Dialectical behaviour therapy (DBT) is a form of cognitive-behavioural therapy that was developed for the treatment of individuals with chronic suicidal thoughts and urges and individuals suffering from borderline personality disorder (BPD).
DBT is a structured therapeutic approach that focuses on reducing self-destructive, therapy interfering and quality of life interfering behaviour. DBT organises treatment using this hierarchy because usually individuals suffering from borderline personality disorder have difficulties in a range of domains and therefore the treatment tries to address problems in these domains in order of priority.
DBT has many principles that organise the treatment but pre-dominantly tries to balance opposite strategies of acceptance and change. For instance, in DBT therapists accept clients as they are whilst also acknowledging that they need to change in order to reach their goals.
DBT teaches clients skills to manage their emotions as it makes an assumption that individuals suffering from emotional dysregulation lack self management strategies. The four sets of behavioural skills that are taught in DBT are mindfulness, distress tolerance, interpersonal effectiveness and emotional regulation.
DBT has a significant evidence base and has been shown to be effective in reducing suicidal behaviour, self harm, substance misuse, anger and depression. It is now recognised to be the gold standard psychological treatment for individuals with borderline personality disorder. There are various adaptations of DBT for the treatment of substance misuse, depression, post-traumatic stress disorder (PTSD) and eating disorders.
What can I expect if I receive dialectical behaviour therapy (DBT)?
- You are likely to meet your therapist once or twice weekly depending on whether you can join a DBT skills’ training group. One of the weekly sessions is for individual therapy and one is for skills’ training.
- You are going to learn skills to manage your emotions and relationships more effectively.
- DBT requires a considerable amount of motivation so often your therapist will be challenging in their approach with the aim of helping you reduce reliance on unhelpful and self-destructive behaviours.
- Your therapist will offer you some out of session contact which will be individually negotiated to help you utilise new skills you learn in the therapy in situations in your life.
- You will be asked to complete diary cards between sessions and also conduct a behavioural chain analysis with your therapist in the sessions. These processes allow you to learn to observe the chain of events that leads to self-destructive behaviours and help you think about how new skills could be used to mitigate against the use of those behaviours.
- DBT is a long-term, intensive therapeutic approach so you should expect to see your therapist for six months to one or two years.