DBT utilizes scientifically-established strategies for improving emotion regulation, and the approach is called “dialectical” because it seeks to balance therapy strategies that appear opposite. Specifically, it includes many strategies aimed to change the individual’s behaviors, thoughts, emotions, relationships, and life problems, while at the same time the therapist validates that the person and their struggles make complete sense, helping the person to fully accept themself and their emotions. The change strategies are cognitive-behavioral therapy (CBT) strategies, including problem-solving, skills training, developing more effective thinking, behavioral activation, and exposure therapy. The primary acceptance skill is mindfulness, which involves learning to focus your attention, and learning to see things for what they are, including your thoughts, emotions, and other people, without getting caught up in assumptions, interpretations, or judgments. Mindfulness is used as a way to decrease suffering by developing the ability to better tolerate emotional pain and accept yourself, your past, and your current life.
DBT is called “behavior therapy” because it is based on the belief that the most effective way for clients to make substantial changes in their emotion regulation is to immediately stop serious out-of-control behaviors such as suicidal and self-injurious behaviors, alcohol and drug abuse, angry behaviors, and overuse of psychiatric hospitalizations and emergency services. The initial goals of treatment are primarily to help the client achieve stability and behavioral control, and to acquire the necessary capabilities to achieve these goals, especially distress tolerance. Immediately, there is a focus on increasing behaviors that are effective for having a life worth living, especially interpersonal relationships and regular meaningful productive activities, including paid employment or volunteer work.