Dialectical Behaviour Therapy, or DBT, is a treatment pioneered by Dr. Marsha Linehan, a clinical psychologist from Seattle.
DBT was originally developed for people who deliberately harm themselves, experience ongoing suicidal thoughts, and struggle with intense and uncontrolled emotions.
Borderline Personality Disorder
Many people with these behaviours are diagnosed with a disorder called Borderline Personality Disorder, and often struggle with co-existing mood disorders, post-traumatic stress disorder, eating disorders, and alcohol and drug problems.
Dr. Linehan is the author of two books published in 1993 describing the treatment that she designed to help people with these difficulties develop control over their emotional experiences, and build a valued life.
The effectiveness of DBT has been thoroughly researched since its inception in the early nineties, and it is now considered the most effective treatment for Borderline Personality Disorder. Research has shown that DBT is also an effective treatment for binge eating, bulimia, depression and substance abuse.
Skills Training in DBT
DBT is a skills-based treatment, and involves several components including training in specific DBT skills, and individual sessions which support the use of skills in the particular circumstances of an individual’s life. DBT skills are usually taught in a group format, although they can also be taught in individual sessions, and are grouped into four modules as below.
- Core Mindfulness Skills – Mindfulness skills are central to DBT. In DBT, there are three primary states of mind, called Reasonable Mind, in which a person is thinking and behaving rationally, and dealing with problems in a logical manner; Emotion Mind, in which a person’s thinking and behaviour are dominated by the energy of his or her current intense emotion; and Wise Mind, which reflects a synthesis or coming-together of rational thoughts and emotional experiences. Mindfulness skills are used in DBT to balance Emotion Mind and Reasonable Mind, to achieve Wise Mind thinking and behaving.
- Interpersonal Effectiveness Skills –This is similar to skills taught in many assertiveness programs, and is particularly useful for people who experience intense emotions which can severely hamper attempts to act in an effective manner. The skills include how to ask for help, how to say no or express an opinion, and how to behave in interpersonal situations in ways which enhance both the relationship with the other person and one’s own sense of self-respect.
- Emotion Regulation Skills – These skills include learning to identify and label emotions and their functions, reducing vulnerability to Emotion Mind; increasing positive emotional experiences and awareness of them; and reducing negative emotional experiences. These skills are important because extreme emotions often produce extreme behaviour, which may have negative and undesired consequences.
- Distress Tolerance Skills – The ability to tolerate distress and survive crises, as well as to accept life as it is in the moment, are important skills, particularly as these abilities can help a person avoid doing things which might worsen an already difficult situation. Distress tolerance skills include crisis survival skills such as distraction and self-soothing, and skills which help with non-judgementally accepting oneself and the current situation (which is not the same as approving of or liking the current situation).
These four skills sets constitute the first stage of DBT, and aim to help a person move from feeling largely out of control of his or her feelings and behaviour, to feeling in control.
After this stage, a person is able to control his or her attention and awareness of the present moment; start new relationships and improve current ones; understand how to regulate emotions; and tolerate emotional pain without feeling compelled to resort to behaviours that may be self-destructive. Once a person has these abilities he or she is equipped to work on any past traumas and improve the overall quality of life, which are the second and third stages of DBT.
Throughout DBT, a broad range of cognitive and behaviour strategies are used. The term Dialectical is used to describe a rather complex philosophical idea, but in practice it refers in part to strategies in which opposing views of a situation or extremes of a feeling are considered, and an attempt is made to produce “a middle path” of thinking and behaving which incorporates or combines elements of both opposing positions.
An example is a person’s wish to be accepted as she or he is, and a simultaneous wish to be encouraged to change. These positions are opposite, but in dialectical terms can be both true at the same time i.e. the person wants to both change and not change. Most of us can perhaps think of other situations where both ends of a particular dimension are true for us, either at the same time, or in different circumstances. DBT focuses on creating a middle path, and acting in an effective manner – “Doing what works”.
Applications for DBT
DBT may be a suitable treatment for people struggling with:
- alcohol and drug abuse;
- binge eating and bulimia;
- trauma-related difficulties;
- difficulties with mood management including Bipolar Disorder and Depression;
- feelings of emotional numbness or overly intense emotions including anger;
- turbulent or otherwise difficult interpersonal relationships;
- urges to self-harm;
- frequent suicidal thoughts.
If you experience any of these kinds of problems, please consider making an appointment with me, so that we can explore your difficulties and decide whether DBT is an appropriate treatment for you.
Author: Bridget Hogg, B.Sc. (Hons), M. Sc. (Clinical Psychology)
Bridget Hogg is a Brisbane Clinical Psychologist drawing primarily on DBT, Acceptance and Commitment Therapy and Mindfulness training to assist clients experiencing distressing thoughts, feelings and physical sensations.
It is an act of courage and self-care to seek therapeutic help for ongoing psychological difficulties, and Bridget respects and admires all clients who take the first step in that process by making their first appointment. She is passionate about helping people improve the quality of their lives, particularly those for whom life feels at times extremely difficult and painful.
To arrange a session with Brisbane Clinical Psychologist Bridget Hogg, you can freecall 1800 877 924 or book online now!