Changing Behavior in DBT

Problem Solving in Action

Heidi L. Heard and Michaela A. Swales
Foreword by Marsha M. Linehan

Hardcovere-bookprint + e-book
October 22, 2015
ISBN 9781462522644
Price: $37.00
266 Pages
Size: 6" x 9"
October 22, 2015
ePub and PDF ?
Price: $37.00
266 Pages
print + e-book
Hardcover + e-Book (ePub and PDF) ?
Price: $74.00 $40.70
266 Pages

This book delves into problem solving, one of the core components of dialectical behavior therapy (DBT). The authors are leading DBT trainers who elucidate the therapy's principles of behavior change and use case examples to illustrate their effective application. Particular attention is given to common pitfalls that therapists encounter in analyzing target behaviors—for example, a suicide attempt or an episode of bingeing and purging—and selecting and implementing appropriate solutions. Guidelines are provided for successfully implementing the full range of DBT problem-solving strategies, including skills training, stimulus control and exposure, cognitive restructuring, and contingency management.

“Readers are lucky to get a book by these two fabulous DBT therapists and trainers. This is particularly true when the topic is problem solving. We all know that this is often the significant challenge facing our clients: they cannot solve the major problems of their lives. But helping a client solve life problems isn't easy. This book by two therapists who know what they are doing is going to help you immensely.”

—from the Foreword by Marsha M. Linehan, PhD, ABPP, Professor and Director Emeritus, Behavioral Research and Therapy Clinics, University of Washington; developer of DBT

“If you really want to increase your adherence to DBT, this is a 'must read,' written by true experts. This book will instantly help DBT clinicians—novices and veterans alike—improve the application of all key DBT problem-solving strategies and develop more precise behavioral formulations. I will recommend it to all of my colleagues and trainees.”

—Alec L. Miller, PsyD, Department of Psychiatry and Behavioral Sciences, Montefiore Medical Center of the Albert Einstein College of Medicine

“With elegance and clarity, Heard and Swales elucidate the cognitive-behavioral principles and problem-solving techniques at the core of DBT. Every chapter is grounded in clinical examples. For beginning students of psychotherapy, the book will effectively introduce evidence-based behavioral change methods, seamlessly blending the theoretical and practical. For experienced DBT clinicians, the book will sharpen the use of problem-solving tools, as it did for me. Each chapter takes up a core DBT practice, details the underlying principles and the use of strategies, and ends with a remarkably helpful troubleshooting guide for noticing and solving typical problems in application.”

—Charles R. Swenson, MD, Department of Psychiatry, University of Massachusetts Medical School

“This book holds a microscope to the precise moments in DBT when the goal is to change an unwanted behavior, describing with remarkable clarity what the therapist must do to bring that change about. All distractions and distortions are stripped away—here is the nitty-gritty of targeting, chain/solution analysis, exposure, contingency management, and skills training, with sharp-focus clinical examples. The chapters are worth reading for the ‘common problems’ sections alone. Students and practitioners should read this book and keep it close at hand.”

—Christine Dunkley, DClinP, Department of Psychology, University of Bangor, United Kingdom

“An instant classic. The authors are pioneers in DBT who draw on extensive clinical experience to outline key principles and strategies of problem solving, highlight challenges that clinicians frequently encounter, and offer excellent explanations and practical advice for tackling and overcoming them. This is an essential addition to the bookshelf of any clinician interested in, or practicing, DBT. It will certainly be prominent on mine for many years to come.”

—Maggie Stanton, DClinPsych, Consultant Clinical Psychologist and Clinical Lead, Southern Health NHS Foundation Trust, United Kingdom

Table of Contents

Foreword, Marsha M. Linehan

1. Changing Behavior in DBT: An Overview

2. Targeting: Selecting and Defining Problem Behaviors

3. Behavioral Chain Analysis

4. Solution Analysis

5. Skills Training

6. Stimulus Control and Exposure

7. Cognitive Modification

8. Contingency Management

Epilogue: Problem-Solving Therapists’ Behaviors: An Illustration



About the Authors

Heidi L. Heard, PhD, has published numerous articles and chapters related to borderline personality disorder and DBT and is coauthor (with Michaela A. Swales) of Dialectical Behaviour Therapy: Distinctive Features. She collaborated with Marsha Linehan on the initial outcome trials for standard DBT and the adaptation for substance abuse and dependence, particularly focusing on the cost-effectiveness of DBT. Now retired, Dr. Heard was the founder of British Isles DBT Training and was a senior trainer for Behavioral Tech, which provides advanced training in DBT internationally. She provided consultation in the United States and Europe to DBT teams working in adult and adolescent outpatient programs and in adult secure inpatient programs, and to individual clinicians in adult outpatient, secure hospital, and prison settings.

Michaela A. Swales, PhD, is Consultant Clinical Psychologist and Professor in Clinical Psychology on the North Wales Clinical Psychology Programme, Bangor University. She trained in DBT with Marsha Linehan and for 20 years ran a clinical program for suicidal young people in an inpatient service. Dr. Swales is Director of the British Isles DBT Training Team, an international affiliate of the Linehan Institute. She has trained more than a thousand professionals in DBT, seeding over 400 programs globally. She coauthored Dialectical Behaviour Therapy: Distinctive Features (with Heidi L. Heard) and is editor of the Oxford Handbook of Dialectical Behaviour Therapy. Her primary research interest is the effective implementation of evidence-based psychological therapies in routine clinical practice. Dr. Swales was a member of the Working Group on Classification of Personality Disorders reporting to the World Health Organization's International Advisory Group for the Revision of the ICD-10 Mental and Behavioural Disorders.


Clinical psychologists, psychiatrists, clinical social workers, mental health counselors, and psychiatric nurses.

Course Use

May serve as a supplemental text in graduate-level courses.