Dialectical Behaviour Therapy (DBT)

Dialectical Behaviour Therapy (DBT) is a treatment developed for individuals who experience difficulties in managing their emotions and who have found understandable but unhelpful ways of coping. These coping mechanisms may include self-harm, abuse of alcohol and other chaotic and risky behaviours.

The underlying principle of Dialectical Behaviour Therapy is that in order to improve their lives, a person needs to truly accept themselves as they are, while at the same time working to understand themselves and develop the skills they need to live the life they want to live.

People who may benefit from DBT are likely to have behaviours consistent with the diagnosis of Emotionally Unstable Personality Disorder (EUPD) or Borderline Personality Disorder (BPD) such as:

  • Reacting more easily to stress and difficult interpersonal situations
  • Self-harm or suicidal behaviours
  • Staying upset for an extended period of time before calming down
  • Problems with anger (They can have difficulties with overly positive emotions as well)
  • Fear of abandonment
  • Difficulties in communicating when emotionally upset
  • Sense of emptiness or not being sure who they are
  • May dissociate or become paranoid when under stress.

For many individuals, repetitive stressful events and an inability to recover fully from one event before another occurs results in destructive behaviors, such as self-harm and suicide attempts or a real desire to do these things. It is very difficult to solve life’s problems while enduring intense emotion.

DBT with Dr Nikki Schuck

I am presently offering individual work based on the Dialectical Behaviour Therapy (DBT) model. Dialectical Behaviour Therapy has a proven track record of effectiveness in aiding individuals who struggle with regulating emotions, have difficulty in tolerating distress whilst struggling with self-harming and risky behaviours. ( https://behavioraltech.org ). DBT helps you to understand and gain control over your emotions and change unhelpful behaviours. It also focuses on accepting who you are and learning to be compassionate towards yourself. DBT places particular importance on the relationship between you and your therapist, and this relationship is used to actively support you to make changes.

DBT helps individuals understand how their difficulties developed and we work together to help you overcome them. DBT theory is predicated on the certainty that some individual’s emotional reactions are in fact physiologically stronger, more intense and last longer than other individual’s emotions. Often these emotional responses are a result of an invalidating or abusive upbringing and/or trauma, as well as inherent biological factors. DBT recognises that it can be difficult to undertake change when your difficulties are a result of other people’s actions and time is spent exploring this issue.

DBT recognises that some people are susceptible to reacting in more intense ways during emotional situations, such as those found in romantic, family, friendship and work relationships. People who struggle with emotions can find themselves trapped in a cycle of repeatedly unsatisfying relationships. Relational difficulties are an important focus in DBT and the improvement in relationships with others can have a huge impact on wellbeing.

Finally, individuals who are diagnosed with or have traits of Borderline Personality Disorder or Emotionally Unstable Personality Disorder often experience extreme swings in their emotions, and seem to encounter repeated overwhelming crisis’. Because other people (even close family members) rarely understand such reactions — people struggling with EUPD or BPD haven’t been taught or able to develop the skills for coping with these sudden, intense surges of emotion. DBT has a method for teaching skills that will help in this task

There are four set of skills taught to help people feel more in control of their lives and reduce overwhelming and painful emotions. The skills are designed to help people with their anger or the expression of anger, feelings of sadness and depression, irritability and anxiety, intense or chaotic relationships, impulsivity, stress and feelings of emptiness.

  1. Core Mindfulness Skills –The focus of mindfulness is to increase one’s awareness of events, emotions, and behaviours and to learn how to do this in a focused and nonjudgmental manner. The aim is to help individuals live in the present, rather than being distracted by unpleasant memories about the past or worries about the future.
  2. Interpersonal Effectiveness Skills – These skills focus on teaching you effective ways of achieving your objectives with other people: to ask for what you want effectively, to say no and have it taken seriously, to maintain relationships and to maintain self-esteem in interactions with other people.
  3. Emotion Regulation Skills – these skills are about understanding emotions, learning how to reduce emotional vulnerability and decreasing emotional suffering. The aim is to help you have more control over intense emotions.
  4. Distress Tolerance Skills – this module increases one’s ability to tolerate and survive crises and includes techniques for tolerating safely these emotional states if they can not be changed for the time being.

These skills will be taught in individual weekly psychotherapy sessions that also emphasize problem-solving behavior for the past week’s issues and troubles that might have arisen in the person’s life. The individual sessions will have 4 main treatment goals:

  • To keep you safe – by stopping self-harming and risky behaviours.
  • To reduce behaviours that interfere with therapy – by addressing issues that might come in the way of you getting treatment.
  • To improve your quality of life – by addressing anything that interferes with this, such as other mental health problems like depression, anxiety or hearing voices, traumatic experiences and PTSD, employment or relationship problems.
  • To work toward developing life enhancing behaviours- helping you to develop a life you want to live.

DBT will help you learn to manage your difficult emotions by letting yourself experience, recognise and accept them. Then as you learn to accept and regulate your emotions, you will become more able to change your harmful behaviour. To help you achieve this, DBT therapists use a balance of acceptance and change techniques.

At the beginning of the course of treatment, we will set some goals – these always include the goals listed above, as well as any specific changes that you want to make in your life. Over time we will work together to solve problems that get in the way of these goals, such as self-harming, alcohol and substance misuse, or emotional regulation difficulties.

What does ‘dialectics’ mean?

Dialectics means trying to balance seemingly contradictory positions. For example, in DBT you will work with your therapist to find a good balance between:

  • Acceptance – accepting yourself as you are.
  • Change – making positive changes in your life.

You might eventually come to feel that these goals are not as conflicting as they seem at first. For example, coming to understand and accept yourself, your experiences and your emotions, can then help you learn to deal with your feelings in a different way.

DBT occurs in weekly one-to-one sessions

Individual DBT. therapy involves one-to-one weekly sessions with a DBT therapist. Each session should last about 50–60 minutes. Often the treatment takes place over a year.