What is Dialectical Behaviour Therapy?
Dialectical behaviour therapy (DBT) is a form of cognitive-behavioural therapy that was initially developed for the treatment of borderline personality disorder (BPD), and for those experiencing chronic suicidal thoughts and urges.
How does DBT work?
DBT is a structured therapeutic approach that focuses on reducing self-destructive, life-interfering behaviours.
DBT organises treatment using a hierarchy because if you’re suffering from BPD, you’re likely to be experiencing difficulties in a range of different domains. For this reason, the treatment tries to address problems in order of priority.
One of the core principles of DBT is that opposites can coexist. In order to change, we have to first accept. It aims to achieve a balance between empathy and acceptance, whilst staying focused on changing any problem behaviours.
DBT teaches clients different techniques and skills to better manage their emotions. 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 BPD.
There are also various adaptations of Dialectical Behaviour Therapy (DBT) for the treatment of substance misuse, depression, post-traumatic stress disorder (PTSD) and eating disorders.
What to expect in Dialectical Behaviour Therapy (DBT)?
- You are likely to meet your therapist once or twice a week 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
- Dialectical Behaviour Therapy (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
- Dialectical Behaviour Therapy (DBT) is a long-term, intensive therapeutic approach so you should expect to see your therapist for six months to one or two years
Frequently asked questions
When would I be offered Dialectical Behaviour Therapy (DBT)?
You are likely to be offered DBT if you are having difficulties managing your emotions and if, at times, you have a tendency to engage in self-destructive behaviours. You may also be offered DBT if you have tried other therapy approaches such as CBT and they have not been effective.
Why might I be offered DBT vs. Mentalisation Based Therapy?
You are likely to be offered DBT over Mentalisation Based Therapy (MBT) if we believe that the focus of your therapy needs to be around learning skills for self-management. MBT can also help you learn how to regulate your emotions but it’s focus is on helping you develop the ability to better understand what’s going on in someone else’s mind. DBT is a more structured, psychoeducational approach to therapy that will teach you coping skills which are not covered in MBT.
How many sessions will I need?
DBT is a long-term therapeutic approach. It tends to address more pervasive difficulties which usually require at least 12 months of therapy. That said, we always take an individual approach and ultimately, it depends on how quickly you are able to utilise the skills you are learning in your therapy. If you are also attending a DBT group, this will tend to be delivered in 4 modules which will usually take about 6 – 9 months to complete alongside your individual therapy.