What is Dialectical Behaviour Therapy DBT?
Dialectical Behaviour Therapy, or DBT for short, is a treatment pioneered by Dr. Marsha Linehan, a clinical psychologist from Seattle. DBT was originally developed for people who deliberately harm themselves, experience ongoing suicidal thoughts, and struggle with intense and uncontrolled emotions. Many people with these behaviours are diagnosed with a disorder called Borderline Personality Disorder, and often struggle with co-existing mood disorders, post-traumatic stress disorder, eating disorders, and alcohol and drug problems.
Dr. Linehan is the author of two books published in 1993 describing the treatment that she designed to help people with these kinds of difficulties develop control over their emotional experiences and build a valued life. The effectiveness of DBT has been thoroughly researched since its inception in the early nineties, and it is now established as the most effective treatment for Borderline Personality Disorder. Research has also shown that DBT is an effective treatment for binge eating, bulimia, depression and substance abuse.
DBT is essentially a skills-based treatment, and includes several components including group sessions for learning the DBT skills sets, and individual sessions which support the use of skills in the particular circumstances of an individual’s life. DBT skills can also be taught in individual sessions, and the skills are grouped into four modules as below.
DBT Core Mindfulness skills
Mindfulness skills are central to DBT. DBT describes three primary states of mind, called Reasonable Mind, in which a person is thinking and behaving rationally and dealing with problems in a logical manner; Emotion Mind, in which a person’s thinking and behaviour are dominated by the energy of his or her current intense emotion; and Wise Mind, which reflects a synthesis or coming-together of rational thoughts and emotional experiences. DBT Mindfulness skills aim to help people achieve a balance between Emotion Mind and Reasonable Mind, to recognise the importance of acknowledging the input available from both. and to reach Wise Mind decisions about behavioural choices. For more information please refer to my article Core DBT Mindfulness Skills
DBT Interpersonal Effectiveness skills
The DBT Interpersonal Effectiveness module teaches a set of skills that is similar to the skills set taught in many assertiveness programs, and is particularly useful for people who experience intense emotions which can severely hamper attempts to act in an effective manner in interpersonal situations. The DBT skills include how to ask for help, how to say no or express an opinion, and how to behave in interpersonal situations in ways which enhance both the relationship with the other person and one’s own sense of self-respect. For more information please refer to my article About DBT Interpersonal Effectiveness Skills.
DBT Emotion Regulation skills
The DBT Emotion Regulation module has skills to help with identifying and labeling emotions and their functions, skills to change emotions, skills to reduce vulnerability to Emotion Mind by taking care of physical well-being and increasing positive emotional experiences, and skills to help with really intense emotions. These DBT skills are important because extreme emotions often produce extreme behaviour, which may have negative and undesired consequences. For more information please refer to my article About DBT Emotion Regulation Skills.
DBT Distress Tolerance skills
The DBT Distress Tolerance skills focus on enhancing the ability to tolerate distress and survive crises, as well as to accept life as it is in the moment. These are important skills, particularly as they can help a person avoid doing things which might worsen an already difficult situation. Distress Tolerance skills include crisis survival skills such as distraction and self-soothing, and skills which help with non-judgementally accepting oneself and the current situation (which is not the same as approving of or liking the current situation). For more information please refer to my article What are the DBT Distress Tolerance Skills?
These four skills sets constitute the first stage of DBT, and aim to help a person move from feeling largely out of control of his or her feelings and behaviour to feeling in control. After this stage a person is able to control his or her attention and awareness of the present moment, start new relationships and improve current ones, understand how to regulate emotions, and tolerate emotional pain without feeling compelled to resort to behaviours that may be self-destructive. Once a person has these abilities he or she is equipped to work on any past traumas and improve the overall quality of life, which are the second and third stages of DBT respectively.
What does the term "Dialectical" mean?
Throughout DBT, a broad range of cognitive and behavioural strategies are used. The term Dialectical is used to describe a rather complex philosophical idea, but in practice it refers in part to strategies in which opposing views of a situation or extremes of a feeling are considered, and an attempt is made to produce “a middle path”, or synthesis, of thinking and behaving which incorporates or combines elements of both opposing positions. An example is a person’s wish to be accepted as she or he is, and a simultaneous wish to be encouraged to change. These positions are opposite, but in dialectical terms can be both true at the same time i.e. the person wants to both be accepted as she or he is presently and to change. Most of us can perhaps think of other situations where both ends of a particular dimension are true for us, either at the same time, or in different circumstances. DBT focuses on creating a middle path, and on acting in an effective manner – “Doing what works”.
DBT may be a suitable treatment for people struggling with
alcohol and drug abuse
binge eating and bulimia
difficulties with mood management including Bipolar Disorder and Depression.
feelings of emotional numbness or overly intense emotions including anger
turbulent or otherwise difficult interpersonal relationships
urges to self-harm
frequent suicidal thoughts
If you experience any of these kinds of problems or are interested in knowing more about the DBT skills described above I encourage you to contact me so that we can discuss your difficulties and decide whether DBT is an appropriate treatment for you.