Dialectical behavioural therapy

Based on cognitive behavioural therapy, dialectical behavioural therapy (DBT) looks to help those who experience emotions very intensely. The approach was developed in the late 80s by psychologist Marsha M. Lineham. Originally created to help people with borderline personality disorder, DBT is now used to help a number of mental health challenges.

Here we’ll look at the goals of dialectical behavioural therapy, the four modules of DBT and what to expect in a session.

What is dialectical behavioural therapy?

Dialectical behavioural therapy, or DBT for short, is a type of talking therapy designed to help you manage difficult emotions. The aim is to help you learn how to accept these emotions and regulate them so you are better able to change any behaviour that may be harmful or unhealthy.

First, let’s look at what ‘dialectics’ means. This essentially means balancing opposing positions and seeing how they can go together. For example, in DBT you will be working towards finding a balance between acceptance (accepting your emotions and who you are) and change (making positive changes to your behaviour and life).

To help create this balance, acceptance and change techniques are used.

Acceptance techniques

These techniques look at helping you understand yourself and why you might do the things that you do (for example misuse alcohol or self-harm). Rather than blaming yourself and telling yourself you’re wrong or a bad person for the way you behave, a DBT therapist will help you understand why you’ve turned to these behaviours.

For some people, the behaviours are the only way they’ve been able to deal with intense emotions. This technique helps you understand that to your mind, these behaviours make sense.

Change techniques

Once you have a greater understanding of why you behave in certain ways, you can look to make positive change. The techniques used here help to replace unwanted behaviours with more positive behaviours. For example you can start to challenge negative thought patterns and learn how to develop a more balanced approach.

Characteristics of DBT

  • It’s support-orientated and so helps people identify their strengths and helps them feel better about themselves.
  • It’s cognitive-based, which means it helps to identify thoughts and beliefs that could be making things harder.
  • It’s collaborative and a joint effort between yourself and your therapist.

There are usually two main components in dialectical behavioural therapy, individual weekly sessions and weekly group sessions. In the individual sessions, the focus is typically on problem solving any issues that have come up in the last week. In the group sessions, you’ll work with a therapist and others to work on skills from the four modules of DBT.

The four modules of DBT

Mindfulness

This is an essential part of all skills learnt in group sessions. Mindfulness helps you to observe your thoughts, be present and grounded in the moment.

Interpersonal effectiveness

These skills will help you learn how to cope with personal conflict, how to say no and how to ask for what you need. On the surface these may sound like simple skills, but they are ones many of us struggle with.

Distress tolerance

Rather than seeking to change a distressing event, DBT helps you understand, accept and tolerate distress better. The aim is to be able to bear pain skillfully and builds on your mindfulness work. Crisis survival strategies you may learn include self-soothing, distraction, weighing up pros and cons and ‘improving the moment’.

Emotion regulation

For people who experience emotions intensely, this skill is essential. Skills you may learn here include identifying and labelling your emotions, increasing positive emotional events and taking opposite action. You’ll also look at what’s stopping you from changing your emotions.

What to expect

There are four stages of treatment in dialectical behavioural therapy. There’s no set timeline for each stage and these will be led by you, depending on your goals.

Stage one

In the first stage you may feel as if you are ‘out of control’. You may be engaging in harmful behaviours like drug and alcohol abuse, self-harm and other self-destructive behaviours. The aim of stage one is to help you move from feeling out of control, to feeling in control of your behaviour.

Stage two

While you may now have greater control over your behaviour, you may still be suffering internally. This could be down to past trauma. The aim of this stage is to help you move on from feeling desperation, to full emotional experiencing.  

Stage three

Here the challenge is to define what your goals in life are. You’ll work to build self-respect and ultimately find peace, experiencing emotions in a way you can manage.

Stage four

For some a final stage may be required. In this fourth stage, further spiritual development helps people feel more fulfilled and connected to a ‘greater whole’.

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