What is DBT and How Does it Work?
Dialectical Behavioural Therapy (DBT) is a form of therapy that helps people who have intense emotional reactions. It’s primarily used by those who live with a borderline personality disorder. The aim of DBT is to help patients find an easier way to manage their emotions. It achieves this by focusing on the psychosocial elements of Cognitive Behavioural Therapy (CBT).
What is Dialectical Behavioural Therapy (DBT)?
Dialectical Behavioural Therapy (DBT) is a form of therapy that’s used to treat individuals with Borderline Personality Disorder (BPD). Individuals who have BPD experience emotional extremes. While someone without the disorder may feel mildly aggrieved by some situations, those with BPD experience intense emotional reactions. They often see the world in black and white and will jump from crisis to crisis. As a result, they find it hard to maintain relationships. Additionally, they may struggle with self-harm and substance abuse.
DBT aims to help those with BPD develop better coping mechanisms. Therapists who use this method will help their patients step away from their chaotic lifestyle and move onto one that’s fulfilling. They achieve this by accepting the patient as they are but helping them to gradually make changes that will be to their benefit.
How does DBT work?
Typical DBT courses run over a 24-week program. The patient will benefit from a blend of group and individual sessions. They’re also able to contact their therapist when they’re in a crisis, so they have assistance with managing their emotions while they’re at home.
Weekly group therapy sessions
Patients will usually participate in a weekly group therapy session. They last for around 2.5 hours.
During the session, patients will either learn about accepting reality, creating effective interpersonal relationships, emotional regulation, or mindfulness skills.
When learning core mindfulness, participants reflect upon how they’ll practice it. They’ll also gain a better understanding of what it means to be mindful.
Creating better interpersonal relationships
Most people with BPD have good interpersonal skills. However, they struggle to use those skills in scenarios where they’re vulnerable or uncomfortable. Sessions that focus on this aspect of DBT help the patients learn how to ask for what they want. They also learn how to say no, without damaging their relationships.
Tolerating distress is a big challenge for people with BPD. They have a lower threshold than most people and may enter a crisis when something triggers their distress. By practising emotional regulation, they can learn to accept situations for what they are, without creating a crisis.
Individuals with BPD may frequently enter periods of anxiety, distress, or depression. While learning emotional regulation, they’ll learn how to label their emotions. They’ll also learn how to focus on the positives, and how to recognise potential barriers to tackling their emotions.
Individual therapy sessions
Individual therapy sessions form an important part of DBT. The therapist will explore ways the patient can use problem-solving behaviours. A lot of the time, this is done with a view to reflecting on problems from the previous week. The patient will discuss periods of crisis, frustration, and harmful behaviours. The therapist will then help them examine problem-solving behaviours and ask them to take a different approach next time a similar issue arises.
Individual therapy sessions also aim to help the patient deal with their self-image. They’ll learn how to recognise their strengths and focus on the positive aspects of their character.
Patients with BPD sometimes experience periods of crisis. During these periods, they may engage in uncontrolled outbursts of anger and harmful behaviours. Patients who are trying DBT will be able to call their therapist when they believe they’re about to enter a crisis. The aim is for them to receive immediate support so they can manage it better.
What does DBT help with?
Individuals who live with BPD often struggle to accept elements of the world around them. For example, they may be unable to accept feelings of discomfort. As a result, they have intense emotional reactions. Additionally, they may struggle to accept opposing points of view and things not going their way.
DBT helps people with BPD develop acceptance. One way of achieving this is through mindfulness. Mindfulness helps the patient accept the present moment and their emotions. It encourages them to embrace what’s happening without struggling to change things.
As their mindfulness skills develop, the patient will be encouraged to accept situations as they are. This is particularly important as it allows them to cope better when a situation is beyond their control. They’ll generate self-soothing skills so they can move through uncomfortable and unfamiliar scenarios without experiencing a crisis.
Creating coping mechanisms
While the majority of people can regulate their emotions most of the time, those who have BPD may be governed by their emotions. The intensity of those emotions can prevent them from engaging with everyday life. When they’re at conflict with another person, the situation may escalate to the stage where their relationship is irreparable.
Using DBT, patients can learn how to manage their emotions rather than letting their emotions manage them. They’ll also learn how to be appropriately assertive and use measured ways to manage personal conflicts. Therapists also help their patients step away from all or nothing thinking processes. For example, they’ll teach patients to accept that they have minor flaws and that those flaws don’t make them an inherently bad person.
What are the benefits of DBT?
One of the biggest benefits of DBT is that the patient is able to pause, check on their emotions, and form a calmer reaction to what’s happening. When they accept reality and no longer form intense reactions, they’re less likely to engage in destructive behaviours. Other benefits include:
- DBT helps patients to become less judgemental. When they take a non-judgemental stance to the world around them, they’re less likely to be governed by negative emotions.
- This type of therapy can also reduce suicidal and other destructive behaviours.
Patients who completed the program can form stronger relationships. In turn, having consistency within their relationships can boost their mental health.
- With a healthier self-image, patients are less likely to use substance abuse as a means of coping with day-to-day life.
- Patients are also less likely to experience hospitalisation for their mental health. As a result, living a more stable life becomes possible.
Dialectical Behavioural Therapy (DBT) is a form of therapy that’s mainly used to treat patients with a Borderline Personality Disorder (BPD). However, it can also be used to treat those who are prone to self-harm and suicidal behaviours. As a treatment program that usually takes place over two 24-week periods, DBT involves group therapy, individual therapy, and phone sessions during a crisis. The aim is to help patients appreciate and accept the present moment, while also forming better coping mechanisms. When successful, patients are less likely to form strong emotional reactions and engage in destructive behaviours. However, it’s also worth knowing that DBT depends on having a strong therapeutic relationship between the patient and their clinician.