Dialectical Behaviour Therapy
Dialectical behaviour therapy (DBT) is one of many therapeutic approaches. In brief, DBT is a form of psychotherapy used for people who feel emotions very intensely, in particular those suffering from borderline personality disorders (BPD).
Here we answer some of the frequently asked questions about this form of psychotherapy.
What is dialectical behaviour therapy?
DBT is a specially adapted version of cognitive behavioural therapy (CBT), developed in the late 1980s, by psychologist Marsha M. Linehan. It combines behavioural science with Zen Buddhist techniques of acceptance and mindfulness.
This talking therapy treatment is designed specifically for individuals with self-harming behaviours and borderline personality disorders.
So, what does dialectical mean?
‘Dialectical’ refers to an integration or synergy of opposites. In DBT it means the ability to view things from multiple perspectives and move gently from extreme positions. DBT provides a framework for making sense of contradictory things. For example, DBT teaches that it’s possible for an individual to work on self-acceptance and change behaviour at the same time.
In DBT the therapist works with the individual to find ways to hold two seemingly opposite perspectives. The therapeutic aims are to promote balance and avoid the all-or-nothing styles of thinking common in individuals suffering from personality disorders.
A key assumption in DBT is that self-destructive behaviours are learned coping techniques for intense and negative emotions, such as shame, guilt, sadness, fear, and anger. It is thought that some people are “hard-wired” or genetically predisposed to feel emotions this intensely, or that extreme emotional or physical trauma has caused the vulnerability.
The ultimate goal of DBT is to significantly reduce impulsivity, interpersonal challenges, emotional reactivity, self-harm, and suicidal behaviour.
What is DBT used to treat?
DBT is recognised as an evidence-based treatment and over the past 30 years has been effective in the treatment of a wide range of disorders.
The therapy was developed specifically for people with borderline personality disorders but is also used to help people with a wide range of mental health and behavioural issues, particularly those prone to react in a more intense and out-of-the-ordinary manner toward certain emotional situations. DBT is most commonly used to treat:
- Borderline personality disorder
- Bipolar disorder
- Anxiety disorders
- Eating disorders
- Post-traumatic stress disorder (PTSD)
- Suicidal thoughts and behaviour
- Substance abuse
- Anger and violent behaviour
- Any other self-destructive behaviour
For people with borderline personality disorders everything feels unstable, including relationships, moods, thinking, behaviour and even identity. DBT is helpful to those who experience extreme mood swings, find it difficult to deal with uncertainty, and seem to jump from one crisis to another.
DBT is a helpful therapy for people considered high-risk and tough-to-treat, particularly those who come with multiple diagnoses.
How effective is DBT?
Randomized controlled trials have consistently shown the efficacy of DBT, not only in borderline personality disorders but also in other psychiatric complaints, such as substance use disorders, mood disorders, PTSD, and eating disorders.
What’s the difference between DBT and CBT?
CBT and DBT are both talking therapies that help to manage problems by changing thought patterns and behaviours. DBT is actually a type of CBT.
CBT focuses on talking about problems and uses logic to help frame thoughts differently. It is based on the concept that thoughts and behaviours influence feelings, and that changing the way we think about and react to situations will help us feel better.
DBT uses a problem solving and acceptance-based framework to understand and accept difficult feelings and develop skills to manage these feelings. The therapy is tailored to help people accept the discomfort they feel, while at the same time choose more healthy behaviours.
DBT still applies the core CBT principles of understanding how thoughts, feelings and behaviour influence each other, but also places a focus on relationships and acceptance.
Learning new behaviours is critical in both CBT and DBT. But, DBT also teaches techniques for managing emotions, building relationships with others, coping with distress, self-acceptance, and mindfulness.
What are the key elements of dialectical behaviour therapy?
The core components of DBT are:
Individual psychotherapy – problem-solving of behaviour issues
Group psychotherapy – learning coping skills and behaviour strategies, from the following 4 modules
- Mindfulness – improving an individual’s ability to accept and be present in the current moment
- Interpersonal effectiveness – maintaining self-respect and building personal relationships
- Distress tolerance – increasing a person’s tolerance of negative emotion, rather than trying to escape from it
- Emotion regulation – strategies to manage and change intense emotions that are causing problems
Is DBT better than CBT?
When it comes to comparing DBT with CBT, it’s not a case of one being better than the other; each has its appropriate use.
DBT was developed because CBT wasn’t working for some people. In particular, it was discovered that people experiencing mental health issues, as a result of intense emotions, were more likely to drop out of CBT therapy, where the focus was purely on change.
DBT places an additional focus on acceptance and regulating emotions and is more suitable for certain states, such as borderline personality disorder.
About The Wave
At the Wave Clinic, we help teens and young adults between the ages of 15 and 30 to overcome eating disorders, behavioural problems, substance abuse, and other mental health problems. We use a combination of physical activities and therapy sessions to help our young people to grow, heal, and lay the groundwork for a successful, happy life.
There are many different types of talking therapy accessible in our programme, including group and family sessions, and individual therapy, as well as creative therapies, which use the medium of art, drama and music to explore a wide range of issues.
Many of our young people respond particularly well to DBT, which is a key therapy programme offered at The Wave. Is your family ready for a true and lasting healing journey? Then we’d love to talk to you.