion regulation,
interpersonal effectiveness, and distress tolerance. Therapists make themselves
available between sessions for consultation to help the clients apply new skills to
prevent the use of problematic behaviors. Finally, the weekly consultation team is
designed to help therapists get the support they need for treating suicidal clients
as well as increase their motivation and adherence to DBT principles.
It is important to note that any facility or clinician that does not offer all of
these four major components, is not offering comprehensive DBT. Rather, they
are providing an adaptation or modification of DBT. Although this type of adaptation
is quite common in the community, unfortunately we do not yet know
whether just one (or two or three) component of DBT is as effective as the whole
Psychotropic medications are also often used to treat symptoms of BPD
and associated problems, in conjunction with DBT, though research on their
effectiveness is limited and we really don’t know whether medication works.
Although not opposed to the use of medications, the stance of a DBT therapist
is generally to help the individual learn to “replace pills with skills.”
Who Is DBT for?
DBT was originally developed for individuals who suffered from borderline
personality disorder, a psychological condition in which people have great
difficulty managing their emotions. DBT has also been adapted to treat other
psychological problems including: eating disorders (specifically bulimia nervosa
and binge eating disorder), suicidal and self-injurious behavior in adolescents,
treatment-resistant depression, and substance use problems that cooccur
with BPD. It is important to note that the reason DBT has been adapted
for those different disorders is because each of these conditions is theorized
to be associated with problems that stem from maladaptive efforts to control
intense, negative emotions.
Is DBT Effective?
There have been numerous studies designed to determine whether DBT is
effective, compared to treatment-as-usual and other, more rigorous control
conditions. Studies on DBT for BPD indicate that DBT is an effective treatment
for reducing suicidal behavior and non-suicidal self-injurious behavior,
reducing hospitalizations and ER visits, and decreasing depression and anxiety.
There are fewer studies on DBT for the other disorders listed above; however,
pilot studies indicate that DBT is effective at reducing core symptoms of
those disorders (e.g., binge/purge episodes in bulimia and substance use frequency
in substance use disorders).
How Long Does DBT Last? How Soon Can I Expect Changes?
The research studies conducted on DBT for BPD have all included one year
of treatment or less. Unfortunately, this does not mean that individuals
should expect to be completely free of symptoms or no longer have problem
behaviors at one year. Most clinicians, including Dr. Linehan, the developer
of DBT, believe that treatment for BPD can often take several years. However,
the research does suggest that “behavioral control”, that is the absence of suicidal
behaviors and other life-threatening behaviors as well as severe qualityof-
life interfering behaviors, can often be achieved within four to eight
months of comprehensive DBT.
As mentioned, there are far fewer studies on DBT for other conditions;
however all such adaptations are shorter than one year and suggest that
improvement can be achieved more rapidly.
Finding a DBT Therapist
Finding the right therapist is often a time-consuming task and DBT therapy
is no exception. It is important to make an educated decision about choosing
to work with a particular therapist based on experience, qualifications,
and degree of “match.”
Some questions to ask a potential DBT therapist:
1. What is the nature of your training in DBT?
Some possibilities include attending an “intensive training” through
Behavioral Tech, a training company founded by Dr. Linehan (see below),
receiving training in graduate school or postdoctoral work, or receiving “on
the job” training at an institution or agency. It is usually important that someone
receive significant supervision by someone considered an expert in DBT.
2. Do you provide comprehensive DBT or a modification? If not comprehensive DBT, why not?
If a person has BPD or significant suicidality, it may be important to
receive comprehensive DBT because that is currently the gold standard for
3. Do you belong to a DBT consultation team? Who are the other members of your team?
Attendance at a consultation team is a crucial aspect of DBT. If a therapist
does not regularly attend a consultation team, they are not doing comprehensive
4. What is your policy on phone calls/emails during the week?
While there is no “right” answer to this question, potential clients should
know upfront whether phone calls and other forms of communication are
accepted during the week. If the therapist states that he or she does not
accept these forms of communication, it is important to inquire how skills
generalization may occur (i.e., how the client might receive skills coaching at
times other than the therapy hour).
5. What length of time do you initially ask a client to commit to?
Again, there is not a “right” answer here. However, it is useful for the therapist
and client to mutually agree on an initial length of commitment (e.g.,
three months, six months, one year) prior to beginning therapy. Then, once
the initial commitment period has ended, the therapist and client can evaluate
gains made over that time and whether it would be fruitful to commit to
another treatment period.
In addition, here are a couple of other resources that may be of use in finding
a DBT therapist:
• Behavioral Tech, LLC (www.behavioraltech.org):
Behavioral Tech is a training company, founded by Marsha Linehan. It is not the only company
that provides training in DBT. However, the Behavioral Tech website offers a
number of resources on DBT including fact sheets, referral information, and
training opportunities for clinicians. Specifically, they have a Clinical
Resource Directory, which lists teams of clinicians that have received training
from Behavioral Tech in DBT that interested parties can search to find potential
therapists in their region.
• TARA Association for Personality Disorders (www.tara4bpd.org):
The mission of TARA is to “to foster education and research in the field of personality disorder,
specifically but not exclusively Borderline Personality Disorder (BPD).” They publish a brochure entitled
“Guidelines for Choosing a DBT Therapist” which can be found
For more information or to find a therapist:
Please feel free to photocopy or reproduce this fact sheet, noting that this fact sheet was writen and produced by ABCT. You may also link directly to our site and/or to the
from which you took this fact sheet