Comprehensive DBT vs. DBT-Informed Therapy: What Is the Difference?

Written By Kristie Lemmon

DBT has become much more popular in recent years and more people are hearing about how helpful it can be. This means that when you are looking for treatment options, you may find many therapists saying they “do DBT.”  However this can mean a lot of different things. 

In the DBT community, we differentiate between comprehensive DBT and DBT-informed therapy. Both can be helpful. But understanding the difference is very important so you can ask questions, know what you are signing up for, and find treatment that fits your needs.

So what is the difference, and how do you know which one you need?

What Is Comprehensive DBT?

Comprehensive DBT is sometimes described as DBT done “by the book” or adherent DBT. This means it follows the treatment developed by psychologist Marsha Linehan, including the structure, principles, and treatment strategies.

DBT was originally developed for people experiencing chronic suicidal behaviors and was first studied with women with borderline personality disorder. Its focus is on helping people reduce behaviors that are making life harder and build a life they experience as worth living.

For standard outpatient DBT to be comprehensive, it includes four components that work together. Having all four is necessary, but how the treatment is delivered in these components matters, too. Comprehensive DBT involves more than offering individual therapy alongside a skills class.

1. Weekly Individual Therapy

In comprehensive DBT, you meet weekly with a therapist trained in DBT who follows set protocols. Together, you identify your goals and the specific behaviors getting in the way of those goals.

Sessions have a structure. Behaviors that threaten your life are addressed first, followed by behaviors that interfere with therapy, and then behaviors that interfere with your quality of life.

You track emotions, urges, and behaviors on a diary card.  Your therapist helps you understand patterns in your behaviors and figure out what you need to decrease and what you need to increase to improve your quality of life.

2. Weekly DBT Skills Class

The skills class is where you learn and practice the DBT tools. It is structured like a class.

Skills are taught through a structured curriculum, with opportunities to practice and review what happened when you tried them outside class. The four main areas of skills are mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness.

You learn how to pay attention to the present, get through painful situations without making them worse, understand and respond to emotions, and navigate relationships while maintaining self-respect.

Learning the skills is one part of the work. Practicing them repeatedly is how they become life changing.

3. Between-Session Skills Coaching

Have you ever left therapy understanding what to do, then struggled to use it when emotions became intense? This is one reason Comprehensive DBT includes coaching between sessions.

Coaching helps you apply skills in the situations where you need them when you need them. It is provided by your individual therapist, not a separate crisis service. You might contact your individual therapist when you are trying to manage an urge, approach a difficult conversation, or respond differently to a pattern.

The goal is to help you become more capable of responding effectively in your everyday life and help strengthen the skills you are learning in individual therapy and skills class.

4. Therapist Consultation Team

This component happens behind the scenes, but it matters. DBT therapists are required to meet weekly with a consultation team to support one another in providing effective treatment. 

The team helps therapists stay consistent with DBT, think through challenges, notice where they are getting stuck, and maintain their own skills and motivation. The consultation team helps therapists keep doing their own work so they can support that process effectively.

All four components have a purpose. Together, they support learning skills, staying engaged in treatment, and using new behaviors beyond the therapy office.

What Does the Research Say?

Comprehensive DBT has a strong research foundation, particularly for borderline personality disorder and suicidal and self-harming behaviors. Research has also examined DBT approaches for adolescents and people experiencing other mental health concerns.

For example, a 2006 study by Linehan and colleagues compared DBT with treatment provided by community experts for women with borderline personality disorder and recent suicidal and self-injurious behaviors. Participants receiving Comprensive DBT were about half as likely to make a suicide attempt during the treatment and follow-up period.

That study also found fewer psychiatric hospitalizations, fewer psychiatric emergency department visits, and lower treatment dropout in the Comprehensive DBT group.

Those findings are encouraging, but they describe a particular study population and comparison. They do not mean every person will have the same results or that DBT always works better than every other treatment.

There is another distinction to understand: research on “DBT” does not always mean research on comprehensive DBT. Some studies examine the full program. Others examine skills training or adaptations for particular concerns, such as substance use, trauma, depression, ADHD, or eating disorders.

What Is DBT-Informed Therapy?

DBT-informed therapy uses parts of DBT without providing the entire comprehensive program. This might involve teaching DBT skills during individual therapy, integrating DBT strategies into another treatment approach, or participating in skills training without the other components.

For example, a therapist might help you use distress tolerance during a difficult time, practice interpersonal effectiveness to maintain boundaries, or use mindfulness to notice emotions before reacting.

Not everyone needs Comprehensive DBT to benefit from DBT skills.

Research on structured DBT skills training suggests it can help some people improve emotion regulation and related difficulties without participating in the full program. However, a researched skills program is different from occasionally introducing a DBT worksheet in therapy.

“DBT-informed” is a broad description, so it is helpful to ask what it means in a particular practice. How often will you practice skills? How will you track progress? What support is available when applying them is difficult?

Which Approach Might Be Right for You?

The answer depends on what you are struggling with, how those struggles affect your life, and the support you need to change them.

If you need help with a few specific skills, DBT-informed therapy may be a good fit. You may already have an effective therapy relationship and benefit from adding some tools for emotion regulation, distress tolerance or relationships.

If you are experiencing repeated crises, suicidal or self-harming behaviors, or patterns that seriously disrupt your life, a comprehensive assessment can help determine whether you need the structure of comprehensive DBT or another level of care.

Sometimes people know the skills but have difficulty using them consistently. Comprehensive DBT addresses barriers to using skills, including strong emotions, avoidance, low motivation, and patterns that interfere with treatment.

If you have tried DBT-informed therapy and it has not helped enough, that does not necessarily mean DBT cannot help you. It may be time to reassess the treatment approach and whether additional components would be useful.

You can ask a provider:

  • Do you offer comprehensive DBT or DBT-informed therapy?

  • What DBT training have you completed?

  • Does treatment include all four components?

  • How do you decide which approach fits my needs?

  • How will we know whether treatment is helping?

You deserve a clear explanation of what treatment involves, what it is intended to address, and how the provider will work with you when obstacles come up. Asking questions is part of making an informed decision.

Our Approach at DBT Network of Utah

At DBT Network of Utah, we provide comprehensive DBT when our evaluation indicates that this level of treatment would be the most effective fit.

On a limited basis, we may offer DBT-informed therapy for a certain number of sessions when an evaluation suggests someone needs focused skills work rather than the full program.

We also provide DBT-informed medication management, weaving skills into medication appointments. Alongside evaluating symptoms and medication response, we help you build skills for responding to emotions and everyday challenges.

Our goal is to help you understand your options and find the support you need to make meaningful changes and build a life worth living.

Sources:

Kristie Lemmon
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What Is Comprehensive DBT? The Four Parts of Treatment