{"id":685426,"date":"2026-11-15T14:02:10","date_gmt":"2026-11-15T14:02:10","guid":{"rendered":"https:\/\/www.newsbeep.com\/ie\/685426\/"},"modified":"2026-11-15T14:02:10","modified_gmt":"2026-11-15T14:02:10","slug":"dialectical-behavior-therapy-and-the-legacy-of-dr-marsha-linehan","status":"publish","type":"post","link":"https:\/\/www.newsbeep.com\/ie\/685426\/","title":{"rendered":"Dialectical behavior therapy and the legacy of Dr. Marsha Linehan"},"content":{"rendered":"

\n Dr. Marsha M. Linehan, creator of the lifesaving, gold standard treatment for borderline personality disorder<\/a> and more, died Tuesday at 83, professionals who worked with her confirmed with CNN.\n <\/p>\n

\n Linehan developed dialectical behavior therapy, or DBT, in the 1980s, basing its emotion regulation and distress-tolerance skills partly on cognitive behavioral therapy<\/a> and elements of Zen Buddhism \u2014 including mindfulness and the dynamic balance of acceptance and change.\n <\/p>\n

\n In addition to being highly suicidal, patients Linehan treated with DBT also typically had a complex array of issues that can be difficult to treat, including other psychological and behavioral problems, substance use disorders, eating disorders and more.\n <\/p>\n

\n Principal among those is BPD, \u201ca notoriously challenging condition to deal with,\u201d Linehan wrote in her 2020 memoir \u201cBuilding a Life Worth Living<\/a>.\u201d\n <\/p>\n

\"Dr.<\/p>\n

\n Dialectical behavior therapy greatly differed from other therapies of the 1970s and 1980s and was heavily influenced by Linehan\u2019s spiritual journey to becoming a Zen master. Her incorporation of mindfulness into psychotherapy was a first for Western psychiatry.\n <\/p>\n

\n \u201cI had to battle to have my radical ideas and approach to therapy accepted by my peers and by the world of psychiatry,\u201d Linehan wrote.\n <\/p>\n

\n Linehan revealed in 2011 that her work was motivated by her firsthand experience with BPD, which she had begun struggling with in high school. Then, she was one of the popular girls, often organizing concert outings or snack runs for her peers, Linehan wrote. But her transformation from her junior to senior year was stark \u2014 going from Mardi Gras queen nominee to resident in a double-secured unit at a psychiatric hospital.\n <\/p>\n

\n Linehan\u2019s confident, spirited sense of self had waned over that period. She had been feeling terribly inadequate and losing her ability to regulate her intense emotions and behaviors.\n <\/p>\n

\n Living at a psychiatric hospital in 1961, Linehan, then 18, \u201cwas drowning in an ocean of self-loathing and shame, of feeling unloved and unlovable, and of indescribable emotional agony, so much so that I wanted to be dead,\u201d she wrote. Linehan\u2019s admission into the hospital for initially two weeks of diagnostic evaluation was per the recommendation of her psychiatrist, whose expertise Linehan\u2019s parents sought since she had also been experiencing debilitating headaches and social withdrawal.\n <\/p>\n

\n To soothe her emotional pain, Linehan began self-harming<\/a> within a few days of her stay. She wasn\u2019t always actively choosing to do these things \u2014 she felt out of control, as if someone else was pulling the strings, but also unable to talk to others about her internal world. Doctors at the institution diagnosed Linehan with schizophrenia. But nothing helped \u2014 not drugs, electroshock therapy or psychoanalysis<\/a>.\n <\/p>\n

\n \u201cBut I survived,\u201d Linehan wrote. \u201cAnd toward the end of my (two plus years) at the institute, I made a promise to God, a vow, that I would get myself out of hell \u2014 and that once I did, I would find a way to get others out of hell, too.\u201d\n <\/p>\n

\n After the institution discharged Linehan, she attempted suicide at least twice, before a religious experience<\/a> in a chapel at a retreat center in 1967 instilled a newfound sense of self-acceptance. After thinking no one could help relieve her despair, Linehan knelt on the floor, gazing at the cross behind the altar when suddenly \u201cthe whole of the chapel became suffused with a bright golden light, shimmering all over,\u201d Linehan wrote.\n <\/p>\n

\n \u201cI immediately, joyfully knew with complete certainty that God loved me. That I was not alone,\u201d she recalled. \u201cWhen I was back in my room, I stood still for a moment. I said out loud, \u2018I love myself.\u2019 The minute the word \u2018myself\u2019 came out, I knew I had been transformed.\u201d\n <\/p>\n

\n That didn\u2019t prevent the distress resulting from a breakup a year later \u2014 but this time, Linehan didn\u2019t resort to cutting herself.\n <\/p>\n

\n As Linehan finished her doctorate in psychology from Loyola University in 1971, she came to understand that having validated herself was a primary driver of her behavioral change \u2014 she realized that her destructive behaviors and desire to be dead made sense given the acute pain and despair she was experiencing.\n <\/p>\n

\n In her attempts to keep that vow she had made to help others, Linehan worked with patients who were chronically suicidal. She witnessed how what helped clients was self-acceptance to feel a bit better about themselves and lay the groundwork for behavioral change \u2014 rather than starting with attempts to adjust behavior before addressing their internal world.\n <\/p>\n

\n \u201cI was determined to find a therapy that would help these people, people who were so often deemed beyond saving,\u201d she wrote.\n <\/p>\n

\n Her work with patients is how she realized BPD is the diagnosis she should have been given as a teenager. Her self-disclosure in 2011 was during talk she gave at the same institution where she\u2019d been hospitalized.\n <\/p>\n

\n Linehan retired from academia and public life in 2019, after a long and illustrious career<\/a> as a professor and director of the Behavioral Research and Therapy Clinics at the University of Washington in Seattle \u2014 during which she still had to manage some symptoms. But her contributions live on. Backed by numerous studies<\/a>, DBT is also used to treat substance use disorders, depression, anxiety, eating disorders, bipolar disorder and post-traumatic stress disorder.\n <\/p>\n

\n Linehan \u201cwas a pioneer in psychology who provided hope and saved thousands of lives through her work,\u201d said Dr. Elizabeth Dexter-Mazza, a certified DBT therapist. Dexter-Mazza was a postdoctoral fellow of Linehan\u2019s and worked closely with her on research. \u201cShe will continue to live on through everyone she has taught and all those whose lives have been touched by DBT.\u201d\n <\/p>\n

\n She was also diligently committed to research on treatment for people previously regarded as untreatable, \u201cat a time when there were many glass ceilings for women doing academic research left to be shattered,\u201d Dr. Vibh Forsythe Cox, director of the Marsha M. Linehan Dialectical Behavior Therapy Clinic at the University of Washington, said via email.\n <\/p>\n

\n While CBT helps treat the ineffective thinking patterns and behaviors that are part of BPD, it doesn\u2019t address \u201cthe internalized self-invalidating narrative or shame,\u201d said clinical psychologist Dr. Rachel Reich, the founder and director of the Center for DBT and Trauma Recovery in New York state. \u201cThe other half of the picture is radical acceptance and validation, and that is the beauty of what Marsha Linehan discovered.\u201d\n <\/p>\n

What is DBT, and who is it for?<\/p>\n

\n The term \u201cdialectical\u201d means a \u201csynthesis or integration of opposites,\u201d according to the University of Washington<\/a>.\n <\/p>\n

\n Accordingly, DBT is a type of cognitive behavioral therapy \u201cthat primarily focuses on teaching clients skills and strategies to regulate their emotions and behaviors, while also balancing acceptance and validation of what struggles they have and why they have those struggles,\u201d Dexter-Mazza said.\n <\/p>\n

\n In Linehan\u2019s case, she understood that her feelings of inadequacy and aloneness were at least partly due to familial experiences. But she had also begun to recognize how the ways she managed those were destroying her life. principles of DBT are why the treatment can help balance black-and-white thinking in other situations, too.\n <\/p>\n

\n Comprehensive DBT involves four components, said Dexter-Mazza, who is also a psychologist and coauthor of the \u201cDBT Skills in Schools<\/a>\u201d curricula for middle and high school. There is a weekly individual DBT session, a weekly DBT skills group session, a weekly consultation team meeting comprised of a patient\u2019s therapist and other therapists, and 24\/7 access to one\u2019s therapist for phone or text consultations between sessions.\n <\/p>\n

\n During individual sessions, the therapist helps a client determine what would help them experience their life as worth living, then devise a plan for getting there and applying skills to their specific difficulties, Cox said. Group sessions are good for practicing skills with other people and gaining additional perspective and community.\n <\/p>\n

\n The consultation team meeting helps DBT therapists adhere to the treatment model, work through any difficulties and reduce burnout to best take care of their clients, Reich said. The between-sessions consultations help patients immediately practice coping skills when triggers and urges toward self-destructive behaviors arise.\n <\/p>\n

\n In DBT for minors, parents or families are often involved in a structured way that includes working on their own communication and emotion regulation skills, experts said.\n <\/p>\n

\n A person\u2019s symptoms don\u2019t have to be severe to need DBT. But people seeking the treatment are often at the point where they\u2019re experiencing problems at work or school, feeling suicidal or losing interest in activities, experts said. They may also be frequently escaping their emotions via drugs, alcohol, gambling, hypersexuality or self-harm. Patients may be in and out of hospitals or relationships, or having many conflicts with friends and romantic partners.\n <\/p>\n

\n In DBT, there are four primary modules of skills training: mindfulness, distress tolerance, emotion regulation and interpersonal effectiveness, experts said. All help a client be able to use their \u201cwise mind,\u201d Dexter-Mazza said, involving both their emotional mind and their rational mind at the same time.\n <\/p>\n

\n Mindfulness skills are the core of DBT and help patients learn to observe the present moment then conclude what the situation calls for, Forsythe Cox said. These skills also aid someone in recognizing when they\u2019re slipping into all-or-nothing thinking, and in noticing when they\u2019re experiencing an urge to act on an emotion in an unhealthy way. Between an urge and a behavior is a slight pause, which creates an opportunity to choose which direction to go in, Dexter-Mazza said.\n <\/p>\n

\n That\u2019s where the distress tolerance skills come in, which \u201con the emotions thermometer are for the seven to 10 zone,\u201d Reich said. These skills, divided into the two subcategories of crisis survival skills and reality acceptance skills, are for getting through a difficult moment instead of making it worse.\n <\/p>\n

\n One crisis survival strategy is what\u2019s called the TIP skill, which helps decrease the intensity of one\u2019s emotions by changing the person\u2019s physiology, experts said. The letter T stands for Temperature, regarding holding your breath and putting your face in cold water or against an ice pack for 10 to 30 seconds. The I stands for Intense exercise to expend pent up energy. And P is for Paced breathing. The latter entails repeatedly breathing deep into your belly for five seconds, then slowly exhaling for seven seconds. This strategy can help calm urges to self-harm or substance use after a distressing fight with a parent, for example, said Dr. Sarah Barnes, director of adult DBT services at Yale-New Haven Psychiatric Hospital.\n <\/p>\n

\n Emotion regulation skills help regulate intense emotional states in the four to seven zone, such as by practicing the \u201copposite action to emotion\u201d skill, experts said. For example, instead of a student thinking he\u2019s a failure because he underperformed on a test, he may be more mindful about what he\u2019s good at and what he still need help with, explained Dr. James Mazza, a professor focused on adolescent mental health at the University of Washington and coauthor of \u201cDBT Skills in Schools.\u201d\n <\/p>\n

\n Or if something your partner said hurt your feelings, instead of thinking they don\u2019t love you or that they\u2019re out to get you, you may recall how just yesterday they brought you flowers and cooked dinner for you. That may help you have an openminded conversation with your partner instead of lashing out or ending the relationship.\n <\/p>\n

\n Interpersonal effectiveness skills, such as the \u201cDEAR MAN\u201d script<\/a>, are for navigating the most trivial relationships, such as with a customer service representative, to the most important ones, like with a partner. These help someone determine the right manner and intensity for asking for something or saying \u201cno.\u201d These skills are for getting what they want or need and maintaining their self-respect, while also still protecting the relationship.\n <\/p>\n

\n Over time, DBT can rewire your brain \u2014 the more awareness and skills you have, the less likely your interpretations, emotions and behaviors will go to extremes, Dexter-Mazza said.\n <\/p>\n

\n Experts recommend that<\/a> people seeking DBT treatment find a psychologist, psychiatrist or licensed therapist<\/a> who has completed a specialized DBT training or certification program and offers a comprehensive treatment model. You can get these details from a provider\u2019s website or during the first appointment.\n <\/p>\n

\n You can also check the DBT-Linehan Board of Certification, or DBT-LBC, Linehan\u2019s organization that helps people find DBT providers<\/a> and programs that conform<\/a> with the evidence-based research.\n <\/p>\n

\n A few factors can limit access to DBT, experts said, including little to no insurance coverage and the comprehensiveness of DBT making it expensive, sometimes amounting to $300 to $500 per week in some states. But this isn\u2019t the case everywhere, so don\u2019t be discouraged from looking for better options.\n <\/p>\n

\n Some providers offer payment plans. You can also ask if they can request that your insurer make an exception via a single case agreement. The DBT-LBC website has a script<\/a> you or your provider can use.\n <\/p>\n

\n Being unable to immediately access comprehensive DBT doesn\u2019t mean that what you can afford isn\u2019t worthwhile, Forsythe Cox said. Even having just a few skills can bring you closer to your goals.\n <\/p>\n

\n Patients receiving comprehensive DBT often need at least six months to a year of treatment, experts said. But people can begin to experience benefits within several weeks \u2014 and the more that patients practice skills and complete homework in between sessions, the faster they can heal. Both research and these experts\u2019 experiences with patients have shown that DBT can dramatically improve someone\u2019s symptoms, quality of life, relationship stability and reasons for living, they said.\n <\/p>\n

\n \u201cA big part of DBT,\u201d Linehan wrote, \u201cis saying yes.\u201d\n <\/p>\n","protected":false},"excerpt":{"rendered":"Dr. Marsha M. Linehan, creator of the lifesaving, gold standard treatment for borderline personality disorder and more, died…\n","protected":false},"author":2,"featured_media":685427,"comment_status":"","ping_status":"","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[35],"tags":[103,61,60,410,411],"class_list":["post-685426","post","type-post","status-publish","format-standard","has-post-thumbnail","category-mental-health","tag-health","tag-ie","tag-ireland","tag-mental-health","tag-mentalhealth"],"_links":{"self":[{"href":"https:\/\/www.newsbeep.com\/ie\/wp-json\/wp\/v2\/posts\/685426","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.newsbeep.com\/ie\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.newsbeep.com\/ie\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/ie\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/ie\/wp-json\/wp\/v2\/comments?post=685426"}],"version-history":[{"count":0,"href":"https:\/\/www.newsbeep.com\/ie\/wp-json\/wp\/v2\/posts\/685426\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/ie\/wp-json\/wp\/v2\/media\/685427"}],"wp:attachment":[{"href":"https:\/\/www.newsbeep.com\/ie\/wp-json\/wp\/v2\/media?parent=685426"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.newsbeep.com\/ie\/wp-json\/wp\/v2\/categories?post=685426"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.newsbeep.com\/ie\/wp-json\/wp\/v2\/tags?post=685426"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}