WHAT IS DBT?
DBT stands for Dialectical Behaviour Therapy, It's quite a mouthful, but what does it is mean? DBT is a form of talking therapy and is based on cognitive behavioural therapy (CBT) techniques. It has been adapted to help those who experience a very intense set of emotions.
DBT was originally developed by psychologist Marsha Linehan to treat chronically suicidal individuals with borderline personality disorder. It has grown to become one of (if not 'the') most effective and recognised treatments for those with that condition.
It offers people a chance to manage difficult emotions by letting them experience, recognise and accept them. It can get very Zen-like.
Whilst it may be based on CBT, it differs from it in a number of ways. Whilst CBT focuses on helping you to change the unhelpful ways you think and behave, DBT includes those, but also focusses on accepting who you are. In addition, it also places more importance on the relationship you have with your therapist. This relationship becomes a key part of your motivation to change.
Sessions can operate on a one-to-one basis or as part of a group. There may also be telephone consultations that take place between you and your therapist.
Because of the nature of the work, therapists usually work in teams, rather than independently. They will have sessions themselves, to share best practice or discuss any issues that arise in their sessions. Overall, treatment usually lasts about a year.
'Dialectical' isn't a word you hear often, unless you're a DBT therapist of course. You might be thinking that, as far as DBT is concerned, its core skills of 'accepting' and 'changing' seem to offer opposing goals that, on first thought, appear to contradict each other, but wait! Let us explain.
HOW DOES DBT WORK?
DBT includes four core components of behavioural skills:
- Mindfulness (underpinned by Zen and contemplative practices) allows those undertaking DBT to become aware and present in the moments.
- Distress Tolerance; How to tolerate pain in difficult situations, rather than change it.
- Interpersonal Effectiveness; Asking for what you want and saying no, whilst maintaining self-respect and your relationships with others.
- Emotion Regulation; How to change the emotions that you do want to chage.
The first two of these focus are 'acceptance-orientated' skills, whereas the latter two are 'change-orientated' skills. As a treatment, DBT is divided into three main stages, although some people need Stage 4.
- At the first stage, the person seeking treatment will be severely depressed, their behaviour will have been deemed to be out-of-control and they may well be suicidial, self-harming or partaking in other self-destructive behaviours. The purpose of the first stage is to move them from being 'out-of-control' into a state where their behaviour is under control. These can often be life-threatening behaviours so are tackled first (obviously) to keep the person safe.
- Once under control, Stage 2 will accept that they still have problems and may continue to suffer, even though they will be in a state of quiet desperation; their emotional experience will be inhibited. The goal of this stage is to help them move from this state into one of full emotional experiencing by addressing issues that might interfere with the treatment. This can include everything from personal problems, money worries, being late for your appointment to issues the therapist may have. If the person undergoing treatment is suffering from PTSD, this is the stage at which this will be treated.
- Stage 3 is where the change-orientated aspects comes into play. This is when they learn to live, to define their life goals, build their self-respect, find peace and happiness and improve their quality of life. This doesn't mean that they can never be 'unhappy', but that they learn to find 'normal' levels of happiness and unhappiness. For some this is the final stage, but others may need to go to Stage 4.
- Stage 4 is for those looking to find a deeper meaning through a spiritual existence (I told you it was quite Zen-like). If the new goals of 'ordinary happiness / unhappiness' aren't enough for you, then stage 4 will concentrate on how you can move towards a more complete sense of self, joy and freedom.
WHO IS DBT FOR?
As we've mentioned, dialectical behaviour therapy is a popular treatment for those living with borderline personality disorder or any condition that experiences very intense emotional states. It also helps those who self-harm.
It has been shown to be effective in treating other disorders including depression, eating disorders and PTSD. Whilst not necessarily related to mental health, it is also helpful for those with a dependance on substances like drugs and alcohol.
No treatment will be 100% successful for 100% of the people who try it. It may work for you, or it may not. You may need to ask some hard questions of yourself and your therapist if you don't think DBT is helping.
It is worth noting that, if you're in the UK, that not all NHS Trusts offer DBT. You should contact your local PALS group to find out more.