Dialectical Behaviour Therapy (DBT) is a widely researched and evidence-based form of talking therapy originally developed in the late 1970s by psychologist and researcher Dr. Marsha M. Linehan and her colleagues. DBT was initially intended to treat individuals presenting with borderline personality disorder (BPD), also known as Emotionally Unstable Personality Disorder (EUPD), which is a mental health condition characterised by long-term patterns of intense and fluctuating emotions, often resulting in impulsive and self-destructive behaviours, and unstable relationships.
DBT is founded on the idea of ‘dialectics’ which means trying to understand how two things which seem opposite could both be true. For example, while accepting yourself and changing your behaviour might feel contradictory, DBT teaches us that it is possible to achieve both these goals together. In other words, saying that it is “ok” to think what you think and feel what you feel, and therefore accepting what is happening inside yourself, is what will help you move in the direction of making helpful changes. In DBT, the therapist will therefore use a combination of acceptance and change techniques. Acceptance techniques focus on helping clients understand themselves as a person and making sense of why they might engage in certain behaviours like self-harm, or substance misuse. Change techniques focus on replacing harmful behaviours with helpful ones, meaning that clients will be supported in re-evaluating their unhelpful thoughts and encouraged to find new ways of dealing with distress and difficult emotions.
Unlike other forms of talking therapies that consist of just one aspect of treatment, such as individual therapy, there are four modes or aspects of DBT:
- Individual therapy – individual therapy takes place weekly for as long as the client is in therapy and runs alongside group skills training. The main aim of individual therapy is to enhance the client’s motivation and support them in applying the skills to specific difficulties in their lives.
- Group skills training – skills training is usually provided in weekly groups and clients are assigned homework to help them practise the skills in their everyday lives. There are four categories of skills that are taught in DBT: mindfulness (the practice of paying attention to the present moment non-judgmentally), distress tolerance (how to tolerate painful emotions when the situation cannot be changed), emotion regulation (how to change emotions that you want to change), and interpersonal effectiveness (how to ask for what you want and say no while maintaining relationship with others and self-respect).
- Phone coaching – clients can contact their individual therapist between sessions to receive skills coaching when they need it the most. This will help the client to learn to apply the skills learned in therapy to different situations when difficulties arise in their everyday life.
- Consultation meetings for therapists – the DBT consultation team supports the therapists in developing and enhancing their skills, monitor their adherence to the DBT model of therapy, and support their motivation to work with individuals presenting with high-risk and difficult-to-treat problems.
While DBT has been traditionally provided for people with EUPD, it has been adapted over the years to help people experiencing other mental health difficulties, including those having difficulty managing overwhelming emotions but who may not necessarily meet the diagnostic criteria for EUPD, those with major depressive and anxiety disorders, difficulties related to substance misuse, eating disorders, and Post-Traumatic Stress Disorder (PTSD).
If you are interested in finding out more about DBT, you may find the resources below helpful:
The Dialectical Behaviour Therapy Skills Workbook: Practical DBT Exercises for Learning Mindfulness, Interpersonal Effectiveness, Emotion Regulation & Distress Tolerance (Matthew McKay, Jeffrey Wood & Jeffrey Brantley)
DBT for Dummies (Gillian Galen & Blaise Aguirre)
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Dr. Ronald Zammit holds a Doctorate in Clinical Psychology from the University of Southampton, has completed Master’s level psychotherapy training in Cognitive Behavioural Therapy at the New Buckinghamshire University in the UK, as well as received training in Dialectical Behaviour Therapy (DBT). He has a special interest in mood and anxiety disorders, post-traumatic stress disorder and other trauma-related difficulties, personality disorders, and compassion-based approaches to treating difficulties related to high self-criticism and shame.