Janelle Stanbury, Clinical Psychologist

Dialectical Behavior Therapy (DBT) is an evidence–based treatment approach developed by Dr. Marsha Linehan for people who have emotions they are unable to manage in constructive ways. People who have difficulty in regulating emotions typically suffer with intense and painful emotions from which they may feel there is no escape. They may also experience quick shifts from one emotion to another and may feel like emotions are controlling their life.

Struggling with intense emotions often results in impulsive or emotion-based actions that cause further pain and problems such as angry outbursts, being emotionally paralysed, suicide attempts/self harm, substance abuse, overspending, gambling, or eating disorders. These symptoms are most often associated with severe depression and/or Borderline Personality Disorder (BPD).

DBT offers alternative ways to manage feelings, deal with painful situations, and improve relationships. DBT therapists understand the emotional sensitivity and offer practical and powerful ways to build a functional life.
What are the treatment goals of DBT?

Like every type of therapy, DBT has some main treatment goals. These are:

  • Developing an increasing awareness of and sense of control over emotions and behaviour.
  • Moving from being emotionally shut down to experiencing emotions fully.
  • Building an ordinary life, solving ordinary life problems with a focus improving quality of relationships.
  • Working with feelings of emptiness to developing completeness/connection.
  • Learning to trust your own emotions, thoughts and behaviour.

How is DBT structured?

DBT includes individual therapy, separate skills training (often in a group), skills coaching by phone between sessions and a treatment team concept.

The DBT individual therapist will work with clients to create a life worth living. The therapy balances empathy and warm acceptance with an unwavering focus on changing problem behaviour. Through this balance, DBT aims to help change the patterns associated with problems in living, while promoting the development of and reliance on inner wisdom.

The specific goal of skills training is to teach DBT skills in an efficient and effective manner, using examples and problems taken from the present. Skills are taught in the areas of Mindfulness, Distress Tolerance, Interpersonal Effectiveness and Emotion Regulation.

Phone skills coaching is worked out with individual therapists.

What skills will I learn in DBT?

The four groups of skills that taught in DBT are:

Mindfulness - This is the core skill behind DBT. Mindfulness allows you to become aware of the flow of your thoughts, feelings, emotions and actions in the present moment in a non-judgmental way.

Interpersonal effectiveness – These skills focus on the ability to mindfully attend to relationships with so that you can achieve goals in interpersonal situations whilst at the same time maintaining the relationship and your self-respect.

Emotion regulation – These skills focus on the ability to regulate emotions through being able to identify and label the emotions you are feeling, moderate them and use them to guide your actions rather than have emotions drive your life.

Distress tolerance - These skills focus on your ability to accept, in a compassionate and non-judgemental way, both yourself and the current situation. These skills are concerned with tolerating and surviving crises and accepting life as it is in the moment.

What is Borderline Personality Disorder?

People with Borderline Personality Disorder (BPD) have extreme difficulty in regulating their emotions and this has consequences for the way they think, behave, their sense of self and the quality of their relationships.
Below are several symptoms of borderline personality disorder:

  • Having emotions that are up and down (for example, feeling confident one day and feeling despair another), with feelings of emptiness and often anger.
  • Difficulty in making and maintaining relationships.
  • Having an unstable sense of identity, such as thinking differently about yourself depending on who you are with.
  • Taking risks or doing things without thinking about the consequences
  • Harming yourself or thinking about harming yourself (for example, cutting yourself or overdosing).
  • Fearing being abandoned or rejected or being alone.
  • Sometimes believing in things that are not real or true (called delusions) or seeing or hearing things that are not really there (called hallucinations).

People with BPD often feel empty, out of control, powerless, and angry a lot of the time. They usually experience repeated crises in their life and struggle with long-term depression, anxiety and/or other mental illness such as eating disorders or substance misuse.

If after reading this you feel you may have BPD, talk to your GP, a clinician psychologist or a psychiatrist about your symptoms. Be very wary of making a self-diagnosis.

Links

You can read more about DBT related research and the technical aspects of DBT at Dr Marsha Linehan’s site: http://behavioraltech.org/index.cfm
A good consumer website for DBT is http://www.dbtselfhelp.com/