September 9th, 2020

Dialectical Behavioural Therapy (DBT): An introduction

By Dan Whale

  • Personality disorders
  • Addiction
  • Anxiety
  • Depression
  • Eating disorders

Dialectical Behavioural Therapy (DBT) is a form of talking therapy which is particularly useful for those that experience emotions very intensely.

It was originally created to help manage symptoms associated with Emotionally Unstable Personality Disorder (EUPD, also referred to as Borderline Personality Disorder) but DBT skills can be applied to many different mental health conditions.

The ‘dialectical’ aspect of this therapy teaches you that two ideas that seem contradictory can both be true. For example, it is possible to accept who you are but still work towards changing yourself.

Why might a therapist suggest DBT?

If you find yourself having intense emotional reactions in situations where others don’t, DBT may be helpful. This is a symptom associated with EUPD which is why DBT is often used to help manage it, but you can experience these intense emotional reactions with other mental health conditions as well.

DBT might also be suggested if you’re experiencing severe depression, substance misuse, disordered eating or problematic behaviour (such as committing crimes and self-harm) - a lot of it is down to what you and your therapist think will work for you. DBT can be offered to children, adolescents and adults.

How it works

DBT is fairly similar to Cognitive Behavioural Therapy (CBT). Both are talking therapies which help you to recognise and change unhelpful ways of thinking and behaving. DBT differs in three key ways:

  • DBT places a greater focus on acceptance.
  • DBT will almost always include some form of group sessions.
  • The rapport and alliance you have with your therapist is a crucial component of DBT. If you don’t feel that you connect, you should share this with your therapist. A change in therapist may be beneficial.

In your individual therapy sessions you will work towards four behavioural goals:

  1. To keep yourself safe, reducing self-harm or suicidal behaviors.
  2. To reduce any behaviours that interfere with therapy.
  3. To address whatever it is in your life that is keeping you from feeling your best Self. This may be something in particular or another related mental health condition (such as anxiety or depression).
  4. To learn new skills to reduce unhelpful behaviours and work towards the life you want to lead.

Sessions will usually be 45 - 60 minutes. After several individual sessions, you will start to participate in group sessions, which will usually be up to 2 ½ hours long.

It is important to note that this is not ‘group therapy’. You aren’t there to process feelings together or share what has brought you to DBT. The focus is more on skill development to help people cope with difficult experiences.

There are usually four modules to these sessions:

  1. Mindfulness - helping you focus on the present moment and your surroundings, as opposed to worrying about the past or future.
  2. Distress tolerance - learning to deal with difficult situations, thoughts, and feelings, without it leading to unhelpful behaviour.
  3. Interpersonal effectiveness - being able to ask for certain things and refuse others. Having respect for yourself and those around you, whatever the situation.
  4. Emotional regulation - developing a greater understanding of your emotions and your ability to manage, cope, and control them. This doesn’t mean they go away or even lose their intensity, but they can be easier to experience.

Finally, you may also be offered telephone crisis coaching, in which you can call your therapist in particular times of need. This will usually be between agreed upon hours and only for a short amount of time.

What we know so far

DBT is an evidence-based therapy. It has been proven to be an effective form of treatment for the symptoms of EUPD and has particular effectiveness in reducing self harm and suicidal tendencies. There is also growing evidence that DBT can cause improvements in conditions such as depression, anxiety and anger.

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DBT is an increasingly popular option and represents something slightly different from what you get with CBT. If you think it might be a good option for you, talk to us today. At HelloSelf we are unable to offer group therapy, but we can provide DBT-informed therapy which will have the same focus and teach the same skillset.

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