Dialectical Behaviour Therapy
The goals of DBT are to teach us:
how to live in the moment
how to develop healthy ways to cope with our stress and emotions
how to know what we're feeling
how to respond to our feelings in positive ways; and
how to get along better with others
You will learn lots of different skills, and some will work better for you than others.
In DBT, we view our coping skills like any other skill in life: sure, some people are naturally better at it... but the more we practice the better we will get.
Clinician perspective: My favourite skill
I take my job as a father seriously, and I want to make sure that my children feel loved.
One of the things I’ve learnt in my clinical experience, and as a parent, is the power of validating your children.
To make sure that they feel heard. To give them space to share their thoughts and feelings and be honest (even if it’s brutal sometimes).
So generally speaking, I thought I was pretty good at validating my kids.
Until I started teaching DBT skills for parents and teens.
As I read and studied and listened to experts sharing in detail about what validation is, and what it is not, I realised that I still had work to do on this skill!
In a nutshell, validation is not problem solving. It’s not telling them that it’s going to be ok, or helping them see the positive outcomes that could occur. It’s not even praise or reassurance.
DBT has strengthened my ability to validate more wholeheartedly. I’m more aware of how easy it is as a parent to slip into the role of ‘coach’ rather than just staying in the present moment with them. To let them know that I’m taking their thoughts and feeling seriously.
There’s a time and place for all the other skills. To challenge and guide and discipline. But in the heat of the moment, in the middle of the emotion storm, there is great power in validation.
Who can benefit from DBT?
While DBT was originally established as a treatment for borderline personality disorder (BPD)(1, 2), there is a growing body of evidence indicating that DBT is an effective treatment for a large range of other mental health disorders (3), including
suicide and self-harm
depression and anxiety
substance use disorders, and
eating disorders (particularly binge eating and bulimea).
DBT skills have also been successfully used with clients with Autism Spectrum Disorder (ASD)(4), Attention Defecit Hyperactivity Disorder (ADHD)(5), and Intellectual Disability (ID)(6), and adapted for use with posttraumatic stress disorder (7).
In its original format, DBT is a comprehensive treatment that incorporates a combination of individual psychotherapy, group skills, training, telephone coaching, and a therapist consultation team. Holding true to the fundamental principles, DTB has been adapted into many formats and settings.
DBT skills are not just for those with ‘problems.’
DBT skills are being taught in schools and workplaces to improve productivity
and help with long-term wellbeing and resilience.
While initially developed for adults, DBT treatment and skills-training programs have been developed for children (8) and teens (7).
School-based programs provide an excellent opportunity to provide universal skills training. That is, training for all willing participants, regardless of whether they have any current mental health concerns. Schools can also opt to teach DBT skills as a selected program that is targeted towards those students identified as needing additional assistance with their emotion regulation.
Preliminary research indicates that DBT skills programs in schools have the potential to equip adolescents to manage emotional turbulance and impulsivity, and learn practical skills that they will actually use (9-11).
As well as upskilling the students, school-wide DBT training provides a common language and approach that can help students and staff work together to manage emotional outbursts.
So why is DBT able to assist such a diverse range of people?
At its core, the primary focus of DBT is on regulating emotions - through mindfulness practice, validation, and a range of skills for managing emotions and relationships.
And in essence, emotion dysregulation is a key underlying factor across a broad spectrum of mental health disorders including personality disorders, anxiety disorders, posttraumatic stress disorder, substance use disorder, and eating disorders (12).
‘When therapists actively install hope in their patients and foster the capacity of hopeful thinking in other ways, long-term outcomes seem to improve.’
Lars Mehlum, 2021
How is DBT different from other behaviour change therapies?
Dr Marsha Linehan began developing DBT in the 1970s, and first published the framework for DBT in 1993. She developed it for treating adult clients with complex and long-term psychological difficulties.
Marsha initially tried behavioural treatment approaches, but found these strategies were too impersonal and clients responded with conflict and resistance.
Marsha moved towards a more humanistic approach, leaning heavily on validation and supportive counselling. However this approach failed to resource clients with the skills and strategies they required to make substantial progress.
Thus, DBT was born out of the need to provide both problem solving and validation. To affirm and learn skills. To help clients believe that they have the power to make changes in their lives, and learn practical steps on how to do so.
If you are looking for help from a psychologist or counsellor, you may want to consider DBT skills training with an experienced DBT trainer.
Dialectics is about considering aspects of truth in two opposing views simultaneously.
At one moment in time, one person is saying 'I hate the rain' because they have an outdoor party set up. Just down the street, someone else is saying 'I love the rain!' because they just planted a new veggie garden.
Sometimes our natural instinct is to act as a judge to decide which perspective is true.
In DBT, we acknowledge the tension of opposing thoughts and feelings - between two different people, or within yourself. We develop the practice of observing without judgment. The goal is not to merge two different viewpoints into one single view.
To think dialectically is to accept that
both perspectives can be true at once.
Get in touch to find out more about DBT.
Skills training for real life.
References
Linehan, M. M., Armstrong, H. E., Suarez, A., Allmon, D., & Heard, H. L. (1991). Cognitive-behavioral treatment of chronically parasuicidal borderline patients. Archives of general psychiatry, 48(12), 1060–1064. https://doi.org/10.1001/archpsyc.1991.01810360024003
Storebø, O. J., Stoffers-Winterling, J. M., Völlm, B. A., Kongerslev, M. T., Mattivi, J. T., Jørgensen, M. S., Faltinsen, E., Todorovac, A., Sales, C. P., Callesen, H. E., Lieb, K., & Simonsen, E. (2020). Psychological therapies for people with borderline personality disorder. The Cochrane database of systematic reviews, 5(5), CD012955. https://doi.org/10.1002/14651858.CD012955.pub2
Mehlum L. (2021). Mechanisms of change in dialectical behaviour therapy for people with borderline personality disorder. Current opinion in psychology, 37, 89–93. https://doi.org/10.1016/j.copsyc.2020.08.017
Ritschel, L., Guy, L., & Maddox, B. (2022). A pilot study of dialectical behaviour therapy skills training for autistic adults. Behavioural and Cognitive Psychotherapy, 50(2), 187-202. doi:10.1017/S1352465821000370
Hirvikoski, T., Waaler, E., Alfredsson, J., Pihlgren, C., Holmström, A., Johnson, A., Rück, J., Wiwe, C., Bothén, P., & Nordström, A. L. (2011). Reduced ADHD symptoms in adults with ADHD after structured skills training group: results from a randomized controlled trial. Behaviour research and therapy, 49(3), 175–185. https://doi.org/10.1016/j.brat.2011.01.001
Brown, J. F., Brown, M. Z., & Dibiasio, P. (2013). Treating Individuals With Intellectual Disabilities and Challenging Behaviors With Adapted Dialectical Behavior Therapy. Journal of mental health research in intellectual disabilities, 6(4), 280–303. https://doi.org/10.1080/19315864.2012.700684
Ritschel, L. A., Lim, N. E., & Stewart, L. M. (2015). Transdiagnostic Applications of DBT for Adolescents and Adults. American journal of psychotherapy, 69(2), 111–128. https://doi.org/10.1176/appi.psychotherapy.2015.69.2.111
Perepletchikova, F. & Nathanson, D. (2020). Dialectical Behavior Therapy for pre-adolescent children: Addressing primary treatment targets. In, L.A. Dimeff, S. Rizvi, & K. Koerner (Eds), Dialectical Behavior Therapy in Clinical Practice. NY: Guilford Press.
Hastings, S.E., Swales, M.A., Hughes, J.C. et al. (2022). Universal delivery of a dialectical behaviour therapy skills programme (DBT STEPS-A) for adolescents in a mainstream school: feasibility study. Discover Psychology, 2(21). https://doi.org/10.1007/s44202-022-00021-x
Mazza, J. J., Dexter-Mazza, E. T., Miller, A. L., Rathus, J. H., Murphy, H. E., & Linehan, M. M. (2016). DBT® skills in schools: Skills training for emotional problem solving for adolescents (DBT STEPS-A). Guilford Press.
Zapolski, T. C. B., & Smith, G. T. (2017). Pilot Study. The Journal of school nursing : the official publication of the National Association of School Nurses, 33(3), 198–204. https://doi.org/10.1177/1059840516673188
Tan, M.Y.L., McConnell, B., & Barlas, J. (2020). Dialectical Behaviour Therapy as a transdiagnostic treatment for common psychiatric disorders: Study protocol for a systematic review, Research Square Preprint. https://doi.org/10.21203/rs.3.rs-144658/v1