What is Dialectical Behaviour Therapy?

Jason Brien.

Dialectical behaviour therapy (DBT) was developed by Marsha M. Linehan with the intention of helping people to increase their emotional and cognitive regulation, learn their triggers, assess and apply coping skills and avoid undesired reactions. DBT is founded on the principle that both acceptance and change is more effective combined than either can be alone. DBT was specifically designed to treat borderline personality disorder (BPD) however It can be used to treat other conditions such as suicidal behaviour, self-harm, substance use, post-traumatic stress disorder (PTSD), depression and eating disorders.

DBT is a modified version of cognitive-behavioural therapy (CBT). Whereas CBT ultimately states that a clients irrational or maladaptive thoughts, feelings and behaviours need to change because they are fundamentally ‘wrong, DBT teaches clients that their thoughts are ‘normal’ given their condition, and should therefore be ‘accepted’, however they must engage in change if they wish to improve their standard of living and overcome their challenges, stresses and distresses. Through the added concept of acceptance, DBT therapists seek to gain greater rapport and trust from their clients rather than having their clients view them as adversaries or people seeking to challenge them at every turn.

DBT involves 4 core components.

1. Mindfulness: Mindfulness is a powerful tool to learn as it helps people to accept and tolerate the powerful emotions they can feel when challenging their habits or exposing themselves to upsetting situations. That is, if a DBT therapist is assisting their client with a particular stressful and anxiety or fear-provoking situation, like past sexual assault for example, the client can engage in mindfulness exercises to reduce their stress, anxiety and fears. When people’s brains are flooded with emotions, the rational side of their brain cannot work properly. Mindfulness exercises bring people into the present moment through the use of their 5 senses. Mindfulness is very much dependent upon acceptance.

2. Distress Tolerance: Distress tolerance helps people to navigate through difficult times particularly when their emotions are at their highest. Distress tolerance teaches people to calm and relax themselves in healthy, adaptive ways. Learning to relax the mind, body and spirit can help people to not become overwhelmed by their strong emotions or provoke them into trying to hide away from them. When people are calm and relaxed, the rational brain kicks in and they can begin to make wise decisions about whether and how to take action. That is, they become proactive towards stress and distress and not reactive. Distress tolerance also teaches people skills so that they don’t engage in problematic behaviours which might make their situation worse.

3. Interpersonal Effectiveness Skills: This module involves helping people to understand and identify what their needs are in their relationships whilst helping them to develop effective ways of dealing with others. It is important to recognise that having needs and desires is typical however they must be willing to get those needs met in healthy and socially responsible ways. This involves respecting the self and others, respecting personal boundaries, listening and communicating effectively and assertively, dealing with difficult people, repairing relationships rather than burning bridges and learning to be able to say no.

4. Emotion Regulation Skills: The DBT emotion regulation skills help people to better understand their emotions. It teaches people to decrease the intensity of their feelings and helps them ride out strong emotions without acting on them. It provides education and knowledge about the function of emotions and how to not be overwhelmed by them. This may include learning how to identify and label emotions, identify obstacles to changing emotions, increasing mindfulness of current emotions or learning how to increase positive emotional events. These skills can be very useful for clients diagnosed with bipolar disorder, Borderline personality disorder or other mental health conditions marked by emotional lability or emotional dysregulation.

What are some common DBT techniques?

#The wise mind: This technique involves drawing two slightly intersecting circles. The majority of the space in the left circle is labelled the emotional mind. The intersecting space is labelled the wise mind and the majority of the space in the right circle is labelled the reasonable mind. Basically, success comes from finding the right balance between emotions and rationality. Too many emotions and we lose our ability to think rationally. Likewise, if we are too rational, we become too detached from our emotions.

#Radical acceptance: This technique involves acknowledging the reality of your circumstances instead of fighting it by thinking “This shouldn’t be happening” or “This isn’t fair.” Radical acceptance doesn’t allow for sugar coating. This technique is challenging for most people at the start as confronting reality can often activate cognitive distortions. Whilst it can be difficult to accept pain, fighting pain or avoiding pain will only make it much worse. Radical acceptance offers a way to accept it and address it and allow you to move forward.

#Journaling: Keeping a mood and thought diary can help you to keep track of yourself and your progress. Journaling requires conscious effort on your behalf and you must be willing to be open and honest with yourself and what you write down. Journaling will not be effective if you write down half truths or if you ignore certain thoughts or feelings.

#Cognitive restructuring: The aim of cognitive restructuring techniques is not to ‘think happy thoughts’ or to replace negative thoughts with positive ones, rather, it is to overcome biases and think accurately which will allow you to accept your thoughts more readily. Cognitive restructuring offers an opportunity to notice maladaptive thoughts as they’re occurring. You can then practice reframing these thoughts in more accurate and helpful ways.