Comprehensive DBT, DBT-Informed or a Skills Group: How They Differ

In crisis or thinking about suicide? Call or text 988 now (in Colorado it reaches the 988 Colorado Mental Health Line). If you are in immediate danger, call 911.

Three things that all get called DBT

If you have searched for DBT, you have likely seen it offered in very different packages. One program lists individual therapy, a group, phone coaching and a team. A therapist's profile says "DBT-informed." A clinic offers a skills class you can join on its own. All three use the name, but they are not the same treatment.

This guide goes deeper into the full model and the lighter versions. For the basics of individual sessions versus group, see your first DBT session. For how group therapy works in general, see group therapy in Denver. If you are still choosing between approaches, start with DBT vs CBT.

Comprehensive DBT: four modes doing five jobs

Behavioral Tech, a DBT training institute, describes four modes of standard outpatient DBT. Researchers describe them as serving five functions of comprehensive treatment. The modes are what you see. The functions are why each piece is there.

• Learning new skills. The skills group teaches mindfulness, distress tolerance, emotion regulation and interpersonal effectiveness, usually in a weekly class with homework.
• Using skills in real life. Phone coaching lets you reach your individual therapist between sessions for help using a skill in the moment.
• Building motivation. Weekly individual therapy works on your goals, reviews your diary card and applies skills to your own problems.
• Shaping your environment. Your therapist helps you manage your own surroundings and steps in directly only when needed. In teen programs, work with parents and family often serves this job.
• Keeping therapists effective. The consultation team helps therapists stay faithful to the model, build their skills and sustain their motivation with hard cases.

DBT-informed therapy: some parts, not all

A Behavioral Tech article on college counseling centers gives a clear example. A center with limited staff might offer a skills group, individual therapy every other week and phone coaching during business hours only. The author says partial models like this fall outside the current research evidence, so they count as DBT-informed models.

That does not make DBT-informed care a bad choice. The same article calls it often a helpful starting point, and notes that a program can grow into full DBT with more training. A 2015 paper by Linehan and Wilks explains that DBT is modular, which is part of why it has been adapted to so many settings.

The trade-off is usually in the pieces that happen outside the room. Without phone coaching, there may be no planned way to get help using a skill at the moment an urge hits. Without a consultation team, your therapist has less built-in support for staying on model with hard cases. These gaps may matter less when risk is low, which is why fit depends on what you are dealing with.

In practice, DBT-informed therapy can mean a therapist who uses DBT skills, validation and behavior analysis in weekly sessions, without a group, coaching or a team. That may suit someone whose emotions are hard to manage but who is not dealing with frequent self-harm or suicidal behavior.

A skills group on its own

The skills group is the most visible part of DBT. The Linehan Institute describes it as a class: a leader teaches skills, assigns homework and helps people use the skills in real situations. Groups typically meet weekly for about 2.5 hours, and the full curriculum takes 24 weeks.

Linehan and Wilks note an effort to use DBT skills as a standalone treatment, and say more research is needed on how the skills work and for whom. One trial gives a clue. In Linehan's 2015 study of women with borderline personality disorder and recent suicidal behavior, three versions of DBT were compared: standard DBT, skills training plus case management, and individual DBT without a skills group. All three did similarly on suicide attempts. The two versions with skills training did better on self-harm and depression than individual DBT alone.

That study had limits worth knowing. The skills-only arm still had case managers, and every provider used the DBT suicide risk assessment and management protocol. Standard DBT also had lower dropout than individual DBT without skills training. So the study does not show that a class by itself is enough for someone at high risk.

A group also has a different job than individual therapy. A 2016 review notes that people can tell the group how they used a skill, but diary cards are mostly worked through with an individual therapist. That deeper look at your own urges and behaviors, and the safety planning that goes with it, usually does not happen in a class.

How to tell what a program offers

Program websites do not always use these terms the same way. Some say "DBT" when they mean a skills class, and some say "DBT-informed" to be careful about what they offer. A few checks can make the picture clear.

• Count the modes. Look for individual therapy, a skills group, between-session coaching and a consultation team. Missing pieces usually mean DBT-informed care.
• Check how often individual sessions happen. In the standard model they are weekly.
• Ask how long the skills curriculum runs and whether it repeats.
• Find out whether your individual therapist and your group leaders talk to each other about your progress.
• Ask what happens between sessions if you need help using a skill, and what to do after hours.

Which one fits, and when none is the next step

If you are not safe right now, none of these is the first step. Call or text 988, or call 911, and see the Denver mental health resources page.

Comprehensive DBT is usually the one to look at first if you are dealing with self-harm, suicidal urges or emotions that regularly lead to crises. It asks the most of you, so read what comprehensive DBT asks of you before you commit. A skills group or DBT-informed therapy may fit when problems are less severe, when you already have a therapist you trust, or when time is tight. For longer lists of questions, see questions to ask a DBT therapist.

Mountainside offers DBT for teens and adults, an adult DBT skills group and a teen multi-family DBT skills group, and a free 15-minute consultation to talk through which format fits. Learn more about DBT therapy in Denver.

Frequently asked questions