What is Dialectical Behaviour Therapy?
Dialectical Behaviour Therapy (DBT) is a cognitive-behavioural treatment approach, specifically adapted for people struggling with emotional regulation, interpersonal conflict and self-destructive behaviours. It can also be used as a treatment for post-traumatic stress disorder (PTSD).
Combining cognitive therapy, skills training, behavioural strategies and exposure therapy, DBT helps us to better understand our thoughts, emotions and behaviours. From this new understanding, we can begin to develop healthy coping strategies and make positive behavioural changes.
As its name suggests, DBT is influenced by the philosophical perspective of dialectics: balancing opposites.
Dialectics can help us break down our beliefs into their seemingly opposite parts - viewed another way as thesis, antithesis and synthesis (or black, white and grey).
Through talk therapy, DBT helps us find ways to understand and accept that two things that seem opposite can both be true, promoting balance and avoiding ‘all or nothing’ styles of thinking and reacting.
The dialectic at the heart of DBT is acceptance and change – learning to understand and accept ourselves, whilst simultaneously working towards change.
DBT provides us with new skills to manage dysfunctional and distressing emotions and replace unhealthy coping strategies with dependable therapeutic tools. It focuses on teaching skills in four key areas:
- Distress tolerance
- Emotional regulation
- Interpersonal effectiveness
As with CBT, DBT works on changing problem thoughts and behaviours, particularly in this skills training aspect of treatment.
The key difference is that DBT emphasises acceptance and validation strategies, which recognise how difficult it can be to change. This variation can significantly help people stay open to and engaged in the process of change.
What does DBT involve? / What can I expect?
Undergoing DBT typically involves participation in three therapeutic settings: individual therapy sessions with a trained therapist, group skills training and phone coaching.
Whilst each therapeutic setting will have its own structure and goals, undergoing DBT will include learning four key skills to support us in effectively changing our behaviour: mindfulness, distress tolerance, emotional regulation and interpersonal effectiveness.
Mindfulness is at the core of DBT. At its essence, mindfulness is simply being present - accepting and being present in the current moment. Being aware of our thoughts, feelings and behavioural urges, in a non-judgmental way, allows us to stay calm and focus on healthy coping strategies rather than engaging in automatic negative thought patterns and impulsive behaviours. We are empowered to be in charge of ourselves in a different way. It is a practice of attention and intention.
Many traditional treatment approaches focus on avoiding painful situations, but distress tolerance in DBT teaches us that there will be times when pain is unavoidable and we can learn to accept and tolerate the negative emotions we associate with it. Distress tolerance skills can be divided into four categories: distraction, self-soothing, improving the moment, and focusing on the pros and cons. Together, they can be used to help us cope with a crisis in healthier ways and experience distress without avoiding it or making it worse.
Emotional regulation involves learning skills to help us manage and change intense emotions that are causing problems in our lives. By naming and understanding the function of our emotions, recognising the action urge that accompanies each emotion (and whether to heed or oppose these), we can reduce the frequency of unwanted emotions, reduce emotional vulnerability and significantly decrease our emotional suffering.
Interpersonal effectiveness teaches techniques that enable us to confidently navigate our relationships and interactions with others in positive and healthy ways. We can learn to approach conversations in a more deliberate and thoughtful manner, rather than acting and reacting impulsively due to stress or intense emotions. In order to successfully apply skills of interpersonal effectiveness, it is crucial that the other building blocks of DBT (mindfulness, distress tolerance, and emotion regulation) are in place.
One of the main benefits of DBT is that it equips us with skills for life, allowing long-term recovery and wellbeing.
DBT skills training is most likely to work for people who are:
- committed to work at therapy and complete homework assignments
- determined to make positive changes for themselves
- ready to focus more on their present and future, rather than their past.
How effective is DBT?
Controlled trials have consistently shown the efficacy of DBT, not only in borderline personality disorders but also in many other disorders, such as substance use, PTSD, eating disorders and depression.
DBT works because it successfully increases our ability to use effective coping skills, especially when expressing, experiencing and regulating intense emotions.
Furthermore, DBT has been evaluated and found to be effective among individuals from diverse backgrounds in terms of gender, age, sexual orientation and race/ethnicity.
DBT has been successfully implemented throughout the world, making it one of the few evidence-based psychological treatments with a truly global reach.
If you believe DBT may be of benefit to you or a loved one, please contact us for further support and assistance.