What is Dialectical Behaviour Therapy (DBT)?

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What is DBT?

Dialectical Behaviour Therapy (DBT) is a NICE-recommended therapy (National Institute Clinical Excellence) for treatment of self-harm, suicidality and high-risk impulsive behaviours. It was developed to help people who experience intense emotions that can lead to self-destructive behaviours.

NICE guidelines base their recommendations on a thorough review of clinical research to make recommendations for treatment provision in the NHS. DBT is one of the few therapies consistently shown to reduce high-risk behaviours and improve emotional regulation.

Structure of DBT Sessions

DBT is normally run as a year long programme consisting of:

  • Weekly one-to-one therapy sessions
  • Skills group sessions
  • Telephone coaching

Sessions follow a structure prioritising life-threatening behaviours such as self-harm and suicidal thoughts. The basic premise here is you must be alive to attend therapy. The skills training component teaches skills in four core modules as seen below.

Core Skills in DBT

The DBT skills programme teaches skills in four key areas, which help individuals manage their emotions and relationships more effectively.

1. Mindfulness

Learning skills to be more present in the moment. Most people who come to DBT struggle to be truly present as the present moment is too painful. Mindfulness is a process of teaching how to be with our experience and relationship with ourselves. This diminishes the power of the emotion and offers more opportunity to proceed with decisions that we wont regret (less impulsive behaviours!)

2. Distress Tolerance

Key skills to calm you down when completely overwhelmed and in crisis without needing to act in a way that risks making the situation worse i.e. self-harm, binge drinking etc

3. Emotion Regulation

Helpful skills to be able to identify emotions, how they feel both on an emotional level but also physically in the body. How our emotions help us communicate things to us and to others and most importantly how we can regulate them.

4. Interpersonal Effectiveness

Key skills to help you challenge any beliefs you might hold about what you deserve or don’t deserve in relationships, how to ask for things from others. How to say no and stick to no, balancing the needs of staying in relationship with negotiating our own needs as well as communicating in a way that upholds our self-respect so we feel good about ourselves. Building new relationships is key but its also important to know how to maintain relationships to stop them deteriorating and knowing how / when to end relationships as well.

Purpose of DBT

Contrary to belief it is not a suicide prevention programme but a programme for helping individuals build a life that is worth living. Having a life that has purpose and meaning in it reduces the risk of us feeling anxious or depressed, it also protects us against the challenges that life will inevitably throw. DBT is an integrated therapy that combines multiple approaches of other therapies that have been tried and tested over the years and proven to work.

What Makes DBT Unique?

What makes DBT stand out is that it is a therapy that constantly evolves between the dialectics (opposites) of acceptance and change. This means accepting situations as they are in that moment (acceptance doesn’t mean approval though!) this opens up the opportunity to then make changes through using different skills and approaches.

A DBT therapist will also provide direct guidance as required which is less common in other types of psychotherapies.

DBT is a powerful, evidence-based approach for those struggling with emotional dysregulation, self-harm, or impulsive behaviours. Through its structured programme and practical skills training, clients can gain control of their emotions and relationships while building a meaningful, fulfilling life.

Need Support?

If you’re considering DBT for yourself or someone else, get in touch today for more information on how I can help.

FAQs

Is DBT only for people with Borderline Personality Disorder?

No. While DBT was originally developed for individuals with Borderline Personality Disorder (BPD), it is now used to treat a wide range of mental health challenges, including depression, anxiety, eating disorders, PTSD, and self-harm. DBT can benefit anyone struggling with intense emotions or impulsive behaviours.

How is DBT different from CBT?

DBT is a type of Cognitive Behavioural Therapy (CBT) but with key differences. DBT focuses more on balancing acceptance and change, uses mindfulness and emotional regulation skills, and often involves group sessions and phone coaching. CBT focuses more on changing thought patterns without as much emphasis on acceptance or emotional tolerance.

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