Dialectical behaviour therapy (DBT)

What is dialectical behaviour therapy (DBT)?

Dialectical behaviour therapy is a relatively new counselling technique which is being used by many psychologists, psychiatrists and counsellors. Some therapists will specialise in this form of therapy, while others will use different techniques to help their patients work through particular difficulties.

Dialectical behaviour therapy is a program which consists of four modules: mindfulness, interpersonal effectiveness, emotion regulation and distress tolerance. This therapy focuses on helping the patient develop skills which can help them to remain grounded and in control of their body and mind, cope with interpersonal conflict, tolerate stressful situations and help them regulate their emotions.

This form of therapy has been shown to be very effective for several psychological problems but is particularly helpful for people who suffer from Borderline personality disorder (BPD) and/or partake in self-harming behaviours.

Why is DBT effective for borderline personality disorder + self-harm?

The purpose of DBT is behavioural modification. Borderline personality disorder clients generally have instability in their moods, extreme 'black and white' thinking, unstable relationships and behaviours, as well as a disturbance in their sense of self. Their emotions surge quickly and take longer to return to a normal level than most people’s emotions.

DBT teaches skills to the patient that helps them tolerate these intense feelings. Self-harming behaviours are often associated with BPD because both people who self-harm and people with BPD experience intense distress.

DBT therefore, is a counselling technique which teaches skills to cope with feelings which in turn can change behaviours.

What other mental illnesses can be treated by DBT?

In addition to BPD and self-harm, DBT has been found to help in treating a number of other mental health issues including depression and other mood disorders, anxiety and other anxiety disorders, anger issues, eating disorders, substance abuse, suicidal issues and personality disorders.

DBT is used for almost all mental health issues because the skills it helps a client learn throughout the therapy course are beneficial for all people, with or without mental health problems

What are the main goals of treatment in DBT?

Like every type of therapy, DBT has main treatment goals. The goals of using DBT as a counselling technique are:

• Developing an awareness and sense of control over emotions and behaviour.
• Moving from being emotionally shut down to experiencing emotions fully.
• Building an ordinary life, solving ordinary life problems with a focus improving quality of relationships.
• Working with feelings of emptiness to developing completeness/connection.

What do the four modules consist of?

Mindfulness

This is the core skill behind DBT. It consists of exercises which are intended to help you become aware of your thoughts, feelings, emotions and actions.

It is also known as a ‘grounding’ technique which can be used when dealing with overwhelming emotions.

This module takes about 4 weeks overall to complete.

Interpersonal effectiveness

This module focuses on situations where the objective is to change something or to resist changes someone else is trying to make.

The skills taught in this module are intended to maximise the chances that goals in a specific situation will be met, while at the same time not damaging the relationship or one’s self-respect.

This module takes about 8 weeks overall to complete.

Emotion regulation

This module focuses on the ability to regulate emotions.

The skills taught in this module are designed to help you identify and label the emotions they are feeling and to have the ability to reduce your vulnerability to these emotions.

This module takes about 8 weeks overall to complete.

Distress tolerance

This module focuses on your ability to accept, in a non-evaluative and non-judgemental fashion, both yourself and the current situation.

The skills taught in this module are concerned with tolerating and surviving crises and with accepting life as it is in the moment.

This module takes about 8 weeks overall to complete.

How does DBT work?

People in DBT receive three main modes of treatment:

• individual therapy
• group skills training
• phone coaching.

In individual therapy, you normally receive once weekly sessions which are between one hour to one and a half hours in length. As a part of the DBT process you also attend a two hour weekly skills training session. Overall, DBT takes up to 1 year to complete.

Unlike regular therapy groups, DBT skills groups are more like classes, where you learn skills in the four major areas (mindfulness, interpersonal effectiveness, emotion regulation and distress tolerance). People are also advised to call their therapist before engaging in self-harming behaviours or potentially destructive actions so that the therapist can help them come up with alternative ways of dealing with the emotions.

People are often given tasks to complete in between the individual sessions and group skills training sessions. A weekly diary card is filled out with your emotions, the intensity of the emotions, any urges felt, how those urges were acted upon, and overall weekly thoughts about completing the DBT modules. This helps the therapist monitor progress and see whether DBT is helping or not, and is also beneficial to the client who can track their individual progress.

Finding out more

Currently, DBT is only new in the treatment of young people and there aren’t very many DBT groups being run for young people at this moment in time. To find out more information about DBT and whether any groups are being run in your area, you can talk to your local doctor, a psychologist or a counsellor.

Check out the Who can help you section for more information about what these people do. To find any of these people in your local area you can check out the beyondblue Directory of Medical and Allied Health Practitioners.

You may also want to ask friends or a doctor if they can recommend anyone.


Acknowledgement

Thanks to Dr Anna Sidis Clinical Psychologist, Brain and Mind Research Institute (BMRI)  for reviewing this fact sheet.