Dialectical Behaviour Therapy (also known as DBT), is a therapy commonly used to assist people who have difficulty managing strong emotions, responding to them in destructive ways such as self-harming and parasuicidal behaviours.
Dialectical Behaviour Therapy is currently the best evidenced treatment for Borderline Personality Disorder, and has also proven highly effective in treating people suffering from life-threatening and quality-of-life-threatening behaviours including:
- impulsive self-destructive behaviours;
- chaotic and volatile interpersonal relationships;
- anxiety and panic disorders;
- mood disorders;
- substance abuse problems;
- eating disorders;
- anger problems;
- and a number of other severe mood and behavioural problems.
DBT was developed by Professor Marsha Lineham Ph.D., in response to her own psychiatric admissions for habitual self-harm as a teenager. She reportedly made a vow to find a better way to treat these conditions, and subsequently studied clinical psychology and developed DBT for the treatment of women with chronic self-harming and suicidal tendencies (1).
What does Dialectical mean?
The word “dialectical” describes the notion that two opposing ideas can be true at the same time. For example, “I hate you, leave now! But I love you, so don’t leave me.” We can feel both, and mean both at the same time. Working with the extremes, dialectics can show people how to find a “happy middle ground”.
It also works with the opposing ideas that some things need to be accepted as they are, while recognizing that some things need to change. In DBT, both acceptance and change are necessary for establishing a fulfilling life.
DBT uses the principles of CBT, in recognizing and working with the link between thoughts, feelings and behaviours. It combines these principles with mindfulness, acceptance and dialectics. It differs from CBT by placing less emphasis on cognitive methods, and instead focusing on the learning and practicing of new skills.
The core skills that are developed in Dialectical Behaviour Therapy are:
1. Distress Tolerance – Working to build up resilience and learning new ways to cope with the effects of upsetting circumstances.
2. Mindfulness – Learning to more fully experience the present moment while focusing less on painful past experiences, or worrying about frightening future possibilities. It also helps to overcome habitual, negative judgments about the self and others.
3. Emotional Regulation – Building skills to help recognize and observe emotions without getting overwhelmed by them. The goal is to be able to modulate feelings without behaving in reactive, destructive ways.
4. Interpersonal Effectiveness – The development of skills to express beliefs and needs, set limits and negotiate solutions to problems, while at the same time protecting relationships and treating others with respect.
Stages of Dialectical Behaviour Therapy
Therapy is structured over 4 stages:
- Stage 1: Treats the most self-destructive behavior, such as suicide attempts or self-injury.
- Stage 2: Begins to address quality-of-life skills, such as emotional regulation, distress tolerance, and interpersonal effectiveness.
- Stage 3: Focuses on improved relationships and self-esteem.
- Stage 4: Promotes more joy and relationship connection.
Types of DBT
Fully Adherent DBT – DBT as developed by Marsha Lineham involves a multi-pronged approach using four modes of intervention: weekly individual psychotherapy; 2 hour weekly skills based group therapy; regular phone calls to check on progress and support during crisis; and consultation team meetings, all of which run concurrently, usually over the course of a year (1). This is a complex and intense therapeutic intervention, however it has been shown to be the most effective treatment for those with extreme distress intolerance conditions such as those with severe Borderline Personality Disorder (2).
DBT Informed Therapy – The principles of DBT can still be utilized in regular (usually weekly) one-on-one psychotherapy. The therapy involves the client and the therapist working collaboratively through the core skills, with the client practicing these skills between sessions. Sessions also focus on cognitive restructuring, dialectics, acceptance and mindfulness. While much of the evidence supporting DBT has gathered results from fully adherent DBT, there is also evidence to support the effectiveness of DBT being delivered purely via individual therapy mode (3).
As compassion and non-judgment are important in DBT, clients are always seen as doing the best they can in a difficult situation. It is the role of DBT and the therapist to help the client find and use behaviours that work better than what they are already doing.
Could DBT work for me?
The skills taught in Dialectical Behaviour Therapy can be of benefit to anyone who feels they are lacking in the core skill areas of emotional regulation, distress tolerance and interpersonal effectiveness and/or those experiencing problem behaviours such as suicidality, self-harm, impulsive self-destructive behaviours, chaotic and volatile interpersonal relationships, anxiety and panic disorders, mood disorders, substance abuse problems, eating disorders, anger problems or severe mood problems. Individual therapy can use DBT solely to focus on these issues, or DBT may be used as part of an integrative approach to address the main presenting problems.
Greta Neilsen is a Loganholme psychologist utilizing DBT Informed Therapy in her integrative approach to therapy. She endeavours to provide her clients with a safe space to understand the challenges they face, as they develop ways to overcome their difficulties.
To make an appointment with Loganholme Psychologist Greta Neilsen, please call (07) 3067 9129 or you can book online today.
- Lineham, M.M. (1993). Skills Training Manual for Treating Borderline Personality Disorder. Guilford Press, New York.
- O’Connell, B. & Dowling, M. (2014). Dialectical behaviour therapy (DBT) in the treatment of borderline personality disorder. Journal of Psychiatric and Mental Health Nursing, 21, 518-525.
- Robins, C. J. & Chapman, A. L. (2004). Dialectical Behaviour Therapy: Current status, recent developments and future directions. Journal of Personality Disorders, 18, 3-89.