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DBT for Depression: What is Dialectical Behaviour Therapy and How Can it Help?

“Times are tough – but I am tougher”.

What is DBT?

Dialectical Behaviour Therapy (DBT) is a structured, skills-based therapy that is especially helpful for those who have difficulty managing their emotions. It was originally developed by a psychologist in the 80s – called Martha Linehan – who created the therapy whilst working with one of her client’s who was struggling with self-harm.

DBT is perhaps best known as one of the most successful types of therapy for treating Borderline Personality Disorder (BPD).

However, because of it’s strong focus on managing and dealing with emotional challenges, DBT can also be hugely beneficial for treating depression – particularly for those who have already tried other types of therapy without much success.

Let’s explore this therapy in more detail to get a better idea of how it can help.

How does DBT work?

Unfortunately – although we might try our best – we don’t always get to choose what happens to us in life. Throughout the inevitable ups and downs, we might end up adopting unhealthy coping mechanisms as a means of dealing with the challenges we encounter along the way.

The overriding aim of DBT is to identify how these coping mechanisms are holding us back so that we can replace them with new, healthier and more stable ways of responding. Because of this, DBT is especially helpful for those who find themselves often led by their emotions or have a tendency to react very impulsively.

Radical acceptance lies at the heart of this type of therapy – both from your therapist, but also in learning to accept the painful thoughts and behaviours you struggle with too. The irony is that it is only when we stop battling with ourselves and truly accept ourselves for who we are that we create the space – and potential – for change.

One of the most crippling things about depression is that it bashes at your self-esteem, often leading to a cycle of self-blame.

No matter how far off it seems, the first steps in your therapy will be about helping you to accept yourself and your current situation as it is right now. And it’s from here that you will be able to work towards finding the motivation to enact the necessary changes in your life.

DBT therapy techniques: what do they look like?

Similar to CBT, DBT draws it focus to changing challenging behavioural patterns instead of talking through the past in a lot of detail.

Instead, the focus rests on learning and developing the following life skills:

1.Bettering your relationships – you will learn to become more assertive in asking for your needs to be met (in a healthy and positive way).

2. Regulating and accepting difficult emotions – you will learn how to accept and manage all emotions, both good and bad.

3. Techniques to better manage distressing situations – e.g. self-soothing, challenging unhelpful thoughts when they arise, distraction techniques etc.

4. Mindfulness skills – fighting difficult emotions tends to only heighten our suffering. You will learn how to pause, check-in and allow challenging thoughts and emotions to simply wash over you, rather than getting wrapped up in them.

DBT is unique in that it is generally carried out in 3 different therapeutic settings:

  • Group skills sessions – a bit like group therapy where you will learn the 4 different skills listed above.
  • Individual therapy – where your therapist will adapt the skills you’ve been learning to your personal circumstances.
  • Phone therapy or ‘coaching’ – in some cases you might have your therapist’s phone number so you can call them when something crops up which you need help navigating.

At their core, all of the DBT therapy techniques teach you how to better understand and manage your emotions so that when difficulties come your way you don’t allow yourself to get swept up in them.

How can DBT help depression?

  1. Teaches you how to accept your sadness

Depression can be both crippling and pervasive. DBT will teach you how to accept the sadness and isolation rather than beating yourself up about it. You might be asked to keep “daily diary cards” charting your sadness on a scale of 1 – 10. This is a good way of identifying the thoughts and behaviours which are holding you back, alongside taking note of the coping mechanisms which help you feel better.

2. Identify and call out your inner critic

Whilst we might not be able to drown out our inner critic completely, we can definitely choose how much we listen and engage with it. If you’re suffering from depression, you probably have a tendency to internalise a lot of the bad things that happen to you. In DBT, you will learn how to pause and “check the facts”. Many of life’s disappointments are far beyond our control – accepting that fact alone can be hugely liberating.

3. Learn how to manage distressing emotions

You will learn how to better manage the struggles of everyday life so that you’re better equipped to deal with crises when they arise.

4. Commit to doing activities that bring you joy

Depression can suck the life out of you. With the help of your therapist, you’ll be encouraged to start doing some of things you used to enjoy that instil you with a sense of wellbeing and joy.

Depression has a nasty way of making you feel hopeless. But there is hope, and  whatever you’re feeling right now, remember that recovery is in sight:

“It is in the darkness that one finds the light, so when we are in sorrow, then this light is nearest of all to us” – Eckhart Tolle.