Dialectic behaviour therapy (DBT)

What is DBT?
DBT is a form of therapy which combines methods of Cognitive Behaviour Therapy (e.g. techniques regarding emotional regulation) with Mindfulness/meditation type techniques.  During a course of DBT Individuals learn more helpful coping skills to deal with distressing emotions and situations, and to improve their relationships.

The term Dialectic comes from the theory of dialectics. This is the theory that opposites can co-occur.  During DBT therapy, different points of view are deliberated, and the individual is then aided to select appropriate skills to either alter or accept situations.

Key Aspects of DBT
DBT assumes the following regarding individuals;

  • Individuals (despite what others think) are generally doing the best they can with the skills they have.
  • Individuals seeking DBT want to improve.
  • Individuals seeking and engaging in DBT have the motivation to do better, work harder, change
  • Individuals engaging in DBT need to learn new behaviours in all areas of their lives.
  • Individuals can not fail in DBT

Skills taught during a course of DBT include;

  • Mindfulness
  • Distress Tolerance
  • Emotion Regulation
  • Interpersonal Effectiveness

What does a course of DBT consist of?
Initial sessions of DBT will focus on a thorough assessment of problems, orientation to the DBT model and the agreement of goals between the therapist and client. There are then 4 main stages of subsequent sessions.

Stage 1, focuses on reducing or eradicating life threatening behaviours (e.g. suicidal, self-injury or aggressive behaviours) and therapy interfering behaviours (e.g. not completing homework, not attending sessions). Stage 1 also focuses on reducing the use of hospitalisation as a mode of handling crises and diminishing behaviours that interfere with quality of life (e.g. alcohol abuse, drug abuse). In addition Stage 1 also aims to increase behaviours that will enable the person to have a life worth living and increase behavioural skills that help build relationships, manage emotions and deal effectively with various life problems. Stage 2 of therapy then aims to decrease any post-traumatic stress type symptoms. Following on from the aim of Stage 3 is to Increase respect for self, set specific individual goals for living and solve any ordinary life problems. Stage 4 then looks to aid the individual to develop a specific aptitude for autonomy, self-determination and pleasure.

Who is DBT for?
DBT is a therapy for people with borderline personality disorder (BPD), particularly those with self-harming behaviour or suicidal thoughts. In addition DBT was specifically developed to address the following types of problems;

  • Intense negative emotions (anger, disgust, guilt, sadness, anxiety) that are hard to control.
  • Impulsive behaviours, (e.g. self-harming, using alcohol or drugs, binge eating, purging) that are utilised to control/block out emotions.
  • Volatile relationships and/or fears of being abandoned by others.
  • A sense of emptiness.
  • Regular mood swings, with your mood going up and down a lot.
  • Suicide attempts.
  • Self-harm.

What is the evidence?
Research reveals that DBT leads to improvement in various difficulties connected to BPD, such as self-harming, suicide attempts, low mood/depression, and feelings of hopelessness. The National Institute for Health and Care Excellence (NICE, 2009) recommends DBT for some forms of eating disorder and people with borderline personality disorders who also self-harm.

How many DBT sessions do I need?
The number of sessions you require will depend largely on the presenting issues and complexity of the problem. It is also worth noting that people may find commencing DBT difficult as it requires the individual to accept problems and working to change them. However, you might find out later that your efforts were worthwhile. As such an eagerness to make changes and complete the home work tasks set by the therapist will inevitably improve the speed of recovery.  If changing self-harming behaviour is not the individual’s priority they may find DBT’s focus on changing self-harming difficult. Your ability and willingness to engage in the process will is vital as the therapist can’t do the work for you.

Your therapist will be in the best position to gauge how many session you require, but this may also change throughout therapy.

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