What is Dialectical Behaviour Therapy? - Types, Benefits & Effectiveness

Dialectical Behaviour Therapy (DBT) teaches patients new ways to deal with upsetting feelings and lessen conflict in interpersonal relationships. DBT specialises in teaching therapeutic skills in four important areas, namely mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness.

Dialectical Behaviour Therapy (DBT) is a variety of talk therapy (psychotherapy). In the 1970s, American psychologist Marsha Linehan led to the development of dialectical behaviour therapy.

This therapy is based on Cognitive Behavioural Therapy (CBT), but it has been modified especially for those who have extremely strong emotional experiences. However, using talk therapy, cognitive behavioural therapy teaches patients how their beliefs influence their feelings and behaviours.

On the other hand, dialectical refers to combining opposing viewpoints. Also, DBT focuses on assisting patients in learning to improve their lives, including eliminating unhelpful behaviours, as well as accepting the truth of their lives and actions.

Individuals who need DBT are frequently diagnosed with numerous issues. Regardless, in DBT, a hierarchy of treatment goals is used to assist the therapist in deciding what issues should be addressed first. So, you should consider a DBT if you have:

• Life-Threatening Behaviours: These include suicidal ideation, suicide communications, and all varieties of suicidal and non-suicidal self-injury. These behaviours are targeted first and foremost because they have the potential to result in an individual’s death.
• Therapy-Interfering Behaviours: Any actions that prevent a client from receiving treatment effectively are considered therapy-interfering behaviours. These actions include being uncooperative in pursuing treatment objectives and arriving late for sessions. 
• Quality of Life Behaviours: These include behaviours that interfere with an individual’s ability to have a fair quality of life. A few examples include marital issues, financial difficulties, housing crises, etc.
• Skill Acquisition: Gaining new skills is necessary for individuals to replace unproductive behaviours and assist them in achieving their objectives. So, if you are feeling demotivated at work, you can consider DBT.

Dialectical behaviour therapy can have a somewhat different format depending on the therapist, but in general, DBT sessions fall into one of the following four categories:

1. DBT Pre-Assessment

Your therapist could offer an assessment before beginning DBT. After that, they will ascertain whether DBT is a good fit for you through questions and an explanation of how DBT functions. They will also ask you to commit to the course of treatment if you decide that DBT is the best therapy for you.

2. Individual DBT Therapy

In the case of individual DBT therapy, each week, you and your therapist will meet, and every session might last between 40 and 60 minutes. The aims of each individual DBT therapy session are as follows:

• To lessen suicidal and self-harming behaviours in order to keep you safe.
• For restricting actions that interfere with effective therapy.
• To remove obstacles to your success, such as mental health concerns or interpersonal problems.
• To assist you in achieving your goals and enhancing the quality of your life.

Furthermore, your therapist might also advise keeping a diary in order to monitor your feelings and activities and to look for patterns of behaviour.

3. DBT Skills Training in Groups

In case you prefer a social environment, you can learn skills in a group setting with your therapist. However, it is important to note that, in group therapy, you can also talk about your issues with others. So, consider it more along the lines of a classroom-style teaching and learning experience.

4. Telephone Crisis Coaching

DBT frequently uses telephone crisis coaching to assist you in your quotidian activities. This implies that you can call your therapist for support at specific times in between sessions.

Nevertheless, here are several situations when you might want to give your therapist a call:

• Firstly, when you require assistance with a sudden crisis, such as the desire to self-harm.
• Secondly, when you're attempting to apply the DBT techniques you've learnt but need guidance.

Some of the techniques of dialectical behaviour therapy include: 

• Mindfulness

The improvement of mindfulness is a significant aspect of DBT. This is because it allows you to live in the moment or focus on the present. Additionally, mindfulness assists you in developing non-judgmental awareness of both what is going on inside of you (your thoughts, feelings, sensations, and impulses) and what is happening outside of you (what you see, hear, smell, and touch).

For instance, when you are experiencing emotional distress, mindfulness can help you slow down and concentrate on employing appropriate coping mechanisms. The technique can also assist you in maintaining your composure and preventing impulsive conduct and automatic negative thought patterns.

• Distress Tolerance

Distress tolerance enhances your ability to tolerate stress and helps you accept both yourself and your circumstances. Additionally, DBT offers a number of crisis management methods, such as:

• Distraction
• Enhancing the present
• Self-soothing
• Weighing the benefits and drawbacks of not tolerating suffering

These techniques for coping with distress can help you prepare for strong emotions. They will provide you with the strength you need to deal with them in a beneficial way.

• Emotion Regulation

This factor is important as you can deal with intense emotions more successfully if you have good emotion control. Also, your ability to recognise and control your emotions will be enhanced by the abilities you acquire from learning emotion regulation.

Additionally, you will be able to detect and manage strong negative emotions, and your emotional susceptibility will decrease if you are able to experience more pleasant feelings. 

• Interpersonal Effectiveness

Interpersonal effectiveness increases your ability to articulate your demands and say "no" in a relationship while maintaining a nice, healthy connection. Besides this, you will be able to respect yourself and others, listen and communicate more effectively, and handle unfriendly people better.

Although Dialectical Behaviour Therapy was developed by keeping borderline personality disorder in mind, it can also help with: 

• Bipolar disorder
• Attention-Deficit/Hyperactivity Disorder (ADHD)
• Eating disorders (such as binge eating disorder, anorexia nervosa, and bulimia nervosa)
• Major depressive disorder
• Generalised Anxiety Disorder (GAD)
• Obsessive-Compulsive Disorder (OCD)
• Suicidal behaviour
• Non-suicidal self-injury
• Substance use disorder
• Borderline Personality Disorder (BPD)
• Post-Traumatic Stress Disorder (PTSD)

Dialectical behaviour therapy teaches you to identify the behaviours and patterns that prevent you from pursuing happiness in ways other than substance addiction. Nevertheless, the following are additional advantages of dialectical behaviour therapy:

• Learning to identify the underlying causes of the ideas and emotions that lead to substance misuse
• Knowing your triggers and using coping techniques to get rid of negative thoughts and cravings
• Figuring out what makes you go down a negative thought path that might make you relapse
• Learning more about who you are and what motivates your addiction

People who successfully enhance their coping abilities with the use of this therapeutic approach can create efficient means of controlling and expressing intense emotions. Additionally, DBT is also effective for people of any age, sexual orientation, gender identity, sex, or race/ethnicity.

• For Borderline Personality Disorder

DBT is beneficial in treating Borderline Personality Disorder (BPD) and lowering the risk of suicide. According to a research paper, more than 75% of BPD patients did not show symptoms of the illness after receiving this treatment for a year. 

• For Suicidal Behaviour

A study proved that therapies that included skill-building as a treatment seemed to be more successful in lowering suicidal tendencies than DBT without skill-building.

• Others

Although the majority of DBT research has concentrated on how well it works for persons with borderline personality disorder with suicidal and self-harming thoughts, it is also useful for treating other mental health issues. For instance, studies have shown that this therapy also appears to be successful in treating PTSD, depression, and anxiety.

The best approach to determine if DBT is the proper treatment for you is to speak with a certified practitioner. In this regard, they will examine your symptoms, treatment trajectory, and therapy objectives.

If you believe that you or a loved one would benefit from the treatment, you should speak with a healthcare physician or mental health expert who is knowledgeable about DBT. Nevertheless, it's not always simple to locate DBT therapists, and you can begin  by doing some online research.

Dialectical Behaviour Therapy (DBT) typically lasts six to twelve months. However, everyone is different, and a few external factors can complicate mental health issues. So, after one year of DBT, you should not expect to be completely free of symptoms or have no problematic behaviours.

Also, many therapists believe that treating borderline personality disorder can take years.

Hence, try not to be discouraged by the duration to improve your emotional management and overall quality of life. Here, the primary thing is that you are seeking assistance, and any progress is beneficial.

Consider the following points while opting for this therapy:

• DBT is time-conusming. Hence, you need to work on skills outside the group and phone counselling sessions along with regular therapy appointments. 
• Continuing this therapy can be challenging for those who regularly struggle to keep up with a routine.
• People explore traumatic events and emotional anguish at various stages of treatment, which can be upsetting and demotivating. This makes the therapy challenging. 
• Some of the tasks used in this therapy can bring back past memories and trauma. 

Hence, Dialectical Behavioral Therapy (DBT) aims to teach clients’ problem-solving techniques. This therapy assists them in recognising extreme or maladaptive behaviours and replacing them with more beneficial and effective ones.