“Dialectical behaviour therapy (DBT) is a modified version of cognitive-behavioural therapy (CBT) designed to treat borderline personality disorder (BPD). It can also be used to treat other conditions, like suicidal behaviour, self-harm, substance use, post-traumatic stress disorder (PTSD), depression and eating disorders.” (1)
The Origins of DBT
DBT is a specific type of cognitive-behavioural psychotherapy, developed in the late 1980s by psychologist Marsha M. Linehan, to help better manage borderline personality disorder (BPD). This condition can be difficult to treat as it is so multi-faceted, however it doesn’t mean it can’t be managed and controlled, giving the patient control of their lives.
Since its development, it has been discovered that DBT could also be useful in helping other mental health issues, and was thus adapted and modified.
A person can be referred for Dialectical Behavior Therapy AFTER they have tried Cognitive Behavioral Therapy; DBT is vital and of great use to people who self-harm and cannot break this pattern.
What does Dialectical Mean?
The term ‘dialectical’ means, ‘working with opposites’. The principle behind DBT is that it challenges negatives, and tries to improve the lives of people who require the therapy. DBT uses seemingly opposing strategies of ‘acceptance’ and ‘change’. The therapist accepts you just as you are, but acknowledges the need for change in order for you to recover, move forward and reach your personal goals.
During a course of DBT, the therapist works with you to help you move away from a chaotic life and towards a life that you find personally meaningful and fulfilling. Needing this therapy does not make you a ‘bad’ person. It usually is a result of a very personal stressor or trauma, and a history of self-harm and/or suicide attempts, that feel uncontrollable for the individual.
DBT involves developing two sets of acceptance-oriented skills, and two sets of change-oriented skills – four modules in all. It is not a “one off”, but rather a course that the individual and/or group must commit to. Followed, taught and attended, this course has been proven to reduce anger, depression, self-harm, suicide attempts, and hospitalisation, and enhance attendance to classes, both individual and group.
The 4 Modules of DBT
The essential part of all skills taught, are the core mindfulness skills.
Observe, Describe, and Participate are the core mindfulness “what” skills. They answer the question, “What do I do to practice core mindfulness skills?”.
Non-judgmentally, One-mindfully, and Effectively are the “how” skills and answer the question, “How do I practice core mindfulness skills?”.
2. Interpersonal Effectiveness
The interpersonal response patterns – how you interact with the people around you and in your personal relationships — taught in DBT, share similarities to those taught in some assertiveness and interpersonal problem-solving classes. These skills include:
- effective strategies for asking for what one needs;
- how to assertively say ‘no’; and
- learning to cope with inevitable interpersonal conflict.
People with borderline personality disorder frequently possess good interpersonal skills. They experience problems, however, in the application of these skills in specific contexts — especially emotionally vulnerable or volatile situations. An individual may be able to describe effective behavioural sequences when discussing another person encountering a problematic situation, but may be completely incapable of generating or carrying out a similar set of behaviours when analysing their own personal situation.
This module focuses on situations where the objective is to change something (eg requesting someone to do something), or to resist changes someone else is trying to make (eg saying no). The skills taught are intended to maximise the chances that a person’s goals in a specific situation will be met, while at the same time not damaging either the relationship or the person’s self-respect.
3. Distress Tolerance
Most approaches to mental health treatment focus on changing distressing events and circumstances. They have paid little attention to accepting, finding meaning for, and tolerating distress. Religious and spiritual communities and their leaders have generally tackled this. Dialectical behaviour therapy emphasises learning to bear pain skilfully.
Distress tolerance skills constitute a natural development from mindfulness skills. They have to do with the ability to accept, in a non-evaluative and non-judgmental fashion, both oneself and the current situation. Although the stance advocated here is a non-judgmental one, this does not mean that it is one of approval: acceptance of reality is not approval of reality.
Distress tolerance behaviours are concerned with tolerating and surviving crises and with accepting life as it is in the moment. Four sets of crisis survival strategies are taught:
- improving the moment; and
- thinking of pros and cons.
Acceptance skills include:
- radical acceptance;
- turning the mind toward acceptance; and
- willingness versus wilfulness.
4. Emotion Regulation
People with borderline personality disorder or who may be suicidal are typically emotionally intense and labile — frequently angry, intensely frustrated, depressed, and anxious. This suggests that people grappling with these concerns might benefit from help in learning to regulate their emotions.
Dialectical behaviour therapy skills for emotion regulation include:
- learning to properly identify and label emotions;
- identifying obstacles to changing emotionsl
- reducing vulnerability to “emotion mind”;
- increasing positive emotional events;
- increasing mindfulness to current emotions;
- taking opposite action; and
- applying distress tolerance techniques.
If you are curious to find out more about whether DBT could work for you, after reading this brief introduction, I welcome you to make an appointment with me.
Author: Liz Taylor, BA (Hons).
Liz Taylor is a social worker with over ten years’ experience in helping people with personality disorders and other mental health issues. Liz’s counselling strategies are drawn from the Relapse Prevention Model, Cognitive Behaviour Therapy (CBT), and Dialectical Behaviour Therapy (DBT). She is passionate about enabling her clients to function and feel a sense of control in their lives, and to achieve the goals and outcomes that they wish.