Dialectical behavior therapy (DBT): skills for overcoming depression , emotional dysregulation, and more | Shireen Rizvi, Ph.D., ABPP

**Peter Attia** (0:11)
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Now, without further delay, here's today's episode.
My guest this week is Shireen Rizvi. Shireen is a professor of clinical psychology and psychiatry at Rutgers University, where she also serves as the director of the Dialectical Behavioral Therapy Clinic. She earned her doctorate in clinical psychology from the University of Washington, where she studied under Dr. Marsha Linehan, the creator of dialectical behavioral therapy, abbreviated DBT. Since joining the faculty at Rutgers in 2009, Shireen has taught courses and conducted research on topics including DBT, cognitive behavioral therapy, or CBT, personality disorders, and trauma. In this episode, we focus specifically on DBT.
We cover the origins of DBT and how dialectical behavioral therapy differs from its cousin, cognitive behavioral therapy. We talk about how its creator, Marsha Linehan, came to find a need for something beyond cognitive behavioral therapy, both to help her and to help her patients. Talk about the structure of DBT and how it is oriented as a skills-based technique. We talk about something called wise mind, emotional mind, and reasonable mind, and how these things are connected. We talk about radical acceptance. We talk about different frameworks, for example, something like Dear Man, which anyone who's done DBT will be familiar with as a framework for interpersonal interactions. And we talk about one of my favorite ideas called opposite action. We also discuss who can benefit from DBT, how it can help children, how mindfulness plays a part of DBT, and how someone can find a well-trained DBT therapist. Lastly, I have a huge personal interest in this because I've been practicing DBT for two years. And I think it's safe to say I feel like I'm barely scratching the surface of what this is about. So I have no delusion that listening to this podcast is going to offer you everything you need to know about DBT. But my hope is that for those of you who listen to this, who see that there might be some benefit in this technique, your curiosity might be peaked enough that you go out, watch the educational videos that exist on this, pick up a workbook, work your way through it, and potentially find a therapist if you think this is something could be helpful. So without further delay, please enjoy my conversation with Shireen Rizvi.
Hey Shireen, it's great to finally meet you. Not in person, but better than being on the phone, I guess.

**Shireen Rizvi** (3:06)
Yes, same here.

**Peter Attia** (3:07)
People on this podcast have probably heard me in a couple of episodes reference this thing called DBT.
I've never really gone into much detail about it, but it's something I've wanted to obviously have a dedicated podcast around, and now we're finally gonna get to do that. So maybe we can just start by defining what it is a little bit before we get into its history, its founder, your involvement and things like that. If you were at a party and somebody said, Shireen, I heard that you're a DBT therapist practitioner. Can you tell me what that is? What would you say?

**Shireen Rizvi** (3:39)
DBT stands for Dialectical Behavior Therapy, abbreviated DBT. And it's a form of therapy or a form of talk therapy that is largely inspired by cognitive behavioral therapy, also abbreviated as CBT. So we often say that DBT is a form of cognitive behavioral therapy that was designed for individuals that have complex mental health problems and originally designed for individuals that are suicidal or self-harming and who may meet criteria for a disorder called borderline personality disorder.
At its simplest, I would say it's a form of cognitive behavioral therapy that was designed for more complex people or presentations. But then, of course, there's a lot more nuance beyond that.

**Peter Attia** (4:33)
Maybe give people a bit of background on what cognitive behavioral therapy is. I mean, that term I've heard a lot, but truthfully, I don't know much about CBT outside of CBTI, which is cognitive behavioral therapy for insomnia, which we have referred, I would say, over the past five or six years, probably a dozen of our patients to CBTI practitioners.