Dialectical Behaviour Therapy

We all have trouble dealing with strong emotions such as anger, guilt and fear from time to time. But some people feel these emotions so intensely and have such difficulty regulating them that they become completely overwhelmed. This can make it very hard to live a normal, functioning life and can even make individuals prone to dangerous and self-destructive behaviours.

Dialectical Behaviour Therapy (DBT) was designed to help people manage these painful emotions and find ways to deal with life’s challenges effectively. DBT is considered a powerful and effective form of treatment for a range of mental health conditions.

So how does DBT work? And how do you know if it’s the right form of treatment for you? Let’s take a closer look.

What is DBT?

DBT is a form of psychological therapy developed in the 1980s based on Cognitive Behavioural Therapy (CBT). It was originally developed to treat borderline personality disorder (BPD) but has since been adapted to successfully treat other conditions, such as:

• Depression
• Post-traumatic stress disorder (PTSD)
• Eating disorders
• Bipolar disorder
• Substance abuse

Dialectical Behaviour Therapy is particularly useful for people who find it hard to accept and regulate strong negative emotions or people who have trouble responding to stressful life situations. DBT can help such people learn to accept and cope with these painful emotions and become more resilient to distress and difficulty.

This therapy is also very useful for people who struggle with risky or self-destructive behaviours, such as substance abuse, unhealthy relationships and self-harming, and for people who experience thoughts about suicide.

DBT vs CBT

DBT shares many similarities with the theory and techniques used in CBT. Both typically involve weekly sessions with a trained therapist as well as homework exercises to practise in between sessions— although both forms of therapy can also be carried out in other formats. In both DBT and CBT, the emphasis is on helping a client to learn new skills and ways of coping with difficult situations.

There are, however, some important differences between DBT and CBT. These include:

DBT is emotion-focused.

• CBT aims to help people identify unhelpful or negative thoughts and to spot the ways these thoughts affect how they feel and act. This allows clients to develop and practise new, more positive ways of thinking. DBT is more focused on emotions and their impact on a client’s daily life. DBT teaches techniques for recognising, managing and expressing difficult emotions. This helps reduce the distress clients experience and can help them respond to difficult situations in a more calm and constructive way.

DBT promotes acceptance and change.

• The emphasis in CBT is often on changing unhelpful thoughts which are contributing to distress. DBT focuses on learning to make changes to how you think and act, but this is balanced by highlighting the importance of acceptance. In fact, the ‘dialectical’ in DBT refers to bringing together these two seemingly opposite perspectives of acceptance and change. DBT teaches that we cannot always change or fully control everything about ourselves or our situation. We can, however, learn to accept ourselves, flaws and all. Doing so can greatly alleviate the distress a person feels by freeing them of any need to ‘fix’ unwanted parts of themselves.

DBT prioritises relationships.

• While learning communication and relationship skills can be one aspect of CBT, it is often at the core of Dialectical Behaviour Therapy. In DBT, relationships are viewed as an essential contributor to our happiness and wellbeing, and clients are taught to examine their important relationships and learn skills to improve how they function. For this reason, DBT often involves group sessions as well as individual sessions to allow clients to practice and role-play important communication skills.

DBT Therapy Techniques

DBT typically proceeds along four stages, starting with targeting the most urgent sources of distress in a client’s life before teaching positive coping skills for the future.

The four stages of Dialectical Behaviour Therapy are:

1. Treating self-destructive behaviours such as self-harm or thoughts and actions around suicide.
2. Teaching skills to improve overall quality of life, such as emotional regulation, relationship skills, and ways to improve one’s tolerance of distress
3. Learning specific ways to improve relationships and boost self-confidence
4. Finding ways to promote joy and improve overall happiness

So, what techniques does DBT use to achieve each of these steps? Generally, a therapist will use a combination of four key techniques:

Emotion regulation.

• Clients in DBT are first taught to identify and name the different emotions they experience. They are then encouraged to accept the unpleasant emotions which sometimes arise rather than trying to shut them out or change them. Clients are also encouraged to develop their skills and talents and to pursue fun, positive experiences. Doing so ensures that they never get too overwhelmed by the unavoidable negative aspects of life. Another technique used in emotional regulation is called opposite action. This technique involves noticing how your emotions make you want to act and then intentionally doing the opposite. For example, if you feel nervous about the idea of speaking up in public, this emotion might motivate you to stay quiet and withdraw. Using the opposite action, you would instead decide to speak up and make your voice heard. Doing so teaches you that your emotions are not always the most reliable guides to how to act and that you don’t always have to listen to them.

Distress tolerance.

• This aspect of DBT involves improving a client’s capacity to experience unpleasant situations and emotions without resorting to self-destructive behaviour as a means of coping. The focus when looking at distress tolerance is on how to improve your experience in the moment. This could be through using techniques like visualisation or breathing exercises to reduce anxiety, or it could involve shifting one’s focus away from negative things we cannot change onto more positive subjects. Another important technique is finding ways to distract from unpleasant feelings rather than getting bogged down in them and letting them guide how we act.

Interpersonal effectiveness.

• This aspect of DBT is about learning better ways to relate to others. DBT teaches clients to be assertive in stating their needs and preferences in a clear and respectful way while avoiding unnecessary conflict. Another core skill in interpersonal effectiveness is learning to show empathy and understanding for other people’s positions, even when you disagree. Developing a client’s self-confidence so that they feel comfortable expressing their needs and values is also important. This can be done using role-play during a therapy session and by encouraging clients to practise different communication styles in between sessions.

Mindfulness.

• Mindfulness is a meditation and self-awareness practice with its roots in eastern spiritualism, which is now widely used in various types of therapy, including CBT and DBT. Mindfulness helps us to live in the present moment and to accept any experiences that come without judgement or critique. Mindfulness meditation teaches individuals to observe and accept their own thoughts and feelings and then let them go. This allows negative emotions like sadness and anger to come and go without taking hold and dictating how we act. Practising mindfulness can teach us to slow down our thinking and make choices based on our important values and beliefs, rather than being driven by strong emotions or pressure from other people. Mindfulness also has very valuable stress-relieving properties when practised regularly and can help improve our overall mental wellbeing.

DBT Online

DBT is traditionally delivered in a face-to-face setting, either as individual therapy or in groups. However, DBT can work in other settings, such as over the phone or online.

DBT is all about learning new skills and then applying them to your daily life. Much of the work, therefore, takes place between sessions. This means that as long as you are learning from a qualified therapist, there is no reason you have to be in the same room for treatment to be effective.

Since relationships are such a key part of DBT, including the relationship between the client and therapist, it is not recommended to undertake DBT alone. Unlike CBT, which can in some cases be completed on a self-help basis or with minimal supervision from a therapist, DBT is unlikely to be as effective without regular support and encouragement from a qualified professional.

Online DBT is often much more convenient and easy to fit in around a client’s other commitments and allows people to take part in therapy when distance or practical concerns might otherwise be an obstacle.

Summary— is DBT Right for You?

Research shows that DBT is an effective and reliable form of treatment for a range of mental health disorders. Most people who come forward for treatment and practice the new techniques they learn show significant reductions in their symptoms and enjoy a greatly improved quality of life.

In most cases, this therapy has been found to be roughly equivalent to CBT in terms of effectiveness, although it is better suited to treating certain conditions, particularly BPD. Choosing between the two forms of therapy is, therefore, a matter of considering your own individual circumstances and challenges.

Do you feel overwhelmed by strong emotions and wish you could have greater control over them? Would you like to learn to accept yourself as you are? Or do you think you need to work on strengthening the important relationships in your life? Dialectical Behaviour Therapy could be the perfect treatment for you.