What Is Dialectical Behaviour Therapy?

  • Saba Amber BSc, Manchester Metropolitan University, UK

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Are you struggling with intense and overwhelming emotions that feel out of your control? Have you received a recent diagnosis of a mental health condition and are eager to explore different therapeutic approaches? 

Dialectical behaviour therapy (DBT) might be the key to unlocking a more balanced and fulfilling life. This form of talking therapy is designed to support people who struggle with intense emotional experiences. Read on to learn more about DBT, explore the principles of DBT, gain insights into what to expect during sessions, and discover who can benefit most from this therapy.

Overview

Dialectical behaviour therapy (DBT) is a type of talking therapy, or psychotherapy, aimed at people who experience emotions very intensely. It was originally adapted from cognitive behavioural therapy (CBT) - another type of psychotherapy which helps you to understand how your thoughts affect your emotions and behaviours - to help people deal with stress. 

The term “dialectical” refers to the idea of combining opposite ideas: DBT focuses on helping you to find a balance between accepting what is going on in your life, while also helping you to learn to make positive changes in other aspects of your life. This unique characteristic sets DBT apart from traditional therapeutic approaches, making it particularly effective for those grappling with complex emotional issues.1

DBT was initially developed by psychologist Marsha M. Linehan in the 1980s and has evolved as a strategy to help people struggling with intense emotional experiences and interpersonal challenges to create a more stable and fulfilling life by:1

  • Enhancing emotional regulation
  • Improving interpersonal relationships
  • Fostering distress tolerance
  • Promoting mindfulness

What are the core principles of DBT?

Dialectics 

Dialectics is a fundamental principle of DBT which focuses on striking a balance between accepting yourself and the current situation you are in without judgement, while also actively working towards positive change. The joining together of these seemingly opposite concepts forms the foundation of dialectical thinking, fostering growth and resilience.

Mindfulness

Mindfulness in DBT serves as a powerful tool for increasing your self-awareness and reducing your impulsive reactions. By staying present in the moment, you can better understand your thoughts and emotions while preparing for adaptive and positive responses to life’s challenges.2 

These mindfulness techniques might include:

  • Meditation
  • Focused breathing
  • Observing thoughts without attachment

These practices can help you to detach from any intense emotions you feel are overwhelming you and gain a sense of control over your responses.

What is DBT used for?

DBT focuses on treating disorders that are characterised by impulsivity and emotional dysregulation

Border personality disorder (BPD)

DBT was initially developed to help people with borderline personality disorder (BPD) as they often struggle with intense and rapidly changing emotions, difficulties in interpersonal relationships, and a heightened vulnerability to self-harm or suicidal behaviours. DBT’s emphasis on acceptance, change, and skill-building makes it particularly well-suited for the complex needs of individuals with BPD.3

Other conditions

However, DBT has also been proven to be effective in treating and managing a wide range of other mental health conditions, including:4

DBT is most often effective for conditions that are associated with unhealthy or problematic attempts to manage intense and negative emotions; for example, turning to drugs or alcohol to numb emotional pain, or withdrawing from social interaction and isolating yourself to try to avoid any emotional triggers. Rather than promote such harmful strategies, DBT helps you to learn healthier coping mechanisms for these emotions so that you can manage and navigate your emotions in a more adaptive and constructive manner.5

However, it is important to understand that everyone experiences therapy differently so there is no guarantee that DBT will be right for you. 

What to expect in DBT sessions?

DBT sessions can vary between different therapists and  individuals, however, DBT usually includes:1

  • Pre-assessment session
  • Individual therapy sessions
  • Skills training in groups
  • Telephone crisis coaching

Pre-assessment 

Some therapists may offer you an assessment or a pre-treatment phase of DBT (usually up to 4 sessions). This is used to help determine how suitable DBT might be for you. Your therapist might ask you different questions about your symptoms and areas of concern, and explain how DBT works. This should help you learn about DBT and decide if it is the right therapy for you before committing to the treatment.

Individual therapy 

Weekly individual one-to-one therapy sessions (typically lasting 45-60 minutes) form an important part of DBT. These sessions are focused on increasing motivation for making positive changes in your life and on building commitment to this therapeutic process. You will work with your therapist to identify specific areas of your life that need attention and set specific and achievable goals to achieve this. 

These goals are set in a clear hierarchy, with the first goals being focused on first before moving on to the other goals:

  • Keep you safe by reducing life-threatening behaviours (e.g., suicidal thoughts, self-harm)
  • Reduce behaviours that interfere with therapy (e.g., missing sessions, not doing homework, problems with your therapist)
  • Help you reach your goals and improve your quality of life by addressing what's getting in your way (e.g., depression, anger issues, addiction, relationship issues)
  • Help you learn new skills to replace unhelpful or harmful behaviours and help you achieve your goals (e.g. distraction skills, mindfulness, emotional regulation skills)

Your therapist might ask you to fill out diary cards at home to track your emotions, problems behaviours, and the skills you are practising. You and your therapist will then look over these for patterns or triggers in your life to decide what will be most helpful to work on in DBT sessions.

Group skills training

Another important part of DBT is skills training where your therapists will teach you skills that you can apply in your day-to-day life. You will learn these skills as part of a group, but it is important to note that this is not group therapy - you are not discussing your behaviours and emotions with others, instead, you are learning practical skills in a group setting.

There are four core skills taught in DBT group therapy, each addressing different aspects of personal development:6

  • Mindfulness: learn to focus your attention on the present rather than worry about the past or the future, promoting emotional regulation and reducing impulsivity.
  • Interpersonal effectiveness: helps you to improve your communication skills, better manage your relationships, and learn to deal with interpersonal conflicts.
  • Emotional regulation: learn skills to help you identify, understand, and have more control over your emotions to promote emotional stability.
  • Distress tolerance: develop strategies to deal with crises without using harmful or destructive behaviours (e.g. self-harm)

Practical exercises, such as role-play, will usually be used in these group training sessions to give real-life applications of DBT principles. You will also be given homework each week to help you practise these skills at home and reinforce the use of them in your daily lives.

Telephone crisis coaching 

DBT often involves telephone crisis coaching to help give you real-time support in your daily life. This usually means that your therapist will be available for you to call at certain times for support between sessions, for example:

  • You need help with an immediate crisis (e.g. wanting to self-harm)
  • You are trying to use DBT skills at home but need advice on what skills to use and how to use them effectively

However, your therapist will set clear boundaries around this phone coaching, typically restricting phone calls to a brief length (5-15 minutes), and giving set times of the day when you can call them.

What to consider before committing to DBT?

It is important to realise that DBT is not right for everyone and it can be very difficult. For example, DBT requires a significant commitment of time. You will be expected to attend regular individual and group therapy sessions, while also completing homework assignments to work on these skills outside of sessions. This can present a challenge for people who have difficulty keeping up with assignments on a regular basis or who have limited time available.7

DBT is more likely to work for you if: 

  • You are committed to the time requirements of therapy and the homework assignments
  • You are ready to commit to making positive changes in your life
  • You feel able to do some sessions in a group with others

FAQs

What is the difference between cognitive behavioural therapy (CBT) and dialectical behavioural therapy (DBT)?

Cognitive behavioural therapy (CBT) focuses on helping you change unhelpful or harmful ways of thinking and patterns of behaviour. Dialectical behavioural therapy (DBT) also does this, but balances making these positive changes with a focus on accepting who you are and your situation at the same time. While both therapies target thoughts and behaviours, DBT places a stronger focus on emotional regulation and developing effective coping strategies for managing intense emotions than CBT. 

How long will I need dialectical behavioural therapy (DBT) for? 

Dialectical behaviour therapy (DBT) usually takes at least 6 months to a year. However, everyone is different and you might require more time than this to achieve what you wanted out of DBT. 

What does dialectical behavioural therapy (DBT) do?

The main goal of dialectical behavioural therapy (DBT) is to strike a balance between accepting who you are and your current situation, while also actively striving for positive change to improve your quality of life. 

What are the 4 skills of dialectical behavioural therapy (DBT)? 

The four core skills taught in group DBT sessions are mindfulness, distress tolerance, interpersonal effectiveness, and emotional regulation.

Summary

In summary, dialectical behavioural therapy (DBT) stands as a dynamic and influential approach in the field of psychotherapy. DBT offers a comprehensive framework for people struggling with intense emotional and interpersonal challenges through its focus on dialectics, mindfulness, and practical skills training. While DBT might not work for everyone, its effectiveness across various mental health conditions makes it an important treatment option. As the field continues to evolve, DBT remains an effective option for individuals seeking a balanced and fulfilling life. 

References

  1. Linehan MM, Wilks CR. The course and evolution of dialectical behavior therapy. APT [Internet]. 2015 Apr [cited 2024 Jan 19];69(2):97–110. Available from: https://psychotherapy.psychiatryonline.org/doi/full/10.1176/appi.psychotherapy.2015.69.2.97
  2. Jennings JL, Apsche JA. The evolution of a fundamentally mindfulness-based treatment methodology: From DBT and ACT to MDT and beyond. International Journal of Behavioral Consultation and Therapy [Internet]. 2014 [cited 2024 Jan 19];9(2):1–3. Available from: http://doi.apa.org/getdoi.cfm?doi=10.1037/h0100990
  3. Neacsiu AD, Rizvi SL, Linehan MM. Dialectical behavior therapy skills use as a mediator and outcome of treatment for borderline personality disorder. Behaviour Research and Therapy [Internet]. 2010 Sep 1 [cited 2024 Jan 19];48(9):832–9. Available from: https://www.sciencedirect.com/science/article/pii/S0005796710001130
  4. Fitzpatrick S, Bailey K, Rizvi SL. Changes in emotions over the course of dialectical behavior therapy and the moderating role of depression, anxiety, and posttraumatic stress disorder. Behavior Therapy [Internet]. 2020 Nov 1 [cited 2024 Jan 19];51(6):946–57. Available from: https://www.sciencedirect.com/science/article/pii/S0005789419301510
  5. Neacsui AD, Bohus M, Lineham MM. Dialectical behavior therapy: An intervention for emotion dysregulation. In: Handbook of emotion regulation [Internet]. J. J. Gross. The Guilford Press; 2014. p. 491–507. Available from: https://psycnet.apa.org/record/2013-44085-029
  6. Linehan M. Dbt? Skills training manual, second edition [Internet]. Guilford Publications; 2014. 529 p. Available from: https://books.google.co.uk/books?hl=en&lr=&id=VfMZBQAAQBAJ&oi=fnd&pg=PP1&dq=dbt+group+skills+training&ots=CghLLUHLLX&sig=YyL6XGZR_5xmnBTPOEeOabd4QxQ&redir_esc=y#v=onepage&q=dbt%20group%20skills%20training&f=false
  7. Carmel A, Rose ML, Fruzzetti AE. Barriers and solutions to implementing dialectical behavior therapy in a public behavioral health system. Adm Policy Ment Health [Internet]. 2014 Sep 1 [cited 2024 Jan 19];41(5):608–14. Available from: https://doi.org/10.1007/s10488-013-0504-6

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This content is purely informational and isn’t medical guidance. It shouldn’t replace professional medical counsel. Always consult your physician regarding treatment risks and benefits. See our editorial standards for more details.

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Charlotte Sutherland

Master of Science – MSc Translational Neuroscience, Imperial College London

Charlotte is a recent MSc Translational Neuroscience graduate from Imperial College London where she undertook research investigating antidepressants and Alzheimer’s disease. She has a strong interest in translational research and is aiming to pursue a PhD in the field of neurodegenerative diseases.

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