Table 2.

Main features, similarities, and differences of DBT and ST.

	DBT	ST
Explanatory model	Emotion dysregulation as central problem, Biosocial theory to explain emotion dysregulation, Focus on connection between emotion regulation and dysfunctional behaviors	Case conceptualization using the mode concept; frustration of basic needs in childhood leads to the development of maladaptive schemas and modes, problems in emotion regulation and interpersonal relationships follow. Emotion dysregulation is not seen as the central problem
Integration of childhood experiences	No explicit focus except for psychoeducation and validation of emotional dysregulation	Full integration: Maladaptive schemas, today's problematic behaviors, fear of emotions and relationships are associated with biographical experiences; psychoeducation regarding basic needs of children
Trained skills	Primary aim is skill acquisition in the area of emotion regulation. Skills are trained in the four DBT-modules emotion regulation, distress tolerance, mindfulness and interpersonal effectiveness	Skills for emotion regulation are not directly trained. Fostering meta-understanding of the current mode, skills for using the healthy adult mode, awareness of one's own needs and ways to meet them
General therapeutic strategies	Validation strategies, explicit techniques in DBT (V1–V6) Dialectical strategies (balance between acceptance and change, pro-contra lists) Commitment strategies Skills training Extensive use of cognitive and behavioral techniques, no special focus on experiential techniques	Special focus on therapy relationship: Limited reparenting and empathic confrontation also contain validation strategies with a special focus on validation of traumatic childhood experiences as well as validation of emotions and needs, but not as explicitly as in the DBT protocol Empathic confrontation contains validation (esp. of needs and relationship to childhood experiences) of current dysfunctional mode-driven behavior and confrontation with problematic consequences and the need for change Skills are not trained directly Special focus on experiential techniques (esp. imagery rescripting and chair-dialogs) and therapy relation techniques Mode-specific use of cognitive and behavioral techniques
Analysis of problem behavior	Chain analysis according to the DBT model for each type of problem behavior; hierarchy of problem behaviors; focus on obvious and threatening problem behaviors such as suicide attempts, self-harm and impulsive behavior, focus on emotions and triggers as well as on consequences of behavior, no focus on needs	Analysis with cognitive or experiential techniques according to the mode model, mostly for problematic situations which lead to emotional suffering and frustration of needs; no specific hierarchy, focus both on obvious problem behaviors, but also on “hidden” problem behaviors such as avoidance or surrender, focus on emotional needs and modes
Structure of the individual therapy session	Fixed structure with a “crisp beginning” involving a diary card, processing of topics according to the DBT goal hierarchy, focus on emotions	No fixed structure specification, flexible hierarchy depending on the dominating mode and frustrated needs
Group therapy and structure of the group session	Group therapy is essential ingredient of DBT. Structure: Homework and goal-related opening and closing round, teaching of skills from the DBT modules with a fixed manual; preferred use of cognitive and behavioral therapeutic techniques	Group therapy is not mandatory, but has shown to be helpful in BPD patients. Structure: Begin with safety imagery, topics are covered depending on the dominating mode; designed as “group family” to create corrective experiences; preferred use of experiential and limited reparenting techniques
Dealing with self-injury	Fixed procedures according to protocol based strategies, top priority in goal hierarchy; self-injuries are usually discussed with behavioral analysis before other issues are addressed	No fixed structure specification, and need not be treated with first priority (only if highly threatening); therapeutic intervention is directed at the trigger mode
Dealing with emotional problems	Comprehensive psychoeducation in the modules for emotion regulation; mindfulness and acceptance of emotions; teaching and training of specific emotion regulation skills, decision on whether one should act according to or opposite to the emotion; emotion processing with the help of emotion protocols (more cognitive approach)	Promotion of safe experiencing of emotions; explaining aversive emotions and problems in emotion regulation within the mode model, especially in the beginning extrinsic emotion regulation through therapist according to the mode-specific goals, focus on needs (e.g. “What do I need when I'm sad?”); focus on experiential interventions, mainly imagery rescripting and chair dialogs, aims at developing corrective experiences
Development of the working alliance	Therapist as a “coach” of the patient; therapeutic team at eye level with patient, dialectical formation of working alliance with warmth, empathy, acceptance and validation on the one side and pushing for change on the other	Therapist acts to a limited extent as a good parent with “limited reparenting,” i.e., meeting needs of patient that were frustrated in childhood; use of the working alliance for changing modes and to experience emotions and relationships in a safe way
Mindfulness training	Central role; non-judgmental attitude is promoted	Not included in ST
Skills training in distress tolerance	High priority; psychoeducation, development of a skills chain for stress regulation to prevent problem behaviors, reality accepting skills to ease emotional pain	Limited use, mainly for emergency situations in the beginning of therapy