Dialectical Behaviour Therapy (DBT)

What is Dialectical Behaviour Therapy (DBT)?

DBT is a form of therapy that was developed from CBT. Its main goals are to teach people how to live in the moment, develop healthy ways to cope with stress, regulate their emotions, and improve their relationships with others.

 “Dialectical” can mean change through the acceptance that two opposing things can both be true. Within DBT the use of “dialectical” captures the sense of balancing both acceptance and change, two forces which can often feel in opposition. Acceptance techniques are developed to help you understand yourself, make sense of why you use the coping behaviours you do, and to be more accepting of those difficult emotions. At the same time change techniques give you skills to change behaviours that can be unhelpful to you (such as bingeing, purging or self-harming) and to use alternative ways of managing distress.

How does DBT work?

Full DBT consists of several components: skills training, individual therapy sessions, in the moment telephone coaching, and DBT consultation groups for the therapists. I am not able to offer this, but I do find it helpful to draw on DBT, especially integrating some of the skills training into individual sessions.

Skills training is made up of 4 key modules:

  • Mindfulness - the practice of being fully aware and present in the moment

  • Distress Tolerance: how to tolerate distressing feelings

  • Interpersonal Effectiveness: how to express one’s needs and set boundaries to build healthy relationships

  • Emotion Regulation: how to change emotions that you want to change

 Who is DBT helpful for?

Although it was first intended as a treatment for people with borderline personality disorder, it has since been found to be useful for the treatment of eating disorders when the eating disorder is being used as a way of managing difficult emotions.

DBT can be a useful approach if CBT-E is not sufficient – particularly in cases where eating disorders are being used as a way of managing powerful emotions. However, DBT is best suited to people who want to engage in quite practical “here and now” treatment. There is a strong emphasis on learning skills and tools, and on practising these between sessions.