Introduction

Dialectical behavioural therapy (DBT) is a type of talking therapy, where you talk about your thoughts, feelings and behaviours with a qualified mental health professional and use strategies to try to accept and manage them. DBT is similar to cognitive behavioural therapy (CBT), but it focuses more on the emotional and social aspects of the condition. The goal of DBT is to accept and manage intense emotions rather than to change thoughts and behaviours like in CBT. Dialectical behavioural therapy can help with many mental health conditions, such as borderline personality disorder and depression, and it has been shown to help with anxiety disorders as well. 

Understanding anxiety

An anxiety disorder is a mental health condition that causes excessive and out-of-proportion feelings of nervousness, fear, restlessness, dread and worry. Anxiety disorders are different from normal, natural feelings of worry during stressful situations.¹

There are several different types of anxiety disorders, such as:

• Generalised anxiety disorder (GAD) 
• Panic disorder 
• Social anxiety disorder
• Specific phobias
• Post-traumatic stress disorder (PTSD)

Generalised anxiety disorder (GAD)

GAD is a long-term condition characterised by constant, uncontrollable worrying and anxiety about everyday situations and issues. People with GAD often find it very difficult to relax, and they will feel anxious most of the time.¹

Panic disorder

Panic disorder is a mental health condition where you have repeated panic attacks. These panic attacks are exaggerations of the body’s normal response to stressful situations, with sudden and intense feelings of fear and anxiety.² They can be unexpected and unprovoked, and they can be very frightening, with both physical and mental symptoms.² As well as an intense rush of anxiety and fear, many people also experience physical symptoms, such as a racing heartbeat, dizziness, sweating, chest pain, shortness of breath and feeling sick.² Panic attacks are very distressing, but they usually only last for a short period of time.

Social anxiety disorder

Social anxiety, also known as social phobia, is an overwhelming fear or anxiety about social situations.³ It is much more than just being shy or quiet– it can stop people from going to work and school, keep them from doing things they used to enjoy, and damage self-confidence and relationships.³

Specific phobias

A specific phobia is an extreme, irrational fear of an object, place, situation, or feeling that poses very little danger in reality.⁴ Specific phobias can be debilitating, as they are much more extreme than normal fears. Some common phobias include phobias of germs, heights and darkness, and situational phobias, such as flying and small, enclosed spaces. 

Post-traumatic stress disorder (PTSD)

Post-traumatic stress disorder (PTSD) is a mental health condition triggered by either witnessing or experiencing a particularly stressful or traumatic event. Domestic violence, abuse, serious illness, war and conflict, and sexual or physical assault are all examples of some of the traumatic and frightening events that can lead to PTSD. People with PTSD often experience flashbacks and nightmares, and they may also have uncontrollable thoughts about the dream, as if they are reliving it.

Symptoms of anxiety

People with anxiety may experience a variety of different symptoms, both physical and mental. Some of the physical symptoms can include:

• Feeling restless and on edge
• Feeling more irritable
• Eating more or less than usual
• Churning feeling in your stomach and nausea
• Feeling dizzy
• Racing heartbeat
• Sweating
• Sleep problems
• Needing the toilet more than usual

Anxiety can also cause low mood and depression, and a feeling of dread about everyday events. It can also make you feel tense all the time, like you can’t relax, and you may even feel like you worry about the anxiety itself.⁵

Dialectical behaviour therapy (DBT)?

How does dialectical behaviour therapy work?

There are four core areas of DBT: mindfulness, distress tolerance, emotional regulation and interpersonal effectiveness. These four areas provide you with the skills to accept and manage intense emotions and challenging situations.

Mindfulness helps with being able to live in the present moment and accepting what is happening without trying to change and control it. Distress tolerance helps you work on how you cope in a crisis, especially when it is out of your control. Emotion regulation works on identifying, labelling, recognising and regulating emotions before they can impact and control thoughts and behaviours– this helps by stopping the issue of negative emotions at the start, before these emotions can grow and develop. Finally, interpersonal effectiveness helps with setting healthy boundaries and learning to say ‘no’, as well as getting better at asking other people for help when needed.

DBT techniques and strategies

Mindfulness practices

Mindfulness through DBT helps you to focus on living in the moment, focusing your mind and becoming more aware of your surroundings. The increased awareness and mindfulness can help with accepting and managing anxiety and other intense emotions. In DBT, mindfulness focuses on observing, describing and participating fully in the present without judgement. This improves self-awareness and helps with appreciating the current moment without trying to change or control it. 

Distress tolerance skills

Distress tolerance is the ability to manage and deal with distressing and difficult situations and emotions. This tolerance determines how you react in these challenging situations. Through improving distress tolerance skills, DBT equips you to better deal with these challenges. 

One major distress tolerance skill is the use of self-soothing techniques, as they can help to soothe and provide relief from difficult situations. Using the five senses can help to provide comfort or relief– for example, listening to relaxing music, or lighting a candle. Self-soothing helps to manage and regulate emotions, giving you time to calm down and consider what to do next.

Radical acceptance is another distress tolerance skill. Radical acceptance is the acceptance of the current circumstances and situation, without trying to change or control it. It helps with moving away from denial and accepting that the facts cannot be changed, even if we do not like them.

Distraction methods are vital short-term skills to help improve distress tolerance and manage overwhelming emotions in difficult scenarios. They help to take the mind off what is happening, and focus on another activity for a short time. Taking the time to do something enjoyable can help relax the mind and provide a distraction whilst calming down. For example, reading a book, spending time with a pet, taking a bath, listening to music and exercising are all good, fun and enjoyable activities that help manage difficult emotions and improve distress tolerance.

Emotional regulation

Emotional regulation in DBT works on understanding the function of emotions and why they are important. It provides the skills to manage and cope with emotions, instead of being controlled by them, and encourages more positive emotions. One of the key principles in emotional regulation is identifying and labelling emotions, as a secure understanding of what you are feeling is key to determining the cause of the emotion, managing it, and over time, decreasing its intensity. Being able to identify and label the emotion is extremely powerful– it is the first step in accepting and managing overwhelming and challenging emotions. This goes hand-in-hand with increasing positive emotions, another key principle in emotion regulation. Increasing positive emotions involves seeking and creating moments of joy and happiness, and acknowledging joyful moments in the present. These skills all help with experiencing challenging emotions and dealing with them better, allowing you to regulate your emotions, instead of being controlled by them. 

Interpersonal effectiveness skills

Building on interpersonal effectiveness skills is vital in DBT, as it helps improve confidence in social situations, voicing needs and setting healthy boundaries. It also helps build self-respect and self-esteem. Interpersonal effectiveness skills give you the tools to build healthier, happier relationships by focusing on communication skills. 

Assertiveness training is one area explored in interpersonal effectiveness skills– it involves both expressing your needs and wants, and being able to say ‘no’ to others and set boundaries. This helps protect yourself and also in voicing your concerns to ensure your needs are met. Interpersonal effectiveness training can also help with conflict resolution, fostering more positive and effective communication and allowing you to deal with challenging situations more easily and confidently.

Why should I try DBT?

What are DBT sessions like?

After thorough assessment and receiving a diagnosis, your doctor, therapist or healthcare team may recommend DBT if they think it will work for you– DBT is not right for everyone. Your DBT sessions will then be planned out, as there are different types of DBT sessions: individual therapy or group therapy, and in-person, online via video link, or over the phone. 

Individual DBT sessions usually take place once per week, and they focus on keeping you safe from harm, helping you learn skills to cope and deal with your emotions, reaching your goals and improving your quality of life. 

In skills training groups, therapists focus on the four key areas of DBT: mindfulness, distress tolerance, emotional regulation and interpersonal effectiveness skills. Skills training is more like teaching sessions, and they may often involve group exercises and role-play.

You may also be able to telephone your therapist in-between sessions, for extra day-to-day support.

Summary

Dialectical behaviour therapy, or DBT, is a highly effective form of therapy, suitable for people with borderline personality disorder, depression, and anxiety, as well as many other conditions. DBT focuses on acceptance and management of overwhelming, difficult emotions, rather than trying to change and control them. Through working on mindfulness, distress tolerance skills, emotional regulation and interpersonal effectiveness skills, DBT aims to equip people with the skills and tools needed to manage intense emotions and challenging situations. Not everyone is a suitable candidate for DBT, and it is not always a quick, easy fix. However, with hard work and perseverance, DBT can help with anxiety conditions.