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Dialectical Behavioural Therapy

DBT; vector image of woman balancing emotions

Dialectical Behaviour Therapy, or DBT, is a unique therapy that helps you to handle your emotions better and improve your emotional well-being.

I trained in DBT post-qualifying as a psychologist when I worked as part of a DBT team in the NHS, and I have used the model to inform my practice ever since.

What is DBT?

DBT is a kind of therapy that Dr. Marsha Linehan created in the late 1980s1. While some therapies, like CBT (Cognitive Behavioural Therapy), focus on changing our thoughts, DBT focuses more on accepting feelings and changing behaviours. It was initially designed to help people with borderline personality disorder but has since been used for many other conditions like anxiety, eating disorders, and even ADHD1..

How Does DBT Work?

DBT stands out because it balances two main ideas: acceptance and change2. This is the dialectic in Dialectical Behavioural Therapy, and for me, it is one of the wonderful things about this model as it teaches you to accept your feelings.

And while you learn to accept and understand your feelings, you also learn how to change harmful behaviours. So, instead of getting stuck thinking, “I shouldn’t feel this way,” you learn to say “I feel this way, and that’s okay. Now, what can I do about it?”

The term ‘dialectical’ encapsulates the essence of DBT. It reflects the notion that seemingly opposing beliefs or thoughts can coexist as truths. In the DBT realm, this means harmonizing acceptance (self-acceptance) with behavioural change. Thus, while DBT and CBT both address negative behaviours and thought patterns, DBT uniquely combines CBT’s behavioural change strategies with its own acceptance techniques.

This is such an incredibly useful skill for everyone, and it is one not to be overlooked. For example, it is bad enough if you have done something that is making you feel ashamed or embarrassed, but if you are also giving out to yourself for feeling this way, it makes you feel worse. DBT helps you to accept all your feelings, and in doing so, you do not add to your pain.

There are two main parts to DBT; individual therapy sessions with your psychologist and group skills teaching.

Skills Taught in DBT

In DBT, you can learn several helpful skills. The skills teaching element of the model are invaluable and I use them extensively when working with clients with strong emotions, such as anger. Indeed I have used the skills teaching element of DBT in my anger management course.

Mindfulness

This is all about staying in the present moment. It teaches you to focus on what’s happening right now rather than getting lost in the past or worrying about the future3.

It enables individuals to discern their feelings, emotions, and urges, promoting calmness and averting detrimental behaviours. Essentially, mindfulness is a remedy for a restless mind, enabling individuals to take control of their thoughts.


Distress Tolerance

It helps you deal with challenging situations without making them worse. For example, you might take deep breaths instead of yelling when you’re upset. Helps manage strong emotions like anger or frustration without reacting impulsively. Techniques such as distraction and self-soothing are employed to navigate intense emotions without exacerbating problems.


Emotional Regulation

This is about understanding and managing your feelings so they don’t control you. Equips individuals to identify, label, and modulate their emotions, paving the way for a constructive emotional future and effective problem-solving.


Interpersonal Effectiveness

This skill helps you communicate and get along better with others. This skill sharpens communication, enhancing relationship quality. It covers areas like assertiveness, effective listening, and handling difficult individuals.


Benefits of DBT


People who have tried DBT often find they can handle their emotions better, improve their relationships, and feel more positive overall1. It’s not just about coping but thriving in life.

DBT is not just for one type of person. It can help those who often feel overwhelmed by their emotions, act on impulse, or have difficulty getting back to a calm state after getting upset.

DBT vs. CBT

While both DBT and CBT can help people change harmful thoughts or actions, DBT also teaches acceptance. So, in CBT, you learn to change negative thoughts, while in DBT, you learn to accept your feelings and also change negative behaviours.

Conclusion
If you or someone you know struggles with intense emotions or impulsive actions, DBT might be worth considering. It offers tools and strategies for a healthier, more balanced life.

For more information, including how to access DBT, please see DBTIreland.

References
  1. Linehan, M. M. (1993). Cognitive-behavioral treatment of borderline personality disorder. Guilford Press.
  2. Chapman, A. L. (2011). The Distress Tolerance Skills Workbook. New Harbinger Publications.
  3. Kabat-Zinn, J. (1994). Wherever you go, there you are: Mindfulness meditation in everyday life. Hyperion.
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