DBT: Dialectical Behavioral Therapy

Dialectical behavioral therapy (DBT) is a kind of cognitive behavioral psychotherapy (CBT) developed in the late 1980s to help treat borderline personality disorder.

It has since been used to treat other kinds of mental health illnesses including borderline personality disordered patients with co-existing substance abuse problems.

As a CBT analogue, DBT is a skills training therapy specifically designed to treat borderline personality disorder and includes 4 behavioral components:

  1. Core mindfulness
  2. Distress tolerance
  3. Emotion regulation
  4. Interpersonal effectiveness.

Together, the 4 skills therapy components are designed to specifically assist borderline personality patients in managing behaviors, emotions and thoughts, a difficult task to be sure with patients that almost inevitably have “control” issues. The strongest evidence for DBT as a useful treatment is for individuals with borderline personality disorder.

Mindfulness, emotion regulation, and interpersonal effectiveness skills therapy usually raise less questions than “distress tolerance” skills therapy.
DBT distress tolerance skills work on the tendency of some patients to experience negative emotions as unbearable and overwhelming. People with a low threshold for things not going their way (i.e. people with control issues) can become overwhelmed when faced with mild levels of usual and customary day-to-day stress, and sometimes react with not very well thought-out behaviors.

However, there is a more important question underneath the question: What is DBT?
The more profound question is what’s up with the coexistence of borderline personality disorder, eating disorders such as bulimia is common, and substance abuse?

Is this a classification misunderstanding?

First of all, there is a dopaminergic phenomenological link between eating disorders and substance abuse (Pottash et al), and it has been hypothesized that DBT is a useful adjunct therapy for individuals presenting with all three problems: borderline personality disorder, eating disorder and substance abuse.

But there is no substantial evidence-based data to support the therapeutic value of treating all three with DBT, however, your Royal Life Centers counselor is DBT trained and may choose to implement it should the indication arise.

The compelling false-classification problem that becomes apparent when these three diagnostic entities coexist can easily be clarified.

People who are over-involved with reality are considered “neurotic.”
People who are out of touch with reality are considered “psychotic.”
People who, for the most part, are involved and/or over-involved with reality (i.e. being on time for work), and occasionally are out of touch with reality (i.e. ideal weight bulimic that feels “fat”), is borderline personality disorder.

Our evidence-based data strongly suggests, therefore, that eating disorders such as bulimia are simply body-dysmorphic “delusional” symptoms associated with borderline personality disorder, rather than persons with eating disorders and borderline personality disorders.

We have data to suggest the DBT is very useful in treating borderline personality disorder with coexisting symptoms of bulimia

We have data to suggest that oxidized food addiction is a yet to be classified Substance Use Disorder that is responsible for more deaths worldwide than any other medical conditions, by virtue of its most common presenting symptoms of:

  • Ischemic heart disease
  • Pulmonary disease
  • Cancer
  • Stroke or atrial fibrillation
  • Alzheimer’s
  • Mood disorders

In fact, we have evidence-based data that suggests the top killers worldwide are:

  1. Oxidized food addiction
  2. Nicotine addiction
  3. Drug addiction

Reach Out

If you or someone you know is struggling with substance abuse problem, please reach out to our addiction specialists for guidance and support, at (877)-RECOVERY or (877)-732-6837. Our addiction specialists make themselves available to take your call 24 hours a day, 7 days a week. Because We Care.


Pottash ALC, Jonas JM, Gold MS, Cocores JA, Phenomenological Link Between Substance Abuse and Eating Disorders. Society For Neuroscience 1986.