Dialectical Behaviour Therapy (DBT)
Changes That Can Change Lives
Although people often talk about therapy as though it were just one thing, the truth is that there are many different styles practitioners can use to help people improve their mental health. There’s a good reason for the range of therapeutic approaches; mental health isn’t a one-size-fits-all situation.
Among the options to consider is Dialectic Behaviour Therapy (DBT), which is one of the approaches that we offer at Trillium Counselling. Here’s a look at what DBT is and how it can help.
What is Dialectic Behaviour Therapy?
Before we talk about what DBT can do, let’s dig into what it is. DBT was originally created to address the needs of patients with borderline personality disorder (BPD), especially women who had demonstrated suicidal behaviours. BPD is notoriously difficult to treat.
This evidence-based approach has not only been shown to help people in that specific population, but its use has also been expanded to support people with other conditions too. It’s been demonstrated to be effective in patients with substance-use disorders, binge-eating disorders, depression, and PTSD.
Dialectical Behaviour Therapy was founded by Dr. Marsha Linehan in the late 1980s, as a professor of psychology at the University of Washington. with its original intent to treat those with Borderline personality disorder and suicidal ideation. Marsha Linehan also founded Behavioural Tech which is an institute developed specifically to train therapists to work with complex disorders using scientifically valid treatments, such as DBT.
DBT is a form of Cognitive Behavioural Therapy, and it emphasizes helping the patient to accept themselves, their feelings and thoughts, and the world as it is in the moment.
DBT Therapy Techniques
The main issue that DBT focuses on is emotional regulation. One way therapists approach this is by helping patients develop mindfulness skills. Nonjudgmental awareness of what’s happening and how you’re feeling can help you cope with intense emotions, instead of getting stuck in a reactive state.
Therapists also work to help patients learn to tolerate distress without resorting to unhealthy coping mechanisms. They guide them to become more effective in interpersonal relationships, to maintain respectful interactions, and to communicate and listen well, even in difficult moments.
DBT Therapy Skills
These are some pretty big concepts, but how does it work in practice? DBT can be used in individual therapy or group therapy settings, but in either setting, it includes activities to help patients learn how to apply them to their lives. Here are a few examples of techniques therapists may use to help patients develop these skills.
1. Strengthen Mindfulness
In order to strengthen mindfulness skills, a therapist could walk a patient through breathing exercises that they can turn to in difficult moments. Practicing these skills during calm times helps people remember how to use them when they're feeling difficult emotions.
2. Distress Tolerance
To help a patient boost their distress tolerance, a therapist might coach them in non-harmful ways they can distract themselves when painful feelings are high. For example, they could simply get up and walk around to give their emotions time to subside and become more manageable.
Emotional regulation teaches us skills to help manage and mitigate intense emotions. DBT helps clients develop strategies to regulate their emotional states (anger, depressed, anxious, intensely frustrated etc.). Developing this skillset includes
- Identify and label emotions (increase mindfulness to current emotions)
- Reduce vulnerability to the emotional mind
- Identify obstacles to changing emotions
4. Interpersonal Effectiveness
Interpersonal effectiveness can improve by learning different ways to interact. A therapist might offer the acronym GIVE to remind a patient to be Gentle, show Interest in others, Validate others' feelings, and have an Easy attitude.
How Does DBT Therapy Work?
Whatever specific techniques are used, there are five basic functions that DBT seeks to fulfill.
DBT Therapy Steps – The Five Components of Treatment
1. Enhancing capabilities
Therapists approach DBT from the standpoint that patients lack certain life skills, such as emotional regulation. Rather than exploring the historical reasons for these gaps in their understanding, they focus on learning and using these skills.
2. Generalizing capabilities
It’s great to understand a different approach–such as choosing not to react in a way that will make a difficult moment worse–but if you forget that new approach the moment you start arguing with your partner, it’s not very helpful. One of the goals of therapy is to learn to use these new skills in real-life situations.
3. Improve motivation and reduce dysfunctional behaviours
Patients fill out self-monitoring forms to help them track their progress in their treatment goals. The therapist uses this information to guide the session focus, helping the patient understand their choices in different situations. They work on the skill that could help them in those situations.
4. Enhancing and maintaining therapists’ capabilities and motivation
This largely applies to therapists who work with patients with BPD. Professional support and guidance helps therapists maintain their focus and goals.
5. Structuring the environment
The patient learns within a supportive therapeutic setting how to manage their own environment to support their goals. This can be as simple as learning not to engage in difficult discussions when they’re tired, or as involved as disengaging from social circles that encourage self-destructive behaviour.
Benefits of DBT Therapy
A core component of DBT is to ensure the development of a structured environment. This includes having a support network for when you are dealing with your mental health challenge so that you don’t feel like you are alone in your therapy. Interpersonal effectiveness is an important component of the DBT process, which helps us understand the importance of social relationships.
The skills learned help us in building and maintaining relationships with trust and respectful boundaries – healthy relationships, which have lasting impacts on our lives.
Skills For Life
The skills that are learned and developed during your DBT therapy are very useful for improving your current mental health state and work to enhance your capabilities. However, the benefits of these skills don’t just end when you improve your mental state. These same skills can continue to be used over and over in other areas of your life (home, work, school etc.)
Improve Quality of Life
As in other therapies, one of the main focuses of DBT therapy is to enhance quality of life. For clients who are experiencing intense emotions and trauma the impact of their mental health on the quality of life can be very high.
Therapy is a process and DBT therapy works to help clients understand and accept there are sometimes challenges. Working with a DBT therapist to develop a core skillset (particularly to regulate and manage emotions) and ensure they understand they aren’t alone. This collaboration and skill development helps clients move in the right direction towards healing.
A Few Things to Consider
Although DBT shows a lot of promise in helping patients live calmer, happier lives, there are a few things to think about before deciding if it’s for you.
First of all, it isn’t a quick fix. To benefit from DBT, you’ll have to invest time and effort. It requires patients to do work outside of therapy sessions. These exercises help you develop the skills you’re working on, and they’re the best way to achieve the progress you’re seeking.
It can also be difficult to confront painful emotions, but coping with these feelings is a central goal of DBT. An experienced therapist will help you navigate these challenges, but only you know if you’re ready to take them on.
Criticism of DBT Therapy
Although DBT therapy was originally developed specifically for use with Borderline Personality Disorder (BPD), it has since become more mainstream in its use of other mental health issues such as depression and trauma. It has been pointed out however that DBT should not necessarily be used as the only method for those with trauma as there is no element of trauma processing. Other therapeutic techniques such as EMDR or CBT would be of better use for those instances. Often a therapist would use an eclectic approach with a client and draw from a number of different methods with DBT being another tool in the toolbox.
Is DBT the Right Approach For You?
Many people have turned to DBT to gain important skills that help them live happier, healthier lives. In the hands of a skilled therapist, it can help patients free themselves of being controlled by their emotions, so they can choose the life they want.
If you’re interested in DBT or want more guidance to decide if it’s the best choice for you, contact us for more information. Our therapists are happy to share their expertise and help you start your journey to find the mental wellness you’re searching for.
Therapists Practicing Dialectical Behavioural Therapy (DBT)
Registered Social Worker,
Rosemary believes that people are resilient, and that people can adapt and find hope in the most difficult of times, when they receive the support that they need.
Registered Social Worker,
I strongly believe that everyone has the capacity for change already within themselves – I aim to empower individuals towards their unique goals in ways that are meaningful to the life they want to live
MSW, RSW -
Registered Social Worker,
“I recognize how much strength and courage it takes to reach out for help in times of suffering. I’d be honoured to be apart of your journey towards wellness.”