Dialectical Behaviour Therapy (DBT)

Dialectical Behaviour Therapy (DBT) is a type of cognitive-behavioural therapy that teaches practical skills for managing intense emotions, improving relationships, and coping with distress. Originally developed for borderline personality disorder, DBT is now used to help people with various mental health conditions.

Table of Contents | Jump Ahead

• What Is Dialectical Behaviour Therapy?
• The Four Modules of DBT
• Who Can Benefit from DBT
• Mindfulness Skills in DBT
• Distress Tolerance Skills
• Emotion Regulation Skills
• Interpersonal Effectiveness Skills
• What to Expect in DBT
• DBT Skills for Daily Life
• Benefits of DBT
• Challenges in DBT
• DBT vs. Other Therapies
• Finding DBT Treatment
• Self-Help DBT Resources
• When to Consider DBT
• Related Terms
• References

What Is Dialectical Behaviour Therapy?

DBT combines cognitive-behavioural techniques with mindfulness practices and distress tolerance skills. The word "dialectical" refers to the balance between accepting yourself as you are while also working to change problematic behaviours.

Core principles of DBT include:

Acceptance and Change: DBT teaches you to accept your current situation and emotions while also working toward positive changes.

Mindfulness Foundation: All DBT skills are built on mindfulness - the practice of being present and aware in the moment.

Skills-Based Approach: DBT focuses on teaching concrete, practical skills you can use in daily life.

Validation and Support: DBT emphasises validating your experiences while encouraging growth and change.

The Four Modules of DBT

Distress Tolerance Skills: Develop abilities to survive crisis situations without making them worse through impulsive actions.

Emotion Regulation Skills: Learn to understand, name, and manage your emotions more effectively.

Interpersonal Effectiveness Skills: Improve your ability to communicate needs, set boundaries, and maintain relationships.

Who Can Benefit from DBT

Primary Conditions

• Borderline personality disorder
• Self-harm and suicidal behaviours
• Chronic suicidal ideation
• Emotional dysregulation

Other Conditions

• Depression
• Anxiety disorders
• Post-traumatic stress disorder (PTSD)
• Eating disorders
• Substance use disorders
• Bipolar disorder

General Benefits: Anyone who struggles with intense emotions, relationship difficulties, or impulsive behaviors may benefit from DBT skills.

Mindfulness Skills in DBT

Describe: Put words to your experience. Describe what you observe using facts, not interpretations or judgments.

Participate: Throw yourself completely into activities. Be present and engaged rather than self-conscious or distracted.

Non-Judgmentally: Avoid labelling things as "good" or "bad." Stick to the facts of what's happening.

One-Mindfully: Focus on one thing at a time. When your mind wanders, gently bring attention back to the present activity.

Effectively: Do what works to achieve your goals. Focus on being effective rather than being "right."

Distress Tolerance Skills

• Temperature: Change your body temperature with cold water or ice
• Intense Exercise: Do vigorous physical activity for a short time
• Paced Breathing: Breathe out longer than you breathe in
• Paired Muscle Relaxation: Tense and release muscle groups

Distraction Techniques

• Activities: Engage in hobbies, exercise, or tasks
• Contributing: Help others or volunteer
• Comparisons: Think of those less fortunate or times you've coped before
• Emotions: Create different emotions through music, movies, or books
• Pushing Away: Mentally push the situation away temporarily
• Thoughts: Engage your mind with puzzles, counting, or reading
• Sensations: Use strong physical sensations like holding ice

Self-Soothing Use your five senses to comfort yourself:

• Vision: Look at beautiful things
• Hearing: Listen to soothing music
• Smell: Use pleasant scents
• Taste: Enjoy comforting foods or drinks
• Touch: Use soft textures or warm baths

Emotion Regulation Skills

Identifying Emotions: Practice naming your emotions accurately. Use an emotion wheel or list to expand your emotional vocabulary.

Reducing Emotional Vulnerability

• Treat physical illness
• Balance eating
• Avoid mood-altering substances
• Balance sleep
• Get exercise
• Build mastery through accomplishing tasks

PLEASE Skills

• PL: Treat Physical illness
• E: Balance Eating
• A: Avoid mood-altering substances
• S: Balance Sleep
• E: Get Exercise

Opposite Action: When your emotion doesn't fit the facts or isn't helpful, act opposite to your emotional urge.

Interpersonal Effectiveness Skills

• Describe: State the situation factually
• Express: Share your feelings and opinions
• Assert: Ask clearly for what you want
• Reinforce: Explain the benefits
• Mindful: Stay focused on your goal
• Appear confident: Use confident body language and tone
• Negotiate: Be willing to compromise

GIVE for Relationships

• Gentle: Be respectful and kind
• Interested: Show genuine interest in the other person
• Validate: Acknowledge their feelings and perspective
• Easy manner: Use humor and smile when appropriate

FAST for Self-Respect

• Fair: Be fair to yourself and others
• no Apologies: Don't apologise unnecessarily
• Stick to values: Act according to your principles
• Truthful: Be honest and authentic

What to Expect in DBT

Skills Group: Weekly group sessions where you learn and practice the four modules of DBT skills with others.

Phone Coaching: Brief phone calls with your therapist between sessions for help using skills in real-life situations.

Therapist Consultation Team: Your therapist meets regularly with other DBT therapists to ensure they're providing the best treatment.

DBT Skills for Daily Life

In Relationships: Practice DEAR MAN to communicate your needs clearly and GIVE to maintain positive connections.

During Emotional Storms: Use mindfulness to observe your emotions without being overwhelmed by them, and opposite action if the emotion doesn't fit the facts.

For Self-Care: Follow PLEASE skills to reduce your vulnerability to emotional overwhelm.

Benefits of DBT

Better Emotion Management: You learn to experience emotions without being controlled by them.

Improved Relationships: Communication and interpersonal skills help you build and maintain healthier relationships.

Increased Distress Tolerance: You develop the ability to cope with difficult situations without making them worse.

Enhanced Quality of Life: Overall functioning and life satisfaction typically improve with DBT skills practice.

Challenges in DBT

Emotional Difficulty: Learning to tolerate distress and change patterns can be emotionally challenging.

Skills Practice Required: DBT skills must be practised regularly to be effective - they don't work automatically.

Group Component: Some people find the group therapy component challenging or uncomfortable initially.

DBT vs. Other Therapies

DBT vs. Traditional Therapy: DBT is more structured and skills-focused than traditional talk therapy approaches.

DBT vs. Mindfulness-Based Therapies: DBT incorporates mindfulness but also includes specific behavioral and interpersonal skills.

Finding DBT Treatment

Check Therapist Training: Ensure your therapist has specific training in DBT and follows the standard protocol.

Consider Intensive Options: Some programs offer intensive outpatient or residential DBT for people who need more support.

Insurance Coverage: Check whether your insurance covers DBT treatment, as it may require pre-authorisation.

Self-Help DBT Resources

Apps: Smartphone apps can help you practice DBT skills and track your progress.

Online Resources: Websites and videos provide information about DBT skills and techniques.

Support Groups: Peer support groups for people learning DBT skills can provide additional practice and encouragement.

When to Consider DBT

• Experience intense, rapidly changing emotions
• Struggle with self-harm or suicidal thoughts
• Have difficulty maintaining relationships
• Feel overwhelmed by stress and crisis situations
• Want to learn practical skills for emotional management
• Have been diagnosed with borderline personality disorder

Related Terms

• Borderline Personality Disorder - Primary condition DBT was developed to treat
• Mindfulness - Core component of DBT skills
• Emotional Regulation - Key skill area in DBT

References

PMC/NCBI. (2024). Dialectical Behaviour Therapy: Current Indications and Unique Elements. https://pmc.ncbi.nlm.nih.gov/articles/PMC2963469/

Cleveland Clinic. (2024). Dialectical Behaviour Therapy (DBT): What It Is & Purpose. https://my.clevelandclinic.org/health/treatments/22838-dialectical-behavior-therapy-dbt

Behavioural Tech Institute. (2024). Core Evidence & Research. https://behavioraltech.org/evidence/

American Journal of Psychotherapy. (2018). The Course and Evolution of Dialectical Behaviour Therapy. https://psychiatryonline.org/doi/10.1176/appi.psychotherapy.2015.69.2.97

ScienceDirect. (2021). Dialectical behaviour therapy: Implementation of an evidence-based treatment. https://www.sciencedirect.com/science/article/pii/S2352250X21000038

This information is for educational purposes only and is not a substitute for professional mental health treatment. If you're considering DBT, consult with a qualified mental health professional to determine if it's appropriate for your specific situation.