Her first core insight was to recognize that the chronically suicidal patients she studied had been raised in profoundly invalidating environments, and, therefore, required a climate of loving-kindness and somewhat unconditional acceptance (not Rogers’ positive humanist approach, but Hanh's metaphysically neutral one), in which to develop a successful therapeutic alliance.
Linehan and others combined a commitment to the core conditions of acceptance and change through the principle of dialectics (in which thesis + antithesis → synthesis) and assembled an array of skills for emotional self-regulation drawn from Western psychological traditions, such as cognitive behavioral therapy and an interpersonal variant, "assertiveness training", and Eastern meditative traditions, such as Buddhist mindfulness meditation.
One of her contributions was to alter the adversarial nature of the therapist-client relationship in favor of an alliance based on intersubjective tough love.
All DBT can be said to involve 4 components: No one component is used by itself; the individual component is considered necessary to keep suicidal urges or uncontrolled emotional issues from disrupting group sessions, while the group sessions teach the skills unique to DBT, and also provide practice with regulating emotions and behavior in a social context.
This approach works towards helping people increase their emotional and cognitive regulation by learning about the triggers that lead to reactive states and helping to assess which coping skills to apply in the sequence of events, thoughts, feelings, and behaviors to help avoid undesired reactions.
DBT assumes that people are doing the best they can but are either lacking the skills or influenced by positive or negative reinforcement that interfere with their ability to function appropriately.
DBT is a modified form of cognitive behavioral therapy (CBT), that was developed in late 1970s by Marsha M.
Linehan, a psychology researcher at the University of Washington, to treat people with borderline personality disorder (BPD) and chronically suicidal individuals.
Although research on its effectiveness in treating other conditions has been extremely limited, DBT is now used in a variety of psychological treatments including treatment for traumatic brain injuries (TBI), eating disorders, and mood disorders.
DBT combines standard cognitive behavioral techniques for emotion regulation and reality-testing with concepts of distress tolerance, acceptance, and mindful awareness largely derived from Buddhist meditative practice.
DBT is the first therapy that has been experimentally demonstrated to be generally effective in treating BPD.
Linehan observed "burn-out" in therapists after coping with "non-motivated" patients who repudiated cooperation in successful treatment.