What is Dialectical Behaviour Therapy (DBT)?

DBT is a National Institute Clinical Excellence (NICE) recommended therapy for the treatment of self-harm, suicidality and high risk impulsive behaviours. NICE carry out research of all the research around to then make recommendations for treatment provision in the NHS.

DBT is normally run as a year long programme consisting of weekly 1:1 sessions, skills group therapy and 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:

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, 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.

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 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.