Embracing Contradictions: the Power of Dialectical Behavioural Therapy

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Recovery from mental health concerns involves positive change. This might mean changes in thought patterns, behaviours, or routines. But for many young people, recovery also requires acceptance.

Accepting and understanding who we are can build the self-worth and self-love that we all need to stay well. While change and acceptance may seem contradictory, with the right support, young people can reach these goals together.

Dialectical behavioural therapy (DBT) is a type of cognitive behavioural therapy that teaches young people to accept their emotions while changing unhelpful ways of behaving or thinking.

This blog offers some information on how DBT works, which conditions it can treat, and how it can support young people to build brighter futures.

What Is Dialectical Behavioural Therapy (DBT)?

Dialectical behavioural therapy is a particular type of cognitive behavioural therapy (CBT) that was first developed for people with borderline personality disorder. Today, psychologists use DBT to treat a variety of mental health conditions, particularly when people are experiencing intense emotions.

Distinguishing CBT and DBT

  • CBT is a type of therapy that focuses on the interactions between our thoughts and behaviours. During CBT sessions, young people work with a therapist to identify negative thought and behavioural patterns and turn them into more positive ones.
  • DBT is like CBT, but it also involves learning to accept your feelings and understand where they come from.

What Does Dialectical Behavioural Therapy Involve?

DBT uses three main types of therapy approaches. These are:

  • One-to-one therapy sessions where young people discuss the skills that they are working on with their therapist. DBT usually involves one hour of one-to-one therapy a week.
  • Group skills training where young people learn and practice new skills with others in their group. Groups usually meet once a week for a few hours. 
  • Phone coaching where therapists can offer additional support in between weekly sessions.

What Are the DBT Core Skills?

DBT sessions revolve around a set of core skills that aim to teach both acceptance and change. DBT core skills cover four main areas: mindfulness, emotional regulation, distress tolerance, and interpersonal effectiveness.

Mindfulness

Mindfulness skills involve being aware of our emotions and thoughts and letting them pass without judgment. They combine different Eastern and Western contemplative practices, putting their ideas into several behavioural skills.

Every module teaches at least one mindfulness skill, such as mindfulness of distress tolerance or mindfulness of interpersonal relations.

Emotion Regulation

Emotional regulation is about managing our emotions, changing unhelpful ones, and creating positive ones.

DBT teaches that emotions are short, involuntary responses to external and internal states that humans have evolved to experience to guide our reactions to these situations. These explanations help young people to understand why they are experiencing certain emotions and how they connect to their past experiences. 

From this understanding, they can begin to both accept what they feel and make positive changes. This might involve challenging unjustified emotions or engaging in ‘imaginal rehearsal’ where young people imagine themselves effectively coping with distressing situations, causing their emotional response to change in the actual event.

DBT emotional regulation skills aim to help young people improve their short-term well-being and their long-term fulfilment, focusing on both present feelings and future goals.

Distress Tolerance

Distress tolerance involves learning to handle difficult situations, become more resilient, and develop healthy coping mechanisms for pain. It includes several different techniques that help young people make it through a crisis without making things worse.

These techniques focus on the body as well as the mind, teaching skills such as temperature change, effective breathing, muscle relaxation, and exercise that can help to decrease the body’s arousal levels.

They also include a set of skills centred around radical acceptance: the idea that by accepting painful facts that cannot be changed, we can reduce suffering and become less bound by our emotions.

Interpersonal Effectiveness

Interpersonal effectiveness is about setting boundaries, saying no, expressing needs, and building lasting relationships. During interpersonal effectiveness skill sessions, young people learn to manage interpersonal conflict, end destructive relationships, and strengthen relationships that already exist.

Managing conflict and maintaining relationships often requires understanding and validating another person’s opinion even where there is disagreement, and treating others around us with compassion.

Acceptance and Change Techniques

DBT core skills involve different techniques aimed at both acceptance and change. 

Acceptance Techniques

Acceptance techniques help young people to understand themselves and why they do certain things. Many young people who do things like self-harm experience judgement from others or feel ashamed about their actions.

DBT teaches that there are reasons why they do these things, such as experiencing intense emotional distress or living through trauma. Through DBT, young people can begin to see that their behaviours make sense and are not ‘wrong’, while at the same time working to change them.

Acceptance techniques can also focus on young people’s emotions. Sometimes, teenagers and adolescents may feel frustrated or angry that they are feeling a certain way. They may blame events or others around them – or turn the blame on themselves.

DBT teaches that fighting these emotions only leads to more pain. Instead, young people learn to accept the things that they can’t change and find more energy to address the things that they can.

Change Techniques

Change skills help young people to change things that are unhelpful or harmful into something positive. It may involve:

  • Identifying and challenging harmful thought patterns
  • Developing new coping methods and strategies to handle distress

Change and acceptance techniques aren’t something that a young person can learn overnight. Learning the core skills of DBT requires commitment, practice, and persistence. DBT skills training isn’t a short-term task: most young people continue to practice, reinforce, and improve their skills long after they complete their therapy sessions.

Radically Open Dialectical Behavioural Therapy

Radically Open Dialectical Behavioural Therapy (RO-DBT) is a type of DBT that’s rooted in three core principles: openness, flexibility, and social connectedness.

During RO-DBT sessions, young people learn to challenge their most firmly held beliefs, opening the door to new ideas, personal growth, and positive change. RO-DBT is about listening to and learning from the experiences of others.

RO-DBT was developed to help young people overcome issues of perfectionism and overcontrol. It involves practising true, honest, and genuine expressions of emotions, supporting the growth of meaningful and close relationships.

By laying the foundations for positive, human connections, RO-DBT helps young people to develop support systems, find meaning, and build better long-term well-being.

What Mental Health Concerns Does DBT Treat?

Initially developed for individuals with borderline personality disorder, mental health professionals now use DBT to treat a range of different mental health concerns.

Research has shown that DBT may effectively treat:

  • Borderline personality disorder
  • Eating disorders
  • Substance abuse disorders
  • Attention-deficit hyperactivity disorder (ADHD)
  • Major depressive disorder (MDD)

Studies have found that DBT is particularly effective in improving certain symptoms, such as:

  • Self-harm
  • Suicidal ideation
  • Emotional regulation
  • Interpersonal problems
  • Stress reactivity
  • Engaging in risky behaviours
  • Binge eating

DBT has also been used outside of a clinical setting to help young people build resilience and tolerate distress in their daily lives. Some middle- and high schools have offered DBT skills training to students to learn valuable skills that lay the foundations for overall well-being.

For young people struggling to cope with their emotions, experiencing self-harm or suicidal ideation, or other mental health concerns, DBT can help them feel validated and accepted as they learn to manage difficult situations in more positive ways.

They can learn to tolerate distressing situations without turning to coping mechanisms – such as binge eating, self-harm, or substance abuse – that cause even more distress in the long term.

Emotional regulation can also help to build more stable and secure interpersonal relationships that can support them through the recovery process and offer care, belonging, and fulfilment.

The Wave Clinic – Specialist Recovery Programs for Young People

The Wave Clinic offers specialist recovery programs for young people, making a difference in the lives of teenagers and adolescents around the world.

We set the standard for young people’s mental health care, combining exceptional clinical care with education, social responsibility, and a gap year experience. Through our seven core elements of treatment, we support young people to recover from the challenges they face and plan and build better futures.

Situated in Malaysia, our centre offers unequalled opportunities for enriching experiences where young people can develop skills, build relationships, and explore different life paths.

We provide vocational qualifications, work experience, outdoor activities, cooking, gardening, and much more. At the same time, our clinical program offers professional care and support of the highest standard, tailored to each young person’s needs.

If you’d like to find out more about our programs, reach out to us today. We’re here to help.

Fiona - The Wave Clinic

Fiona Yassin is the founder and clinical director at The Wave Clinic. She is a U.K. and International registered Psychotherapist and Accredited Clinical Supervisor (U.K. and UNCG).

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