Dialectical behavior skills in coaching (reference)

Dialectical behavior therapy (DBT) was developed by Marsha Linehan for people with long-standing suicidal behavior and intense emotion. Its skills are taught in groups and practiced with a therapist. They cover emotion regulation, distress tolerance, mindfulness and interpersonal effectiveness. The full therapy has been tested in randomized trials, mostly for borderline personality disorder. The skills are only part of DBT, and learning them alone is not the setting those trials tested.

What it is

DBT skills are practical tools for moments when feelings run high: getting through a crisis without making it worse, changing how intense an emotion is, staying in the present, and asking for what you need in a relationship without damaging it. They come from a broader therapy that balances accepting how things are with the push to change them.

In the therapy, the skills are learned in a group and then applied to real situations with an individual therapist. A coach's part is narrower. A coach can talk about these skills with someone who is already in DBT, and encourage them to use what their clinician taught, for example by asking how a skill went between sessions. A coach does not teach the skills modules or run DBT. If someone mentions thoughts of harming themselves, or is not already working with a clinician, the step is to refer them to one. This page describes the skills in general terms and does not reproduce any program material.

Where it comes from

Linehan's 1991 paper describes a cognitive behavioral treatment for chronically parasuicidal borderline patients (Linehan, 1991). Her later trials compared the approach with usual treatment and with therapy by experts (Linehan, Heard & Armstrong, 1993; Linehan et al., 2006).

The 1993 follow-up describes DBT as a cognitive behavioral therapy that combines individual psychotherapy with group behavioral skills training. The skills are one part of that combined therapy.

The principles underneath

Acceptance and change together

The therapy holds that a person can accept their situation and also work to change it. The skills are built on that balance.

Getting through the crisis

Distress tolerance skills help a person get through a difficult moment without making it worse, rather than solving the problem at once.

Turning down the intensity

Emotion regulation skills aim to understand emotions and to change how intense or long-lasting they are, in steps that are checked against what actually happens.

Asking for what you need

Interpersonal effectiveness skills help a person ask for something, or decline it, in a way that keeps the relationship intact.

How a session runs

A trained therapist asks what happened in the week, and which moment of strong feeling or difficult conversation the person most wants to handle.
The therapist names the skill that fits that moment and explains what it is for, in plain language.
The person practices the skill in the session, sometimes through role-play, so it can be tried before it is needed in real life.
The person reports back on how they used the skill, what helped, what got in the way, and what they would change.
Between sessions the person records their practice, and the next session starts from it.

When it tends to fit

A feeling is so intense that you want to act on it before you have thought it through.
You keep having the same argument with someone you rely on, and it always ends in the same place.
You want to ask a manager or partner for something, and you tend either to give in or to become defensive.

What the research shows

Evidence: Randomized trials or meta-analyses

The trials are of the full therapy, not of the skills on their own. Linehan's 1993 follow-up of a randomized trial, with 39 women who had borderline personality disorder and a history of parasuicidal behavior, found that the superiority of DBT over treatment as usual, reported in earlier studies at the end of a year of treatment, was retained during a year of follow-up. Linehan and colleagues' 2006 randomized trial, with 101 women, compared DBT with therapy by experts for suicidal behavior and borderline personality disorder. DBT gave better outcomes in most target areas and was associated with fewer suicide attempts. A 2020 Cochrane review of 75 randomized trials found that psychotherapies, mostly DBT and mentalization-based treatment, reduced borderline personality disorder symptom severity compared with usual treatment, with moderate-quality evidence.

Where the evidence is thin: The 1993 and 2006 trials were run by Linehan's own research group, and the 1993 trial had 39 participants. The Cochrane review covers psychotherapies broadly, so it does not isolate the skills. We did not find trials of the skills on their own in the sources reviewed for this page.

Sources

Where it stops

If you are thinking about harming yourself or ending your life, contact emergency services or a crisis line now. This page is not a crisis resource.

DBT is a structured program of individual therapy and skills training, and the trials cited ran for a year or longer. Skills read on a page are not the same as learning them with a clinician.

Most of the trial evidence is for borderline personality disorder, so it is not established that these skills suit every difficulty. A clinician decides who is suited.