Dialectical Behaviour Therapy (DBT)
Dialectical Behaviour Therapy (DBT)
What is Dialectical Behaviour Therapy?
Dialectical Behavioural Therapy (DBT) is a type of cognitive-behavioural treatment which is specifically adapted to help people who experience emotions very intensely. There is an evidence base to suggest that this a therapy used to help manage borderline personality disorder. The word ‘Dialetical’ means understanding how opposite statements can be both be true.
An example of this may be saying ‘Accepting who you are’ and ‘changing your behaviour’. DBT coaches people to understand that it is possible for you achieve both of these despite appearing to be opposite statements.
How does Dialectical Behaviour Therapy work?
As a cognitive behavioural therapy, DBT works by helping people identify and change negative thinking patterns meanwhile also encouraging people to accept who they are.
DBT explores acceptance techniques such as understanding who you might be as a person and making sense of why you might engage in certain behaviours (for example, self-harming or substance use).
DBT also uses explore techniques such as challenging unhelpful thoughts and encouraging new ways or strategies to deal with stressful situations.
Why might I need DBT?
DBT was originally designed to help therapists work with people diagnosed with Borderline Personality Disorder. However, many people don’t like that label and may be resistant to attending therapy due to this.
DBT can be used to treatment many other issues especially if intense emotions are experienced by an individual. This does not mean if you experience intense emotions that DBT will be right for you. This would be discussed at assessment.
What problems can DBT help with?
The aim of DBT is to help you understand and accept difficult feelings, learn new skills and find emotional management techniques.
DBT has been adapted for the youth population and is an evidence-based treatment. DBT is especially effective for the following challenges and disorders:
- Borderline Personality Disorder
- Suicidal thinking or behaviour (suicide attempts)
- Self-injury and other self-destructive behaviours
- Anger and anger management
- Problems with emotions (such as intense sadness or recurrent fear)
- Impulsive behaviours that can be dangerous (such as reckless driving, recurrent unsafe sex, etc.)
- Difficulty building and maintaining healthy relationships
- Chronic feelings of emptiness
- Problems with substance use
- Eating disorders such as bingeing and purging
- Offending Behaviour (committing crimes, repeated patterns of re-offending).
The skills group focuses on how to:
- manage attention (mindfulness skills)
- manage and cope with emotions (emotional regulation skills)
- deal effectively with others (interpersonal skills)
- tolerate emotional distress (distress tolerance skills)
How many sessions would I need?
This is dependent on the individual and would be discussed at assessment if this was found to be the right therapy for you. Your issues and goals would be explored and the therapist could make recommendations about how many sessions would be beneficial for you to achieve these.
Sessions are usually approximately 45-60 minutes. The individuals sessions have a hierarchy of goals:
- To help keep you safe by reducing suicidal and self-harming behaviours.
- To reduce behaviours that may interfere with therapy.
- To help you reach your goals and improve your quality of life by addressing what’s getting in the way. There may be other mental health problems that you may be experiencing such as hearing voices or depression or personal issues such as relationships or work life.
- To help you learn new skills to replace unhelpful behaviours and help you achieve your goals.
DBT can be ran in group sessions, especially in community settings however this is an option to work on a one to one basis with a therapist.
Dialectical Behaviour Therapy Case Study
Becky was diagnosed with Borderline Personality Disorder and had an extensive background of trauma of being abused by partners over a period of 10 years.
She engaged in problematic drug and alcohol use and failed to form attachments often presenting as being emotionally detached from everybody she was once close to including her children who were taken off her to go into care due to the substance use and domestic violence within the household.
She would become physically sick and get angry when asked to analyse her feelings and what body sensations she experienced.
Assessment and treatment
After establishing a relationship with Becky, skills training started immediately with her. She was given a daily mood chart to encourage her to document her mood and feelings throughout the day. This helped Becky to understand her emotional patterns and we maintained the goal of ‘What skills work?’ or ‘Are these skills effective or ineffective?’. We decided that this was the best way to address her emotion management as given her diagnosis of BPD, to probe at her emotions constantly would have caused a greater emotional reaction.
Over time, Becky was able to adopt different skills to address her emotional regulation, distress tolerance and interpersonal skills. For example, she engaged in mindfulness based practice by completing deep breathing exercises and tuned into how it would affect her level of anxiety and body.
By establishing techniques, she was able to be safer in her own environment and in her own body so it did not result in her becoming angry. By the end of treatment, she felt like she was better equipped to manage her emotions and decided to continue working on identity and trauma work.
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