Group Skills Training in Dialectical Behavior Therapy (DBT)

Theoretical aspects of Dialectical Behavior Therapy (DBT)

Dialectical behavior therapy (DBT) is a cognitive-behavioral therapy (CBT) originally developed to treat women with a history of chronic suicidal behavior who meet the criteria for borderline
personality disorder (M Linehan, 1993). According to Marsha Linehan, Standard DBT includes multiple modes of treatment, including weekly individual therapy, weekly group skills training, and as-needed phone coaching to address skill and motivational problems common in people diagnosed with BPD.


The original manualized DBT program consists of four group skills training modules

a) Group skill training of mindfulness, interpersonal effectiveness, emotion regulation, and distress tolerance modules,

b) individual counseling,

c) telephone crisis coaching, and

d) a therapist consultation team

The DBT components became popular because it address skills deficits (via group skills training modules and phone coaching), in addition to issues related to motivation for change through individual therapy.

Typically, DBT skills training aims to teach skills to reduce dysfunctional behavior and facilitate the adoption of new behavioral, emotional, and thinking patterns through (but not exclusively delivered in) a group format(Linehan, 1993).

Four modules address skills deficits associated with BPD:

(a) core mindfulness skills center on ways to strategically deploy attentional control;

(b) emotion regulation skills teach clients to identify and influence emotions elicited by the
environment;

(c) interpersonal effectiveness skills help clients to learn to respond effectively to
interpersonal demands and conflicts; and

(d) distress tolerance skills teach clients to identify crisis situations and experience strong negative emotions while inhibiting dysfunctional behaviors that could serve to make the situation worse (Linehan, 1993)

Currently, DBT group skills training standalone modules are being utilized in some capacity in a wide variety of clinical settings that serve a diversity of client populations (e.g., Dimeff & Koerner, 2007). Considering the high cost and professional investment required to administer a DBT group
(e.g., two group leaders, weekly 2.5 hour sessions, expensive, individual therapy, telephone support and time-consuming group leader training and supervision), it is important that future studies compare DBT skills group treatment standalone to other forms of therapy to determine whether DBT skills training is actually more effective than shorter term and less expensive treatments.

The general lack of randomization, control groups, and longer-term follow-up in many of
these DBT group skills training standalone modules studies is to be expected, given the early stage of this literature. These studies represent the creative application of DBT skills training as a means of improving global functioning by reducing dysfunctional behaviors.

Although one need to be cautious to interpret outcome data from uncontrolled studies, we can use
these findings to inform future treatment research. There is some preliminary evidence of the
feasibility and acceptability of standalone DBT skills training across a range of populations (i.e., incarcerated adults and adolescents, adults with intellectual disability, and caregivers at risk for elder abuse perpetration)