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What the Heck is DBT?


Dialectical Behaviour Therapy (DBT) is a structured, skills-focused therapeutic modality that combines cognitive-behavioural therapy with Eastern philosophies. It is based on dialectic and biosocial theories of psychological disorders that emphasize the

difficulties of regulating emotions. There is a focus on challenges with under and over-emotional control which can be linked to various mental health disorders, impulse control difficulties, interpersonal relationship issues and negative self-image.


DBT was initially developed in the 1980s by psychologist Dr. Marsha M. Linehan to treat individuals with borderline personality disorder (BPD) experiencing intense emotional dysregulation, self-harm behaviours, and difficulty in interpersonal relationships. DBT has since been adopted and implemented for numerous mental health conditions and symptoms including depression, anxiety, bipolar disorder, eating disorders, substance use disorders, and more. Traditional DBT consists of individual psychotherapy, group skills training, phone coaching and a therapist consultation team however DBT has been adapted so that various components are offered as stand-alone treatments.


DBT focuses on helping individuals develop skills to manage their emotions, thoughts and behaviours, and interpersonal patterns associated with problems to enhance someone's overall quality of life. Four core skills are taught in DBT which are dialectic in nature and based on acceptance and change principles. A core fundamental philosophy in DBT is for clients to accept themselves as they are and recognize the need to change.


The four core skills and principles include:

  1. Mindfulness: There is a strong emphasis on mindfulness, which involves being fully present in the moment without judgment. Mindfulness skills help individuals observe their thoughts, emotions, and sensations without becoming overwhelmed by them.

  2. Distress tolerance: DBT equips individuals with techniques to tolerate and cope with distressing situations and emotions without resorting to self-destructive behaviours.

  3. Emotion regulation: Individuals learn skills to identify, understand, and manage their emotions in effective ways. This includes strategies to tolerate distress, reduce emotional reactivity, and improve emotional regulation.

  4. Interpersonal effectiveness: DBT teaches effective communication and interpersonal skills, helping individuals navigate relationships, set boundaries, and maintain self-respect while interacting with others.

In addition to the four core skills and principles, there are several other important concepts in DBT including:

  1. Middle Path and dialectics: The dialectics in DBT refers to the integration of opposing viewpoints or seemingly contradictory ideas. The concept of the "middle path" encourages individuals to find balanced perspectives and solutions that acknowledge these multiple viewpoints.

  2. Validation: DBT therapists validate the client's feelings and experiences. Therapists also foster a supportive therapeutic relationship integral to the change process.

  3. Behavioural change: While rooted in acceptance and validation, DBT also emphasizes the importance of behaviour change. It helps individuals identify problematic behaviours and work towards more effective alternatives through problem-solving strategies.

  4. Hierarchy of targets: DBT addresses multiple areas of a person's life, including life-threatening behaviours, therapy-interfering behaviours, quality of life, and skill acquisition. These areas are addressed in a hierarchical order based on immediate safety needs in treatment.

How can DBT help?


DBT treats pervasive emotion dysregulation using the four core skills so that individuals can learn how to regulate their emotions. DBT also teaches individuals valuable skills and strategies to manage their distress, improve their interpersonal relationships, and enhance their overall well-being. DBT helps individuals build mindfulness skills to reduce automatic reactions and promote nonjudgmental acceptance.


DBT is also effective in:

  1. Reducing self-harm and suicidal behaviours: DBT offers strategies to manage these behaviours and develop alternative coping mechanisms. This can lead to increased safety and reduced risk of harm.

  2. Coping with negative thoughts: DBT addresses negative thought patterns by helping individuals challenge distorted thinking and replace negative self-talk with more balanced and realistic thoughts.

  3. Increasing self-efficacy: As individuals develop and apply DBT skills, they experience a sense of empowerment and increased self-confidence in managing their emotions and navigating life's challenges. This increased self-efficacy can be seen in other areas of an individual's life.

  4. Building resilience: DBT helps individuals build resilience by teaching adaptive ways to cope with setbacks, stressors and difficulties. Individuals learn how to bounce back from adversity and maintain their well-being.

  5. Enhancing self-compassion: Individuals learn how to reduce self-criticism and build a more positive relationship with themselves through developing self-compassion skills.

  6. Improving quality of life: As individuals become more skilled in managing emotions and relationships, their overall quality of life often improves. They are better equipped to pursue their goals, engage in meaningful activities, and experience greater life satisfaction.

  7. Reducing substance use: DBT can be effective in treating individuals with substance use disorders by providing them with strategies to cope with cravings, manage triggers, and build a life that supports recovery.

The skills learned in DBT continue to be valuable long after therapy ends, helping individuals maintain progress and effectively manage challenges in the future. Overall, DBT offers a comprehensive approach that combines acceptance and change strategies, making it particularly effective for individuals struggling with intense emotions, impulsivity, interpersonal difficulties, and self-destructive behaviours. It empowers individuals to take control of their lives and make positive changes to achieve better mental health and well-being.


What to expect in a session


Dialectical Behavior Therapy (DBT) is a structured, skills-focused therapeutic modality. Those participating in a comprehensive DBT treatment program can often expect several components in a typical DBT session. Sessions begin with a check-in where clients share their emotional state and any challenges or progress they've experienced since the last session. Clients in DBT typically have homework assigned to them in either the skills training group or individual psychotherapy. Homework is an important aspect of treatment as it allows individuals to practice skills. The therapist may review how the client implemented these skills and address any questions or difficulties they encountered. The therapist may also use mindfulness exercises, problem-solving strategies and role-playing practices in the session to further facilitate learning.


The therapist and client work together to set goals and strategies for managing problematic behaviours and specific focus is given to targeting the hierarchal target behaviours. Collaboration is essential in DBT, so the therapist and client work together to ensure that the therapy process is effective and aligned with the client's goals.


It's important to note that the structure and content of a DBT session can vary based on the client's individual needs, the therapist's style, and the stage of therapy. DBT is generally considered a highly structured and skills-based approach that aims to help individuals manage their emotions, develop healthier behaviours, and improve their quality of life. Some therapists may use principles and strategies of DBT in their practice without necessarily offering a fully structured approach depending on their training, expertise and preference.


In my practice, I tend to use the principles and strategies of DBT with those I support. I often weave in behavioural change strategies, validation and dialectical strategies in addition to other modalities like cognitive behaviour therapy, solution-focused therapy and


psychodynamic therapy to meet individuals where they are and support them in reaching their goals. I am able to provide a more structured approach if someone feels that would be helpful.


DBT Resources


There are several helpful resources available to individuals that focus on DBT coping skills and strategies as well as difficulties with emotion regulation. Some of the resources I recommend include:


Books:

Websites:


Apps:




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