Understanding dialectical behavioural therapy (DBT)

You may well have heard of cognitive behavioural therapy (CBT) – a talking therapy used in psychology to help patients change the way they think and behave. However, you may not have heard of the similarly-named dialectical behavioural therapy (DBT). Psychologist Dr Matina Sotrilli explains.

What is dialectical behavioural therapy?

Dialectical behaviour therapy (DBT) is a type of cognitive behavioural therapy (CBT) developed in the late 1980s by psychologist Marsha M. Linehan.

How does it differ from cognitive behavioural therapy?

Dialectical behaviour therapy (DBT) treatment is a type of therapy that combines a cognitive-behavioural approach with an emphasis on the psychosocial aspects of treatment. 

CBT focuses on how your thoughts, feelings and behaviour influence each other, while DBT focuses more towards regulating emotions, being mindful, and learning to accept pain. CBT teaches people to recognize when their thoughts might become distorted and gives them techniques to find helpful alternatives to those thoughts. DBT helps people find ways to accept themselves, feel safe, and manage their emotions to help regulate potentially destructive or harmful behaviours.

Both CBT and DBT help people to learn constructive behaviours and reactions to distressing situations.

How did dialectical behavioural therapy develop as a treatment? What is the theoretical basis?

The theory behind the approach is that some people are prone to react in a more intense way towards certain emotional situations, primarily those found in romantic, family and friend relationships. DBT theory suggests that some people’s arousal levels in such situations can increase far more quickly than the average person’s, attain a higher level of emotional stimulation, and take a significant amount of time to return to baseline arousal levels.

People who are diagnosed with borderline personality disorder (BPD) experience extreme swings in their emotions, see the world in black-and-white shades, and seem to always be jumping from one crisis to another. These people don’t have any methods for coping with these sudden, intense changes of emotion and haven’t learnt ways of soothing and comforting themselves. DBT is a method of teaching skills that will help them towards this goal.

The main components of DBT include:

A) Mindfulness – this component helps people learn to be attentive to the present moment and improve self-awareness.

B) Interpersonal effectiveness – this includes teaching people assertive communication, conflict resolution and problem solving.

C) Emotion regulation techniques – this includes people learning to identify emotions, name them, develop a “wise mind” and increase positive emotional events.

D) Distress tolerance – this includes teaching people to accept reality without being judgmental of their position. Distraction and self-soothing are part of the core skills that people learn in this process.

Which conditions or difficulties is it most suited to – and why?

DBT was initially developed to help people with a diagnosis of borderline personality disorder, self-injurious behaviour and substance abuse within a context of BPD. However, it is now used to help people with other mental health difficulties and there is ongoing research looking at how DBT can help people with post-traumatic stress, binge eating disorder and mood disorders.

Visit Dr Sotrilli’s Top Doctors profile to book an appointment.

Reference:

Marsha M. Linehan (2015). DBT skills training manual, the Guildford press, New York