ABOUT Dialectical Behaviour Therapy (DBT)

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Dialectical Behaviour Therapy (DBT) is a structured form of evidence-based therapy that emphasises on building 4 essential skills (mindfulness, distress tolerance, emotional regulation and interpersonal effectiveness). Originally developed for borderline personality disorder (BPD), the function of DBT has now extended to manage various forms of mental health concerns: 

 

• Eating disorders

• Substance use problems

• Suicidal behaviour

• Depression

• Anxiety disorders

• Bipolar disorder

• Borderline Personality Disorder

 

DBT is a form of cognitive behavioural therapy (CBT). DBT builds on the elements of CBT with its own tools to strengthen the psychoeducation component and to help one develop resources in dealing with difficult emotions and situations. Dialectical (the “D” in DBT) refers to the integration of two opposites and is grounded in the idea of balancing both change and acceptance. For example, a therapist can help a client understand that while it is reasonable to engage in dysfunctional behaviour (in response to stressful situations), it may be helpful to find healthier and more adaptive ways of coping. In other words, DBT helps clients accept and validate their experiences, while finding ways to change dysfunctional responses over time.

 

Benefits of DBT

• Enhanced mindfulness

• Increased distress tolerance 

• Increased internal resources and skills 

• Better emotional regulation 

• Healthier boundaries and better communication

• Improved relationships

• Greater sense of self-acceptance

• Reduced suicidal thoughts and behaviour

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4 Core Skills of DBT

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1. Mindfulness

 

Mindfulness is a fundamental skill of DBT and sets the foundation of the other three skills. Essentially, mindfulness focuses on encouraging one to attend to the present moment, observe the situation and experiences without judgement. Mindfulness in DBT helps the client in managing difficult emotions, lower stress levels and improve relationships with others. 

 

2. Distress tolerance

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Distress tolerance is an important skill in dealing with difficult life experiences, crises and intense emotions. It refers to the ability to manage these actual or perceived life stressors. Clients can gradually increase their distress tolerance by learning skills such as identifying distracting and pleasurable activities; grounding, radical acceptance and identifying an emotional crisis. Using these tools, clients can learn to better cope with these intense emotions and reduce the likelihood of maladaptive impulsive behaviour. 

 

3. Emotional regulation

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Unlike distress tolerance, emotional regulation focuses on managing emotions before they become too intense. Because many of the unhelpful and maladaptive behaviours are strongly associated with emotional dysregulation, DBT includes many behavioural skills that help clients learn to recognise, label and regulate emotions. Emotions are also closely linked to thoughts. During DBT sessions, therapists help clients identify negative thinking patterns that have shaped their emotional experiences over time, and clients will learn strategies to adjust these patterns. 

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4. Interpersonal effectiveness

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As the final skill of DBT, it builds on the foundations of the previously learned skills to help the client identify their communication style, learn assertiveness, set interpersonal boundaries, build trust, and manage conflict. Specifically, clients learn to communicate in a healthy and assertive manner that strengthens their self-respect and confidence, and lower feelings of resentment. This is an essential skill as healthy interpersonal skills will lead to fulfilling relationships in the long run, resulting in meaningful social support for the client. On the other hand, remaining in the same negative loop of poor interpersonal skills can result in increased social isolation, depression, and chronic relationship issues.