Dialectical Behavioural Therapy

Dialectical Behaviour Therapy (DBT) is an approach that was developed in the 1980’s by Dr Marsha Linehan. DBT was originally used in the treatment of people who were suffering from suicidal thoughts and Borderline Personality Disorder. DBT has now proven to be successful in the treatment of many people with a wide range of different conditions.

DBT is an adapted ‘cognitive-behavioral’ approach that aims to give you tools and skills that will enable you to succeed in reaching your therapeutic goals – emotionally, cognitively, and socially. To this end, the therapist will help you to explore and understand your process, and also help you to learn effective skills sets.

Dialectical Behavioral Therapy differs from traditional Cognitive Behavioral Therapy in its focus on validating your experience. Your counsellor will help you to accept your uncomfortable thoughts, behaviours, and feelings instead of fighting against them or denying them. Once a thought, behaviour, or feeling, has been acknowledged and accepted it becomes easier to change. The term ‘dialectical’ in its name, refers to the idea of finding a balance between two different perspectives that exist simultaneously, like acceptance and change.

DBT enables you to learn effective emotional and cognitive skills (acquisition), and apply those skills to your life (generalization). Generally, DBT tackles difficult and distressing emotions and improves your capacity for emotional regulation and emotional expression.

DBT is effective for a range of mental health problems, including addictions, eating disorders, and mental health difficulties. The skills you learn help you differentiate emotions from facts, allowing you to work with and manage emotions effectively. The skills you learn through DBT will last a lifetime and can still be applied when you feeling fine.

How Is DBT Useful?

DBT can be effective for almost anyone. There are four skill sets that DBT focuses on developing, these are:

  1. Core Mindfulness Skills – teach you to the experience the present moment without judgement, rather than ruminating about the past or worrying about the future. Practising mindfulness can help you to identify thoughts and emotions and to make healthy, informed decisions about how to manage.
  2. Distress Tolerance Skills – help you to practice healthy and effective ways of dealing with stress. Distress Tolerance skills are used when it is difficult or impossible to change a situation. These skills will help cope effectively during a crisis.
  3. Emotion Regulation Skills – help youto process and tolerate your emotions when you can’t change them or reduce their intensity.

Difficult emotions are a normal part of life, we all feel grief when someone we love dies, or disappointment when we don’t get a job that we really wanted. Anger too is a normal response to seeing happen things that seem wrong or unjust.

Some of us seem to experience intense distress that makes it very difficult to manage ourselves and our lives without developing some unhelpful coping strategies.

Emotions, thoughts and behaviours are all linked, using DBT skills for the emotional part of the cycle will help improve all aspects of the situation

  1. Interpersonal Effectiveness Skills– teach you to nurture your relationships through building communication and assertiveness skills. Building on interpersonal skills can help with building a more supportive and fulfilling social network.

Addictions

Dialectical Behavior Therapy is a cutting edge therapeutic approach for those experiencing addiction.

DBT aims to treat addiction as a symptom of emotional dysregulation. Many people have fallen into addiction through using substances/behaviours as a way of coping with intense, painful feelings. Using chemicals or behaviours to manage feelings may seem to work in the beginning the consequences soon become all too apparent.

DBT offers another way of managing emotions without the use of substances or addictive behaviours. DBT training can really help people to manage intense feelings and replace the addictive behaviour with healthy and effective strategies.

In terms of addiction recovery dialectical behaviour therapy focuses on:

  • Decreasing dependence on substances.
  • Self-care through the detox process
  • Taking the power out of cravings and urges to use
  • Awareness of triggers as part of relapse prevention
  • Developing a support network whilst working on interpersonal and relational skills
  • Developing and becoming skilled in recreational and vocational activities that support abstinence

Eating Disorders

DBT will help you to let go of your eating disorders and develop ways of coping, ones which will help you to flourish. DBT will help you to embrace your reality, and your feelings through:

  • Being present in the moment without judgment
  • Practising acceptance rather than resisting what is
  • Valuing your feelings and understanding your process
  • Learning to decrease intense emotions
  • Learning to accept feelings, even when they are uncomfortable. Often the pain of avoidance is worse than the pain of facing difficult emotions, memories, or thoughts.

Dialectical Behavior Therapy is based on the dialectics of recovery with the focus on the central dialectic of acceptance and change. Through this process, you will be able to accept where you are in the present whilst also moving toward positive change.

Because of the emphasis on regulating emotions and use of healthier coping mechanisms, DBT is has been successfully integrated into eating disorder treatment programmes.

Depression and Other Mental Health Disorders

Emotions serve important functions in our lives. Primary emotions linked to anxiety, such as fear and sadness, can at times make perfect sense. Fear and sadness can motivate us to protect ourselves or prompt others to help us when we are facing difficult or dangerous situations.

At times, however, emotions like fear become disproportionate and are not helpful. These emotions can be difficult to cope with and can lead to chronic anxiety and depression.

If you are experiencing mental health difficulties DBT can help you to learn and apply emotional and cognitive skills. DBT tackles difficult and distressing emotions and it can help you improve your capacity for emotional regulation and expression.

Mindfulness and distress tolerance techniques can really help you accept the present moment with willingness, rather than fighting or avoiding reality. These techniques could include breathing exercises, counting to ten, or mindfully holding an ice cube in order to bring awareness to the present.

DBT’s emotion regulation skills tools include checking the facts, acting opposite to the action urge of the emotion, and problem-solving.

Is It Effective?

Dialectical behaviour therapy is a comprehensive cognitive-behavioural treatment. Though it is best known as for a treatment for borderline personality disorder and suicidal ideation, DBT is widely recommended as a treatment for personality disorder and suicidal ideation, in professional guidelines.[i]

DBT significantly decreases suicide-related outcomes (e.g., suicide attempts, non-suicidal self-injury, and suicidal ideation), psychiatric hospitalization, use of emergency services, treatment discontinuation, depression, and substance use; additionally, it allows for growth, healing, and flourishing.

Through DBT skills training manual, patient workbooks, [ii]5, 6 and clinicians and counsellors working with this exciting therapy people have built up their emotional skills and effectiveness.

DBT skills training has been found to create improvements in suicidal behaviour, non-suicidal self-injury, depression, anger control, emotion dysregulation, and anxiety.

A recent analysis evaluated the importance of the skills training component of DBT. Interventions that included skills training were found to be more effective in re­ducing non-suicidal self-injury, depression, and anxiety.[iii]7

DBT is an intensive, cutting edge and effective therapeutic approach. It has proven to be useful for a wide array of different people, with different issues. Including personality disorders, eating disorders, addictions, and mental health difficulties.

DBT skills training can be adapted and tailored to suit different people, with different needs and goals. Because it is such a rigorous approach this type of therapy does require a large commitment from the client as well as the therapist. The results are certainly worth the effort.

How Long Does It Take to Work?

Often people come to treatment wanting to see instant results. This is not surprising, as perhaps life has been difficult for a while, and you really want things to change. Some groups of people find waiting for results very difficult, preferring instead instant fixes.

Unfortunately, therapy does require commitment and time to work. The term dialectics refers to Dr Linehan’s original goal of finding the balance between acceptance and change, whilst going through a transformative therapeutic process. DBT is equipped to help you through the difficulties you may experience before you find relief from your symptoms.

Like all therapeutic approaches DBT will take some time to work, DBT usually helps clients experience a gradual transformation. As with any therapeutic approach, the length of time it takes to see effects in your life will vary from person to person and will depend on how able you are to commit to the process.

The more willing you are to engage with the process, do the recommended ‘homework’ and practice DBT skills, the quicker, usually, you will start to see and feel positive effects.

[i] Stoffers JM, m BA, Rücker G, et al. Psychological therapies for people with borderline personality disorder. Cochrane Database Syst Rev. 2012;8: CD005652.

Tarrier N, Taylor K, Gooding P. Cognitive-behavioral interventions to reduce suicide behavior: a systematic review and meta-analysis. Behav Modif. 2008;32:77-108.

Klonsky ED. Borderline Personality Disorder. Society of Clinical Psychology; 2015. http://www.div12.org/psychological-treatments/disorders/borderline-personality-disorder/. Accessed January 11, 2016.

SAMHSA’s National Registry of Evidence-based Programs and Practices. Intervention Summary: Dialectical Behavior Therapy. 2015. http://legacy.nreppadmin.net/ViewIntervention.aspx?id=36. Accessed Janaury 13, 2016.

[ii] Linehan MM. DBT® Skills Training Manual. 2nd ed. New York: Guilford Press; 2015.

Linehan MM. DBT® Skills Training Handouts and Worksheets. 2nd ed. New York: Guilford Press; 2015.

[iii] Linehan MM, Korslund KE, Harned MS, et al. Dialectical behavior therapy for high suicide risk in individuals with borderline personality disorder: a randomized clinical trial and component analysis. JAMA Psychiatry. 2015;72:475-482.

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