Dialectical Behaviour Therapy (DBT)

Dialectical Behavior Therapy (DBT) is an empirically supported therapy that deals with how individuals think about themselves, the world around them, and how they cope with emotional pain. DBT is an effective technique to assist people to better understand their thoughts and feelings, while learning more effective and constructive coping mechanisms. This is accomplished through a combination of individual therapy sessions, group therapy sessions, phone coaching, and homework assignments. DBT is typically a longer-term therapy, with treatment lasting anywhere from six months to several years.

One of the core principles of the DBT is dialectics. The term dialectic refers to the existence of opposites and, true to its name, DBT balances two opposing elements. The first is to recognize and accept the reality of one’s life and behaviour. The second is to make positive changes in daily life as a step to move forward and deal with emotional pain or trauma.

Stages of DBT

A typical DBT treatment includes 4 stages of treatment, each with its own goals and objectives. The four stages of DBT therapy are designed to help clients develop the skills and strategies they need to manage their emotions and build healthier relationships. While the length of each stage can vary depending on the client's needs, the goal is always to help clients achieve a sense of emotional stability, self-awareness and meaning in their lives.

Stage 1 - The Attainment of Stability

The goals of stage 1 include:

• Reduce self-harm and suicidal behaviors

• Build a foundation of safety and stability

• Learn how to cope with intense emotions

• Reduce any behaviours that are interfering with daily functioning

Stage 2: The Development of Emotional Control

The goals of stage 2 include:

• Reduce emotional reactivity and impulsivity

• Improve communication and relationship skills

• Learn how to balance acceptance and change

• Increase the client's sense of self-respect and self-esteem

Stage 3: The Development of Self-Awareness

The goals of stage 3 include:

• Develop a stronger sense of self-identity

• Cultivate a greater awareness of the client's thoughts, feelings and behaviours

• Improve the client's ability to communicate effectively and assertively

• Identify and work towards meaningful life goals

Stage 4: The Attainment of Meaning and Purpose

The goals of stage 4 include:

• Achieve a sense of purpose and meaning in life

• Find a balance between acceptance and change

• Develop a stronger sense of self-respect and self-esteem

• Identify and work towards long-term goals and aspirations

What Conditions Does DBT Treat? 

Although DBT was originally developed to help people with borderline personality disorder (BPD), it has since been modified to be used as a treatment option for individuals with various mental health issues that can put a person's safety, relationships, ability to work and emotional well-being at risk. DBT can help with:

• Depression

• Eating disorders

• Substance abuse

• Self-harm

• PTSD

• And suicidal behaviour

Core Skills of DBT

DBT focuses on four core skills areas to help individuals regulate their emotions, improve interpersonal relationships and cope with distress.

How Does DBT Work? 

DBT combines group and individual therapy formats in an effort to provide the patient with useful self-management skills for everyday life. A conventional DBT program usually suggests a commitment of one year from the client but there are shorter programs referred to as DBT informed programs that can be beneficial for some individuals. DBT generally consists of the following four types of sessions, however the format might vary from therapist to therapist:

• Pre-assessment

• An evaluation is done before the therapist can start the treatment process. The therapist will determine if DBT is a suitable fit by asking a few questions and explaining how the therapy works. If you then decide that DBT is the right therapy modality for you, they will ask you to commit to the course of treatment. 

• Individual Counselling

• Enhancing motivation and assisting patients in using proper skills to address particular difficulties and events in their life are the main goals of individual psychotherapy. This also gives a chance for the therapist to connect with you (the client) on a personal level and talk about your unique goals. These sessions typically last from 60-90 minutes and are held once a week. 

• Group Therapy

• Clients gain crucial life skills training in group therapy like mindfulness, distress tolerance, interpersonal effectiveness and emotion regulation. Guided group therapy also helps to improve interpersonal interactions as you have a chance to connect with others who may be travelling a similar path and understand your circumstances better.

• In-the-moment Crisis Coaching

• In-person coaching, telephone coaching, and other methods are used to offer immediate assistance in day-to-day activities. This allows you to contact the therapist for help at certain times (depending on the therapist) between sessions. During crisis coaching, the DBT therapist will work with you to identify and validate emotions, while also providing guidance on how to manage a distressing situation in a healthy and effective way. The therapist may use specific DBT skills, such as mindfulness or distress tolerance techniques, to help you stay grounded and cope with the distress. DBT crisis coaching is designed to be flexible and responsive to your needs and may involve a range of strategies and interventions depending on the situation. For example, the therapist may help you in developing a safety plan or provide guidance on how to navigate a difficult interpersonal situation. The goal is to help you manage the crisis in a way that is consistent with your values and goals, while also preventing relapse and promoting long-term recovery. Decide what time of day is ideal for you to call your therapist, and be sure to set clear boundaries with them. Examples of situations in which you might want to contact your therapist: 

• You require assistance with a sudden crisis, such as the desire to self harm. 

• You are attempting to apply the DBT techniques you've learnt in therapy but need guidance.

Overall, the collaborative and supportive nature of DBT allows it to be adapted to each person's specific needs and objectives. For those who struggle with emotional dysregulation and related issues, it can be a transformative experience that gives them the resources and support they need to thrive. If DBT sounds like something you could benefit from, we invite you to book a free virtual consultation with one of our therapists at The Mind Collective.