Dialectical Behaviour Therapy (DBT), developed by Marsha Linehan PhD at the University of Washington, is a type of psychotherapy that focuses on behavioural change for individuals with extreme emotions and distress. The “D” means “dialectical.” A dialectic is a synthesis or integration of opposites. In DBT, dialectical strategies help both the therapist and the client get unstuck from extreme positions. Dialectical strategies keep the therapy in balance and help clients reach their ultimate goals as quickly as possible. The “B” stands for “behavioural.” DBT requires a behavioural approach. This means that we assess the situations and target behaviours that are relevant to our clients’ goals in order to figure out how to solve the problems in their lives. The “T” stands for “therapy” which DBT is.
Research Support for Dialectical Behaviour Therapy
DBT was the first psychotherapy shown to be effective in treating BPD in controlled clinical trials — the most rigourous type of clinical research. While DBT is no longer the only therapy to have shown effectiveness in controlled trials, it has grown a large evidence base and is considered one of the best treatments for BPD in terms of documented success rates.
Theoretical Basis for Dialectical Behaviour Therapy
DBT is based on Dr. Linehan’s theory that the core problem in BPD is emotion dysregulation, resulting from mixing biology (e.g., genetic and other biological risk factors) and an emotionally unstable childhood environment (e.g., where caregivers punish, trivialise or respond erratically to the child’s expression of emotion) together. The focus of DBT is on helping the client learn and apply skills that will decrease emotion dysregulation and unhealthy attempts to cope with strong emotions
What to Expect in Dialectical Behaviour Therapy.
Usually, DBT includes a combination of group skills training, individual psychotherapy and phone coaching, although there are exceptions. Patients in DBT are asked to monitor their symptoms and use of learned skills daily, while their progress is tracked throughout therapy.
There are five main sets of skills that are covered in DBT skills training.
Mindfulness Meditation Skills. These skills centre on learning to observe, describe and participate in all experiences (including thoughts, sensations, emotions and things happening externally in the environment) without judging these experiences as “good” or “bad.” These are considered “core” skills that are necessary in order to implement the other DBT skills successfully.
Middle Path Skills. Middle path skills are used to balance acceptance versus change. They teach acceptance of others and yourself as well as change strategies to help modify behaviours. The skills are described as dialectics, validation and behaviouralism is the key of Walking the Middle Path.
Interpersonal Effectiveness Skills. The focus of this skill module is on learning to successfully assert your needs and to manage conflict in relationships.
Distress Tolerance Skills. The distress tolerance skills module promotes learning ways to accept and tolerate distress without doing anything that will make the distress worse in the long run (e.g., engaging in self-harm).
Emotion Regulation Skills. In this module, patients learn to identify and manage emotional reactions.