Dialectical behavior therapy (DBT) is a type of talking therapy that aims to teach individuals ways of living more ‘in the moment’. As a modified type of cognitive-behavioral therapy (CBT), it helps people develop healthy ways to cope with stress, regulate their emotions, and improve their relationships.

What is DBT Therapy?

DBT therapy is an evidence-based treatment for multiple mental health illnesses and addiction, proving to be an especially effective treatment for those who feel intense emotions. DBT combines standard cognitive-behavioral treatment methods for emotional regulation with concepts of distress tolerance, acceptance, and mindful awareness. As a result, it can be particularly helpful for people who experience difficulty with emotional regulation or those struggling to control self-destructive behaviors, including self-harm, eating disorders such as bulimia nervosa, and alcohol abuse. DBT therapy helps people understand how two things that may seem like opposites can both be true. For example, this could mean accepting that everything is different, yet every day feels the same, or acknowledging that your experiences and behaviors are valid but working to change them and learn to manage emotions in order to move forward. Dialectic behavior therapy shares the belief that you can be accepting of yourself and want to change your behavior, even though this may feel contradictory.

How Does DBT Work?

DBT therapists use a range of techniques to help a person work through the issues they have been dealing with. Dialectical behavioral therapy often combines group therapy with individual therapy sessions.

Mindfulness Skills

A core benefit of DBT is the development of mindfulness skills, where clients are encouraged to focus on the present or “live in the present moment.” Mindfulness skills training generally begins in individual therapy and can help clients pay attention to their thoughts, feelings, sensations, and impulses from moment to moment. Clients also learn to use their senses to gain a deeper assessment or understanding of what is happening around them. Mindfulness relies heavily on the principle of acceptance and regular practice encourages observation of emotions or reactions in a non-judgmental way.

Developing mindfulness can help those experiencing intense negative emotions or other intense emotions to become more aware and grounded in a moment or place. This can be particularly helpful for practising healthy coping skills when an individual feels as if they are in crisis, are being triggered, or are having a flashback. Mindfulness strategies can help you interrupt or avoid automatic negative thought patterns before they seem ‘uncontrollable’. Key mindfulness practices include; focusing on five things you can see, four things you can hear, three things you can touch, two things you can smell and one thing you can taste. And also focusing on the sensation of the belly rising and falling as you breathe.

Distress Tolerance

Distress tolerance skills help you with handling a crisis through actions such as:

• Distraction

• Improving the moment

• Self-soothing

• Thinking of the pros and cons of not tolerating distress

These may seem relatively simple or basic actions to take, but they can make a difference in interrupting an intensifying cycle of negative thought. Distress tolerance tactics are more situational than mindfulness techniques and may be used in combination with them.

In moments that you may feel out of control or as if you are about to lose control, it serves as a reminder that you are in control of your body. This can be done by simple tasks such as getting up and going for a walk, running up and down the stairs, or going outside. DBT therapists can help you expand your toolkit and increase your feeling of control or autonomy in high-stress situations.

Emotion Regulation Skills

Emotional regulation can be challenging for people for a number of reasons, for example, due to a biological vulnerability to emotional sensitivity, having experienced abuse or trauma – especially during childhood – and in some cases, as a result of not having been shown or taught how to manage difficult emotions.

Developing emotional regulation skills begins with working on recognizing when you are having an emotional response and understanding what that response is. In DBT, this often begins with accepting your emotional responses as opposed to rejecting them or reacting to them with a feeling of discomfort or fear.

Dialectical behavioral therapy, therefore, addresses the dialectic, or contrast in the feeling of acceptance of these emotions, while working on strategies that allow you to reduce the intensity of the emotions you’re feeling and avoid damaging behavior that you may normally engage in when experiencing emotional pain such as self-harm, drug use or binge eating.

Working on emotion regulation can also help clients maintain healthy relationships and experience a range of positive changes in their social, work and personal lives.

Types of Dialectical Behavioral Therapy (DBT)

DBT can generally work in different settings, depending on the goals of the client and what stage they are at in the therapeutic progress. Dialectical behavior therapy sessions can be done either one to one with a DBT therapist, or trained therapists can conduct a group therapy session.

Group Setting Behavioral Therapy

Group sessions involve clients working through skills modules with other people who may be in the same or similar situation to themselves. It is quite common for DBT techniques and behavioral skills to be taught in a group setting.

Individual Behavioral Therapy

Individual therapy is done one on one with a trained professional. This can be a useful way of helping the client accept themselves in a space they feel more comfortable in. Feeling safe and able to be vulnerable is essential to radical acceptance of yourself, including emotional dysregulation. It is not easy, and often positive changes occur more quickly in one to one settings. Clients will learn to face and accept emotional pain and develop new skills to avoid behaviors like self-harm, substance abuse or violence when this pain surfaces.

What Can Dialectical Behavioral Therapy (DBT) Treat and Help With

Dialectical behavior therapy has shown success in treating a range of mental health conditions, including binge eating disorders, post-traumatic stress disorder, generalized anxiety disorder and borderline personality disorder. It has shown particular efficacy in chronically suicidal borderline clients and opioid-dependent women.

Dialectical behavioral therapy was originally designed as a treatment for borderline personality disorder (BPD) and for people showing suicidal behavior, as it became apparent that CBT alone did not work as well as expected in clients with borderline personality disorder.

PTSD

Mindfulness strategies can be particularly helpful for those with post-traumatic stress disorder (PTSD). PTSD is a mental health condition that affects those who have experienced a particularly stressful or traumatic event. Any situation that a person finds traumatic can cause PTSD, including:

• serious road accidents

• natural disasters

• violent assaults such as sexual assault

• serious health problems

• traumatic childbirth experiences

After such events, people often experience some symptoms of PTSD, including feeling numb, hyperarousal or insomnia. For many, these symptoms pass within a few weeks, but if they remain for longer than a month or get worse, you may be given a diagnosis of PTSD.

When people with PTSD are triggered, they can feel as if they are reliving a traumatic event as if they are really there. The mindfulness strategies that DBT teaches can help clients with connecting to their senses and environment, which can often ground people that are having a panic attack or a flashback.

Borderline Personality Disorder (BPD)

Borderline personality disorder can be a controversial diagnosis that some prefer not to use; however, despite how you understand your problems, dialectical behavioral therapy could help you manage them. Clinical trials have shown that DBT is effective in treating borderline personality disorder (BPD) and other related mental health problems, as well as suicidal behavior and drug and alcohol dependence. One study even found that after a year of DBT, 77% of clients no longer met the criteria for borderline personality disorder.

People with personality disorders such as borderline personality disorder may also have a co-occurring diagnosis of mental health conditions such as depression, eating disorders -including binge eating disorder – or may engage in self-injurious behaviors. In these cases developing DBT skills through dialectical behavior therapy (DBT) can help clients develop coping mechanisms to deal with everyday stressors.

DBT for Addiction

While there is no conclusive clinical evidence that dialectical behavior therapy helps treat a stand-alone substance use disorder (SUD), several studies have shown that dialectical behavior therapy (DBT) can be an incredibly useful component in a holistic treatment plan for those with a SUD. Such treatment plans include a variety of treatment options to address the SUD and co-occurring mental health disorders, such as depression or PTSD.

Other Mental Health Problems

Though developed with borderline personality disorder (BPD) in mind and shown to be particularly effective in PTSD, DBT might also be an effective treatment for:

• Bipolar disorder

• Eating disorders (such as anorexia nervosa, binge eating disorder, and bulimia nervosa)

• Generalized anxiety disorder (GAD)

• Attention Deficit Hyperactivity Disorder (ADHD)

• Major depressive disorder (including depression resistant to antidepressant medications)

• Obsessive-compulsive disorder (OCD)

• Substance use disorder

• Suicidal behavior

If you wish to learn more about DBT or speak to a member of our friendly, professional team, contact The Revoke Programme today.