DBT: Dialectical Behavioural Therapy

DBT is an effective, evidence-based psychological therapy for people struggling with intense, overwhelming emotions. Psychologists call these patterns 'emotional dysregulation'. Experiencing emotional dysregulation can bring a range of associated difficulties in terms of behaviour, relationships, and feelings about oneself.

A DBT approach can help you learn to understand and connect skilfully with your emotions, as well as to balance the other difficulties that come along with overwhelming and out of control emotions. DBT can help you find emotional stability, achieve your goals, and build relationships that feel balanced and connected - with yourself and with other people.

Often people coming to DBT experience behavioural patterns such as self harm, suicidal behaviour, binge eating, and substance abuse. In DBT, we understand these patterns as functional coping strategies. This means we do them because they serve some function for us. They are often a 'solution' to unbearable  experiences, such as difficult emotions. Unfortunately, coping in these ways often has unintended consequences, such as relationship difficulties, negative feelings about oneself, and shame. In this way, problems can inadvertently escalate and get more complicated over time. The hopeful news is, that DBT offers a way to get unstuck from these harmful patterns.

Whilst we start by working to change these behaviours that are no longer serving you, DBT is an emotion focused approach. In DBT we aim to help you develop a wise way of working with your emotions, so you can build a life you feel is worth living.

DBT was originally developed for people diagnosed with Borderline Personality Disorder (BPD; also called Emotionally Unstable Personality Disorder), though this diagnosis is not necessary for this therapy to be helpful. Since it was developed in the early 1990s, DBT has been shown to be helpful for various difficulties (e.g. substance abuse, eating disorders, PTSD, C-PTSD, ADHD, treatment resistant depression). DBT has an excellent evidence base and is recommended in the NICE guidelines for BPD.

DBT is a multi component therapy, including:

  • Weekly 1:1 sessions with your individual DBT therapist,
  • Weekly group skills training sessions,
  • Telephone coaching to help skills generalisation, available 7/7.
  • A consultation team for therapists.

Full program DBT involves all components of therapy.

It is also possible to engage with a Skills Only DBT program of treatment. This is available to people who are presenting with a lower risk to themselves and could benefit from learning the DBT skills. Learning these skills is at the heart of DBT and research says that both full program and skills only DBT are helpful approaches.

DBT progresses through different stages of treatment:

Pre-treatment: This stage includes assessment, developing an understanding of your difficulties and goals, learning about DBT and testing out whether it'd be a good fit for you, and building a relationship with your 1:1 therapist.

  1. Stabilisation: This phase of DBT focuses on addressing behaviours that interfere with your ability to live, engage with therapy, and have a good quality of life. Skills to take hold of your mind (mindfulness), manage emotions, build healthy relationships, and tolerate distressing situations are all actively taught during this phase of therapy.
  2. Trauma: This phase of therapy involves emotionally processing traumatic and invalidating experiences. For clients with PTSD/ C-PTSD we can use the DBT-PE treatment at this stage.
  3. Reclaiming life: This phase of therapy is focused on building happiness, meaning, learning to trust yourself, and work on your individual goals.

There is no set timeline for DBT and people may not move through the stages of DBT in a linear way.

Skills only DBT may take 6 to 12 months, depending on whether you'd like to complete one or two cycles of skills training.

Full program DBT usually involves an initial commitment of 12 months. A number of clients choose to continue beyond this date, to continue working on building lives that feel meaningful and enjoyable and worth living.

Unfortunately, it is common for people who need DBT to have also experienced serious, traumatic events in their lives. In some cases, you might also be experiencing symptoms of Post Traumatic Stress Disorder (PTSD/ CPTSD). If this is the case, we can use a specialist form of DBT, called DBT-PE, which will help you safely work through your traumatic experiences and reclaim your life. Trauma work happens after we have helped you find stability - in stage 2 of DBT.

To have a conversation about whether DBT/ DBT PE might be a helpful approach for you, get in touch and let’s consider this together.


DBT Skills Training

A summary of each of the four DBT skills modules.

To help you learn the DBT skills, we recommend you get a copy of the "DBT Skills Training Handouts and Worksheets" by Marsha M Linehan.

Another useful resource is: https://www.youtube.com/dbtru - where you'll find a number of short videos introducing each of the key DBT skills.

If you'd like to find out how we can help you learn these DBT skills to support change in your life, please reach out using the link below and let's discuss what you need. 

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