Keywords: DBT (Dialectical Behavior Therapy), Psychosis / Psychotic Disorders, Vulnerable Populations Recommended Readings: Mullen, M. (2021). The Dialectical Behavior Therapy Skills Workbook for Psychosis. New Harbinger Press., Phalen, P., Lucksted, A., Fox, K., Yusuf, A., Hochheiser, J., Jones, N., Fetisova, A., Hackman, A., & Bennett, M. (2025). Pilot of Dialectical Behavior Therapy (DBT) skills training for people with psychosis spectrum conditions and high risk of suicide. Psychosis, 1–17., Lawlor, C., Vitoratou, S., Duffy, J., Cooper, B., De Souza, T., Le Boutillier, C., Carter, B., Hepworth, C., & Jolley, S. (2022). Managing emotions in psychosis: Evaluation of a brief DBT-informed skills group for individuals with psychosis in routine community services. The British journal of clinical psychology, 61(3), 735–756., ,
Dialectical Behavioral Therapy (DBT) is an evidence-based treatment utilized to help those that struggle with intense experiences of emotion dysregulation. However, when one thinks of psychosis, an experience that can greatly disrupt one’s ability to engage in emotion regulation, DBT is not commonly thought of as a therapeutic intervention. Psychosis often includes intense emotional responses to stress, a slow return to baseline emotional levels (Vaessen et al., 2019), and increased subjective emotional intensity (Kimhy et al., 2014)—experiences central to the DBT biosocial model. Additionally, individuals who experience psychotic experiences also report high levels of suicidal thoughts and behaviors, with a recent meta-analysis suggesting a lifetime prevalence of suicidal ideation at 34.5% of individuals with schizophrenia worldwide (Bai et al., 2021). Research consistently identifies DBT as an effective treatment for suicidal behavior (Decou et al., 2019), thus making it a potentially important intervention to target the high rates of suicidal behavior for individuals experiencing psychosis.
By examining the four modules of DBT (distress tolerance, emotional regulation, mindfulness, and interpersonal effectiveness), we will discuss how to apply DBT-informed concepts and principles to benefit clients with Psychotic Spectrum Disorders utilizing a culturally responsive, disability justice framework. There will be an emphasis on skill-building interventions derived from DBT, rather than a strict adherence to DBT treatment protocol that is customary for DBT programs.
Learning Objectives:
Describe the prevalence of emotion dysregulation, suicide, self-injury, and trauma among people with Psychotic Spectrum Disorders.
State four overarching principles of how to effectively offer DBT to people with Psychotic Spectrum Disorders
Offer three DBT skills to people with Psychotic Spectrum Disorders
