What is Dialectical Behavioural Therapy (DBT)
Dialectical Behavioural Therapy (DBT) is a type of cognitive-behaviour therapy developed in the late 1980’s by Marsha Linehan, a clinical psychologist and faculty at the University of Washington. She created, researched and made known this evidence-based treatment that involves teaching clients a set of skills to apply to help themselves.
Dialectical behaviour therapy (DBT) is a therapy designed to help people that suffer because they experience their emotions in extreme ways that they cannot handle. It helps people who need to change patterns of behaviour that are not helpful, such as self-harm, suicidal ideation, and substance abuse. This approach works towards supporting clients to increase their emotional and cognitive regulation. It involves learning about the triggers that lead to reactive states and helping to assess which coping skills to apply in the sequence of events, thoughts, feelings, and behaviours to avoid undesired reactions and consequences. The word dialectic (in Dialectical Behaviour Therapy) means to balance and compare two positions that appear very different or even contradictory. In dialectical behaviour therapy, the balance is between change and acceptance. Clients need to change the behaviours in their life that are creating more suffering for themselves and others while also accepting themselves the way they are. To address problems, DBT utilizes the following four skills building categories:
1. Emotional Regulation:
Some people experience their emotions in a very intense way. Small, daily situations usually trigger extreme reactions that seem unjustifiable or disproportionate to observers. These reactions create difficult interactions with others who can’t understand where a certain reaction came from, so they don’t know how to respond. Learning emotion regulation skills help people to recognize more clearly what they feel and observe each emotion without getting overwhelmed by it. The goal is to become aware and able to modulate their reactions without behaving in reactive, destructive and disproportionate ways. DBT skills for understanding and regulating emotions include:
- Learning how to distinguish emotions and identifying them
- Distinguishing obstacles to managing emotions
- Decreasing vulnerability to emotional reactions
- Increasing positive emotional events
- Increasing mindfulness of current emotions
- Engaging in actions that are the opposite of the ones that feel natural
- Applying distress tolerance techniques
2. Distress Tolerance:
DBT emphasizes learning to bear pain skillfully in a new healthier way so that it does not lead to suffering. This can be accomplished through learning distraction techniques, relaxation and coping skills. Distress tolerance have to do with the ability to accept, in a non-evaluative and nonjudgmental way, both oneself and the current situation. Since this is a non-judgmental stance, this means that it is not one of approval or resignation. The goal is to become capable of calmly recognizing negative situations and their impact, rather than becoming overwhelmed or hiding from them. This allows individuals to make wise decisions about whether and how to act, rather than falling into the intense, desperate, and often destructive emotional reactions.
3. Interpersonal Effectiveness:
Interpersonal response patterns taught in DBT skills training include developing assertiveness and interpersonal problem-solving techniques. They incorporate effective strategies for asking for what one needs, saying no, and coping with conflict in relationships. An individual may be able to describe effective behavioural sequences when discussing another person in a problematic situation, but may be completely incapable of doing the same when analyzing their own position.
The interpersonal effectiveness module focuses on situations where the objective is to change something (e.g., requesting someone to do something) or to resist changes someone else wants (e.g., saying no in an assertive and adequate manner). The skills taught are intended to maximize the chances that a person’s goals in a specific situation will be met, while at the same time not damaging either the relationship or the person’s self-respect.
Mindfulness is the practice of being fully aware of the present moment and one of the core ideas behind all elements of DBT. It is considered a foundation for the other skills taught in DBT, because it helps individuals accept and tolerate the powerful emotions they may feel when challenging their habits or exposing themselves to upsetting situations. Within DBT it is the capacity to pay attention, non-judgmentally, to the present moment; about living in the moment, experiencing one’s emotions and senses fully, yet with perspective.
These four dimensions are included in the psychological treatment so clients can acquire tools to manage their emotional distress and interpersonal relationships in a healthier manner. DBT has been shown to improve the emotional wellbeing and relationships of the clients who engage in and commit to their treatment.
Written by Dr. Silvina Galperin