Introduction

Dialectical Behaviour Therapy (DBT) was originally developed by Dr. Marsha Linehan to address challenges in treating individuals with borderline personality disorder (BPD). DBT has gained widespread acceptance worldwide and its effectiveness extends to conditions such as depression, anxiety and eating disorders. In the UK, DBT is used as a valuable tool for diverse psychological difficulties.

What is dialectical behaviour therapy?

DBT is a therapeutic approach that is designed to help people to manage intense emotions, to build healthier relationships and to develop effective coping strategies. Put simply, DBT teaches people how to better understand and regulate their emotions, manage interpersonal conflict and improve their overall well-being.

Techniques used in DBT

These techniques collectively empower individuals to create positive changes in their lives, fostering emotional well-being and healthier interactions with others.

1. Distress tolerance

A lot of individuals, if not the majority, cope with crisis situations and intense emotions by resorting to harmful behaviours. To avoid such issues, the following techniques are used:

• Distraction strategies
• Self-soothing activities and radical acceptance
• Encouraging tolerance when change is not immediately possible

2. Interpersonal effectiveness

Navigating relationships and interpersonal conflicts is a very important aspect of life. Techniques implemented to improve this skill include:

• Learning assertiveness and setting boundaries
• Improving communication to enhance the quality of relationships
• Most importantly, doing all of the above while maintaining self-respect

3. Core mindfulness

DBT incorporates the art of mindfulness to help individuals stay fully present in the moment. It is not only the foundation of DBT, but also of a healthy mental state. When learning this skill, you must practice:

• Observing, identifying and describing your emotions, thoughts, and surroundings without any judgment
• Participate in positive and constructive conversations and behaviours
• Comprehending your own situation and feelings first and explaining to others in an understandable manner

4. Emotional regulation

Emotional Regulation is considered one of the most essential skills taught in DBT sessions. An individual with intense, uncontrolled emotions is likely to damage themselves and others at some point. The motive behind these techniques is to feel less vulnerable and overwhelmed. It includes:

• Identifying and labelling emotions
• Encouraging activities that generate positive emotions
• Accepting your feelings but evaluating them before taking actions

What is validation, and why is it important in DBT?

As the individual goes through various stages during the therapy, they experience a spectrum of emotions. Validation involves acknowledgement of the individual’s experiences without judgment. It provides them with a sense of emotional safety, trust and helps them progress with the therapy.

It is also crucial to note that validation does not mean agreeing with the individual or supporting their actions, not matter what. It simply means that you understand their behaviour, recognise their history, and want to be there for them through the process.

But how to validate someone appropriately?

The first and foremost thing you need to know about validation when it comes to emotions is that ‘all emotions are valid’. Yes, even the negative ones. You can disagree and still provide compassion by recognising the existence of a belief, an emotion, or experience.

In DBT, there are 6 levels of validation:

Level one: be present

Pay attention to the individual. Do not multitask or seem uninterested. Treat the individual as if what they are explaining is important, meaningful and valid (because it is). 

DO’s: nodding, maintaining eye contact, saying “yes, I understand” or something similar.

DON’t: judgmental expressions, rolling eyes, crossing arms, using cellphones, doing any other task.

Level two: reflect back

Summarise what the other person said to check if you understood it correctly and at the same time, this would display the fact that you were paying attention making the individual feel valued and validated.

DO’s: repeat parts of the conversation, ask questions with compassion.

DON’t: respond negatively, disregard their feelings.

Level three: read minds

Listening to what is being said is important but understanding what is not being said is equally essential. The body language, personal history, changes in expressions and voice tones may help you understand the nonverbal cues.

At the end of the day, we are not mind readers, so it’s always recommended to confirm whether your interpretation was on point.

DO’s: be attentive to nonverbal cues, and confirm your interpretation.

DON’t: make assumptions, or neglect any signs.

Level four: be understanding

Try seeing things from the individual’s perspective, it allows you to realise why they may be feeling or reacting in a certain way and how it makes sense to them. Even if you don’t approve of the situation, understand that there are two sides of the same coin and both are valid when it comes to emotions.

DO’s: be respectful, understand their perspective.

DON’t: invalidate their reaction, ignore their reasons.

Level five: acknowledge

In this level, we not only show the individual that we understand them but also agree to them. This is where their emotions get validated fully. We acknowledge their response to the situation considering the facts that it made sense and was understandable.

DO’s: remind them that their actions made sense in that situation. 

DON’t: disagree with them, advice what they should have done instead.

Level six: radical genuineness

This is where you just be yourself! You treat the other person as an equal, not as someone fragile or who needs help. This makes the other person feel validated for getting respected like any other individual should be.

DO’s: be a friend, show equality, say that you’d do the same in that situation. 

DON’t: one-up or one-down for the other person, invalidate if it doesn’t make sense to you.

What validation is not!

• Justifying harmful behaviours
• Making the conversation about yourself
• Agreeing to anything a person says
• Disagreeing to everything a person says
• Promoting dysfunctional traits
• Normalising unacceptable behaviour

Resources for DBT in the UK

1. Contact your GP: They can provide you with resources around you or refer you to a specialist
2. NHS services: availability may vary depending on your region
3. Private healthcare services: available but at higher costs
4. Charities and support groups: free or low-cost therapy options provided
5. Online support and resources: certain websites and self-help books/videos may provide you with necessary information and help

Summary

Dialectical Behavior Therapy (DBT) is a therapeutic approach that combines practical skills with acceptance and mindfulness. It’s like a toolkit for managing emotions and improving relationships. In DBT, validation is the glue that holds it together—it’s about accepting someone’s feelings without judgment. This helps people feel understood, creating a safe space for them to explore and handle their emotions, leading to better mental well-being and healthier connections with others.