Dialectical Behavioral Therapy (DBT for short) is a specific subtype of Cognitive Behavioral Therapy (CBT for short) originally developed by Dr. Marsha Linehan to treat individuals with borderline personality disorder. The program focuses on learning and practicing emotional and interpersonal skills that are usually not well developed in people suffering with this condition.

DBT’s Five Core Modules/Skills

DBT contains a number of modules for building specific skills both in an individual and group setting. Training targets the development of five core skills:

• Mindfulness
• Distress Tolerance
• Emotion Regulation
• Interpersonal Effectiveness
• Self Management

The Case for Using DBT to Treat Bipolar Disorder

Beyond its role in DBT, mindfulness has gained a great deal of attention recently as a tool for helping in the treatment of a number of psychiatric conditions including depression and ADHD. The strategies of mindfulness are actually ancient techniques, but we are increasingly able to study and prove the brain benefits of these practices.

In a number of studies, DBT has been shown to be effective for Borderline Personality Disorder and has become much more readily available. Evidence of its effectiveness specifically in the treatment of bipolar disorder is scarce, but DBT still makes sense as an adjunct in bipolar treatment for several reasons:

• The training model and many of the core competencies addressed in DBT are applicable to many different diagnoses.
• People with bipolar often struggle with the same issues as those with borderline personality disorder; for example; learning to tolerate distress and regulate emotions.
• Although DBT may not be effective specifically in the treatment of full blown episodes of depression or mania, it can be useful in managing stressors that may trigger emotional and physical reactions that can make people more vulnerable to depression or mania. Being able to tolerate stress and frustration without falling apart or losing their cool are often daily challenges for those living with bipolar.

Not all people with bipolar disorder have difficulties dealing with stress and mood regulation between episodes, but many do. And DBT could potentially be a powerful tool for individuals who do struggle with these challenges.

Possible DBT Limitations

DBT is certainly not a panacea for the mania and depression that characterize bipolar disorder, and the jury’s still out on how effective it can be as an adjunct treatment. It’s usefulness is somewhat questionable for several reasons:

• At this time, few studies are available for assessing the effectiveness of a formal DBT program for individuals with bipolar disorder. Some researchers are looking at this but the data are still limited.
• DBT is not designed specifically to treat the depressive, manic, mixed, or hypomanic episodes of bipolar disorder.
• DBT’s effectiveness in managing day-to-day mood reactions may not translate into a model that assists in regulating the big picture of cycling. Some features may overlap, but that is certainly not clear yet.

DBT in My Practice

Practicing various forms of mindfulness discipline improves well being, attention, and positive emotions while decreasing negative feelings and distress, so it may be a valuable tool in the toolbox for people living with bipolar disorder. I am practicing it myself and starting to teach some patients – and I think it will become an increasingly important strategy in the overall work of managing mental illness for individuals and families.

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    Last reviewed: 9 Sep 2010