Dialectical Behavior Therapy (DBT)

When you’re leading an emotionally painful life, it’s important to be treated by a professional who has the proper training. Otherwise sessions can seem frustrating and uncomfortable. No one wants to leave a session feeling misunderstood and judged.

Our team leaders and program director are DBT-Linehan board certified (DBT-LBC), and each of the program’s expert providers have all completed a 16-week-long, intensive training program followed by a year of monthly consultations with an expert DBT consultant. We also offer annual refresher training for our team and community providers.

As part of an academic medical center, Stony Brook DBT offers a wealth of experience from outpatient child psychiatry, outpatient adult psychiatry and inpatient psychiatry, and provides DBT skills groups on our adult and child inpatient units. We also have a psychologist and postdoctoral associate trained in DBT working several days a week in our Comprehensive Psychiatric Emergency Program (CPEP) to help identify individuals who are displaying symptoms and might benefit from a referral to our program.

Stony Brook’s DBT program is informed by the biosocial model.  This means that we aim to understand each individual’s problems wholistically, as the sum of their biology, developmental learning experiences and social environment. We understand that individuals often don’t create their own problems and they still have to solve them.

While our standard adult and multifamily-adolescent programs run for 24 weeks, we also offer a condensed, 14-week DBT University program for young adults aged 18-25. This program is designed to better fit the academic calendar of most colleges.

Our DBT program is the only full, comprehensive one on Long Island that accepts most insurance plans. That’s huge when you consider that for those paying out of pocket, as DBT can cost upwards of $20k per year.

More information on the programs and groups offered at Stony Brook can be found below:

DBT Level I Skills Groups

• Adults of all ages

DBT University Level I Skills Groups

• People 18 to 25 years of age. As the name implies, this option, which is for 14 weeks, is a popular choice with college/university-age students.

DBT Adolescent/Multi Family

• Designed for teens and preteens between the ages of 12 and 17 and their caregivers. This 24-week program is designed to equip teams and their families with the skills for managing difficult emotions, improving communication and reducing problem behaviors. Teens and at least one parent or caregiver participate in groups together to facilitate family resilience and skill development. Individual therapy is also required for teens in the program and may also be recommended for parents/caregivers.

Level II DBT Graduate Groups

• Open to graduates of our Level I Skills Groups. Emphasizes skills for maintaining treatment gains and continuing to work towards a life worth living. Advanced DBT skills as well as skills drawn from Cognitive Behavioral Therapy (CBT) and Acceptance and Commitment Therapy (ACT) are introduced.

Radically Open DBT (RO-DBT)

• Aimed at adults aged 18 to 25. Designed for people with problems of over-control such as autism spectrum disorder, obsessive compulsive personality disorder, perfectionism and anxiety problems.

Each option includes:

• Meditation and mindfulness exercises
• Skills for managing intense emotions
• Skills for developing flexible thinking
• Classroom structure – with a skills group, workbook, and lesson plan

DBT teaches life skills to help people cope with difficult feelings, manage troubling moods, and avoid high-risk and dangerous behavior. DBT for adolescents and caregivers includes the caregiver(s) and the adolescent.

1. Distress Tolerance: How to get through distressing times in life, how to survive a crisis without making the situation worse, how to accept reality as it is, not as we wish it were.
2. Mindfulness: How to be aware and present in our lives in an intentional, nonjudgmental way.
3. Emotion Regulation: How to recognize, understand, and label emotions in a non-judgmental way. How to tolerate emotions better and change them if they are not helpful.
4. Interpersonal Effectiveness: How to have healthier relationships. How to balance speaking up for what you want, keeping good relationships, and maintaining self-respect.
5. Walking the Middle Path: How to bridge communication between parents and teens to maintain a relationship during challenging times.

No. While the majority of individuals who come to DBT have chronic thoughts about committing suicide and may have attempted suicide on multiple occasions, the goal of DBT is not to prevent suicide. The goal is to help a person "build a life worth living" by learning skills, accepting who they are, and changing what they can so that they will no longer want to kill themselves.

No. Many people who come to DBT have very little, if any, hope that their suffering can be lessened. We know that it's only with time that your experiences with DBT will help to increase hope. We ask that participants in our DBT program "act opposite" to their limited hope by showing up regularly to sessions, practicing their skills, and allowing the treatment to work.

Definitely. Many people who come to DBT have had limited success in other therapies. This is usually because the other therapies didn't effectively treat the skills deficits that lead to their difficulties. DBT believes that gaining insight into the reasons for difficulties/behaviors doesn't solve the issue. Instead it may be the first step to changing the behaviors. However, insight isn't necessarily required to make changes.

Absolutely not. In multi-family DBT we have the following beliefs/assumptions about everyone who attends the program:

• You're doing the best you can
• You want to improve
• You need to do better, try harder, and be more motivated to change
• You may not have caused all of your own problems but you have to solve them anyway
• The lives of suicidal individuals are unbearable as they are currently being lived
• You must learn new behaviors in all relevant contexts
• You can't fail in therapy

DBT is a marathon, not a sprint. Changing behaviors takes time and patience. In some ways, we're "re-wiring" the connections in the brain by teaching people to act and think in different ways, which then leads to different outcomes. As DBT therapists, we don't expect to see major, if any, changes, until closer to the end of the treatment cycle. Some individuals and families need two cycles of comprehensive DBT to see changes, which is understandable given that adult DBT programs are generally a year-long commitment!

Only one. The only real "rule" in DBT is that if you miss three consecutive individual sessions, three consecutive DBT skills group sessions, or five sessions (group + individual) all together within the 24-week period, you'll be discharged from the program. This is based on the idea that DBT can only work if a person is coming to treatment. There are no "excused" absences for things like being in the hospital, going on vacation or being sick. Ultimately, if you miss a full month of treatment for any reason, it's clear that the timing just isn't right for you to be in DBT.

Probably not. DBT sees both suicidal and self-harm behaviors as problem-solving strategies that are effective in the moment to deal with distress, yet don't help a person in the long-term, and have many consequences that actually lead a person to suffer more and feel worse. If you're not willing to work on replacing these strategies with more effective long-term strategies, DBT sessions would be filled with endless battles because of differing goals. Both you and the therapist would quickly burn out, making it difficult for therapy to continue.

Unless you want to be in DBT treatment, it's unlikely to work. Just showing up isn't enough. You'll be asked to practice skills outside of sessions and if you don't have a little bit of motivation or interest in doing the work, nothing will change. All DBT sessions would then have to focus on why you weren't doing the work, which would lead to battles because of differing goals. Both you and the therapist would quickly burn out, making it difficult for therapy to continue.

No! DBT is a recovery-based model. This means that we'll try our hardest to work with you on building a life that doesn't require you to be in DBT or any other treatment forever. Most people who graduate from our program go on to live very meaningful lives with much reduced suffering.

No. While DBT was originally created for individuals with BPD who were chronically suicidal and self-harming, it's now used to treat individuals with multiple diagnoses who have difficulties with emotional dysregulation, distress tolerance, interpersonal relationships and impulsivity.

It depends. While early childhood experiences are helpful in the beginning of therapy to fully understand how the biosocial theory applies to you (e.g., invalidating/ineffective environment, biological irregularities), DBT primarily focuses on the present and future.

The DBT group is structured like a class. Because our time in the group is limited, we try to stay structured to keep focused on learning the skills. The group starts each week with a homework review. We typically limit each person to a maximum of two minutes to report on skills practice from the previous week. Individuals can “skip” if they don't want to report on homework that day. We also discuss skills that we're learning in the group, but your participation is optional.

Yes! To participate in the Adolescent DBT program, at least one parent/caregiver must attend skills group with their teen on a consistent basis. If another parent/caregiver cannot come every week, that's okay, as long as the attending family members keep them updated on what's missed.

In Adolescent DBT, we ask that parents/caregivers observe rules of confidentiality by not asking us to provide specific information learned in individual sessions. You, however, are welcome to provide us with information about your child/teenager. Confidentiality will be broken, as by law, if your child/teenager is at imminent risk to themself or others, or reports feeling threatened, so that their safety or the safety of others is maintained.

Each week, you'll be expected to complete an assignment for the DBT skills group. This usually involves practicing a skill and filling out a short worksheet. Participants complete a daily diary card that they bring to both the DBT skills group and individual sessions. At times, homework may also be assigned by your individual therapist if you or they believe it will be helpful in reaching your goals. While not required, individuals who review what was taught in the skills group during the week tend to have more success in DBT.

Once the cycle is completed, there are a number of treatment options depending on the needs of the individual, their family and treatment recommendations of the team:

• Contracting for another cycle of comprehensive DBT
• Stepping down to a 16-week graduate group and continuing individual/family therapy
  • ​​​​​Graduate group is a teen-only group, designed to help teens generalize their skills into their lives, support them while they do trauma work, and get them closer to their long term goals. The graduate group allows teens who have already learned the skills to practice them in a session with other members, process and discuss current struggles, and solidify their understanding of how to integrate DBT in their lives. Teens are allowed to join the graduate group only if they've shown progress, have the skills necessary to be in a less structured/processing group and are actively working towards long term goals.
• More intensive DBT-informed family therapy
• Trauma-focused therapy using evidence-based treatments, such as trauma-focused cognitive-behavioral therapy, and/or prolonged exposure.

When individuals, families and therapists have agreed that their DBT goals have been reached,  they will graduate from therapy. Some join other therapeutic groups in the community or get support from their environment only.