What is dialectical behaviour therapy?

Continuing the theme of exploring and demystifying different therapeutic approaches, today we will be looking at dialectical behaviour therapy - otherwise known as DBT.

The history of DBT

In a previous article, we looked at cognitive behavioural therapy (CBT), and it's worth mentioning this as DBT is considered a third wave therapy. This means that, originally, there was the first wave of cognitive and behaviour therapies, then the second wave where these two therapies were combined to make cognitive behavioural therapy, and now we have some newer third wave therapies such as DBT, acceptance and commitment therapy (ACT), and mindfulness-based cognitive therapy (MBCT).

DBT was developed by Dr Marsha Linehan in the late 1980s. She created this therapy as a way of treating people with borderline personality disorder (BPD), specifically for helping them with their chronic suicidal feelings. Dr Linehan has BPD herself.

One of the key aspects of this therapy which led to the creation of it was that Linehan observed that the chronically suicidal patients had been often raised in profoundly invalidating environments, which led people to need a strong and robust therapeutic alliance that required loving-kindness.

What does DBT involve?

DBT is made up of four components, which include;

• group skill training
• individual sessions that review the issues of the week and what skills the person did or could have used to handle them, as well as targeting suicidal and sabotaging behaviour
• consult meeting for the therapists
• phone coaching for helping the person use their skills throughout the week

DBT is split up into four skill modules which includes

• Mindfulness - learning to be present in the here and now
• Interpersonal effectiveness - learning how to communicate with others effectively
• Distress tolerance - learning to accept, in a non-evaluative and non-judgemental fashion, both oneself and the current situation
• Emotion regulation - people with borderline personality disorder can often feel emotions very intensely, and this teaches people how to manage these feelings
• Adolescents have one more module called walking the middle path, which is designed to get parents and carers on board

DBT is a very active therapy, and it consists of roleplaying, worksheets, and participating.

How long?

It is not uncommon for someone to complete more than one cycle of DBT. This enables them to learn more skills and reinforce the ones that they have already learnt. A typical cycle would last 24 weeks, which includes one group and one individual session each week. Below, you can see that this takes the form of two-weeks of mindfulness followed by six-weeks of a module. This is then repeated until emotion regulation, distress tolerance, and interpersonal effectiveness have been covered.

Is DBT for me?

DBT is primarily used for people who have a diagnosis or symptoms of borderline personality disorder or emotionally unstable personality disorder. However, more recent studies have shown it to be effective with depression, bulimia, binge-eating, bipolar disorder, post-traumatic-stress disorder, and substance abuse, but the body of evidence remains limited.