Dialectical Behaviour Therapy (DBT)

What is DBT and what is it for?

Dialectical Behaviour Therapy (DBT) is a Cognitive Behavioural treatment for people who experience difficulties in managing their emotions and who may have found ways of coping as self-harm and attempted suicide.

People who may benefit from DBT are likely to have behaviours consistent with the diagnosis of Borderline Personality Disorder, such as:

Sudden mood changes that feel intense and overwhelming;
Acting in self-damaging ways such as drinking too much or taking drugs, spending too much, uncontrollable eating, having sex with people you hardly know, or “unsafe” sex ;
Problems in relationships which may be intense and unstable possibly related to a fear of being abandoned;
Being unsure of your identity, perhaps involving lots of sudden changes in goals, career plans, religious beliefs, or simply being different things with different people
Problems thinking straight such as getting spaced out or confused;
Feelings of emptiness inside;
Self -harming as a way of managing difficult emotions.

How does it work?

Some people’s lives can feel unbearable. DBT aims to decrease emotional suffering and help build a life worth living.

It works by focusing on set targets, especially reducing life-threatening behaviours. DBT works by teaching people specific skills to deal effectively with themselves and with the world around them. In particular, the treatment focuses on:

Core mindfulness

Mindfulness is central to DBT. The skills taught are psychological and behavioural meditation practices drawn from Eastern traditions. It focuses on states of mind known as “emotion mind” and “rational mind” and attempts to balance these two to produce a third mental state known as “wise mind”.

Interpersonal effectiveness

This is learning how to be effective in getting what you want, saying “no” and dealing with conflicts within relationships whilst maintaining self-respect.

Emotion regulation

This teaches how to understand and label emotions. It also teaches skills to enable you to deal with intense and painful emotional states, and helps you to put things in place that will bring about more positive emotions

Distress tolerance

This teaches crisis survival skills to help you cope when you can’t immediately make changes for the better. As the name suggests, it also teaches how to tolerate difficult feelings, without resorting to impulsive strategies or ways that only make things worse.

What will happen if I am referred for DBT?

Someone from the DBT team will meet to assess you .

We may ask you complete some questionnaires to help work out your diagnosis and whether DBT is likely to help you or whether other therapies would be more suitable.

If DBT is suitable, we may invite you for some one to one pre-treatment sessions with a DBT therapist to learn about the therapy, identify goals, try a few skills and to resolve any potential obstacles to fully engaging in DBT.

Then, if appropriate, we will together write up a treatment agreement. This will set out what we you can expect from us and what we will expect from you.

What happens next?

You will then be expected to commit to treatment, to attend regular one to one sessions with an individual therapist and to attend group skills training sessions.

You may also get telephone coaching with your one to one therapist if s/he is able to provide this.

You will have to fill out a weekly diary card and will be expected to try new skills and keep practicing them.

How effective is DBT?

DBT has been found to be effective in seven clinical research trials (which compared DBT with other treatments) for people with Borderline Personality Disorder (BPD) and self-harming behaviours.

National Institute of Health and Clinical Excellence (NICE) guidelines propose DBT as the treatment for women with Borderline Personality Disorder (BPD) where reducing recurrent self-harm is a priority.