Dialectical Behavioural Therapy (DBT)

What is a Dialectical Behavioural Therapy (DBT)

Dialectical Behavioural Therapy (DBT) is a form of Cognitive Behavioural Therapy. DBT was developed by an American Psychologist, Dr Marsha Linehan in the 1970s. DBT was one of the first psychotherapies to incorporate mindfulness to encourage living in the present and to develop effective coping strategies for stress and to regulate emotions in relationships with others. Dialectical Behavioural Therapy is based on the Biosocial model which explains that emotional sensitivity and growing up in an invalidating environment can lead to difficulty regulating emotions which can result in behavioural difficulties. DBT incorporates both an humanistic and behavioural approach so that the client is validated whilst encouraging the concept of change. DBT has been used to help those with borderline personality disorder but has also been more widely validated to support those with eating disorders, suicidal beaviour, anxiety, depression, and substance misuse.

The idea behind DBT

DBT is based on the idea of dialectics which means an integration of oppositions in order to keep two different view points in mind so that the client feels validated. This requires working with the concept of acceptance to validate the person as they are today but also keeping the possibility of change in mind. DBT also employs a behavioural approach to look for behavioural triggers and modifications to help the client reach their overall goals and achieve a life that is worth living. DBT requires learning four key skill sets:

1. Mindfulness
   Mindfulness is key to DBT in order to learn how to be present in the moment and have the desire to stop the behaviour that may be causing problems. Mindfulness is based on 3 mind states;
   Emotional Mind When emotions take over, such as sadness, anger and frustration. Reasonable Mind Based on logic and data Wise Mind Synthesis of emotional and reasonable mind that employs intuition and a sense of knowing
2. Distress Tolerance
   This involves learning how to cope with difficult situations that may trigger strong emotions. This also involves accepting the reality of crisis situations and stopping the urge to act  on unhelpful behaviours by learning STOP skills: Stopping, taking a step back, observing and proceeding mindfully.Distress tolerance also includes TIP skills which involves using strategies such as using a cold temperature to calm; engaging in intense exercise and breathing/muscle relaxation. This can also involve learning self soothing and distraction strategies to use until the difficult situation has passed.
3. Interpersonal Skills
   Learning how to be assertive whilst maintaining relationships with others. This can involve learning to see the situation from another’s point of view whilst having empathy.Interpersonal skills also requires maintaining self-respect and keeping to one’s own values whilst validating the other person.
4. Emotional Regulation
   To manage emotions more effectively through labeling emotions and identifying which unwanted emotions to change. This can involve using opposite action by identifying the urge of the emotion and the then using an opposite more helpful coping strategy.
   Emotional regulation also involves incorporating daily self care strategies into everyday life.

Format

DBT can be carried out individually or in a skills group format. Clients are expected to complete diary cards and homework after each session. Clients are also able to have contact with their therapist outside of sessions for telephone coaching sessions in between face to face sessions.

Dialectical Behavioural Therapy (DBT) skillsets are