What is DBT?
DBT stands for Dialectical Behaviour Therapy. It is ‘dialectical’ because it is concerned with the dynamic between two opposing forces. Sometimes in life two opposing things can both be true, and the challenge for us is to find a way of managing this dissonance. An example of a dialectic that we might examine in DBT is ‘I love my brother but I hate my brother’ – it’s two seemingly opposing statements that can both be true. DBT looks at the dynamic of situations where the two things are true. There are four different components of DBT: mindfulness, emotion regulation, distress tolerance and interpersonal effectiveness.
Where did DBT come from?
DBT was developed in the 1970s by a woman called Marsha Linehan. It came out of Cognitive Behaviour Therapy (CBT), which encourages the development of personal coping strategies and seeks to change unhelpful thought patterns, so there are similarities between the two. CBT wasn’t effective for people with Borderline Personality Disorder (BPD) and that was why DBT was developed. DBT has very high success rates for people diagnosed with BPD, who were otherwise seen as untreatable. It has since been extended to treat specific issues associated with BPD, including suicidality, drug and alcohol abuse, eating disorders and self-harming.
In what contexts is DBT most effective?
DBT is effective with people who have difficulties regulating their emotions. Research has shown that DBT is particularly effective in reducing suicidality and self-harm as well as symptoms of BPD. One study included a two-year follow-up and showed that the effects were beneficial over time, with participants half as likely to make a suicide attempt. People with Borderline Personality Disorder frequently have comorbidities such as anxiety disorders, and DBT is also effective in treating these by focusing on ways of coping with emotions and body sensations.
What happens in a DBT session?
Skills group sessions are a key element of DBT. These are informative teaching sessions with some discussion. There are clear teaching points that are addressed throughout each session that build on one another. The skills are practised in the sessions, and participants are then given a diary card that they use to track their use of the skills in their day-to-day life, and the effectiveness of these skills.
For example, participants might be taught the observe-describe-participate technique to practise mindfulness. At Body & Soul, where many of our members have experienced significant childhood trauma, we use the following exercises:
Observe. When the member is becoming distressed, they are asked to express what they can see in a factual way, e.g. to count how many items of a particular colour there are in the room.
Describe. A member might be invited to describe their journey to work that day in as much detail as possible, or to describe their body sensations as they begin to feel anxious or angry. Putting words to the physical sensations they are experiencing when they have heightened emotions has the effect of reducing the level of distress that they experience. This can be part of ensuring that the distress doesn’t escalate to crisis level.
Participate. This skill is simply about getting involved. We are often in situations where we would rather be elsewhere and zone out. This means that we are not being present and it is at times like these that we are more likely to worry about the future or become distressed about the past. The aim of this exercise is to teach members to be present in the moment, and to show them that there is a way of managing their thoughts. One group activity we often invite members to participate in at Body & Soul is working together to keep a number of balloons in the air without touching the ground: because members have to concentrate on keeping the balloons in the air, they are prevented from ruminating on their past or worrying about the future, which can become a loop of distressing thought patterns.
Why is DBT suited to Body & Soul’s work?
DBT uses practical everyday skills that can benefit all of us. DBT focuses on how we can regulate our emotions and navigate relationships more effectively – and to do these things more consistently. Members at Body & Soul tend to have experienced significant hardship and/or trauma, which can make it difficult to avoid succumbing to maladaptive thought patterns. It is therefore useful for members to learn ways of regulating their thoughts and emotions.
A useful summary of published research on DBT can be found here.