Dialectical Behaviour Therapy (DBT), developed by Marsha Linehan PhD at the University of Washington, is a type of psychotherapy (sometimes called “talking therapy”) for Borderline Personality Disorder (BPD). DBT is a cognitive behavioural therapy, meaning it is a therapy that focuses on the role of cognition (e.g., thoughts and beliefs) and behaviours (e.g., actions) in the development and the treatment of BPD. DBT includes some changes to the traditional cognitive behavioural elements of therapy in order to help specifically reduce the symptoms of BPD.
Research Support for Dialectical Behaviour Therapy
DBT was the first psychotherapy shown to be effective in treating BPD in controlled clinical trials — the most rigourous type of clinical research. While DBT is no longer the only therapy to have shown effectiveness in controlled trials, it has grown a large evidence base and is considered one of the best treatments for BPD in terms of documented success rates.
Theoretical Basis for Dialectical Behaviour Therapy
DBT is based on Dr. Linehan’s theory that the core problem in BPD is emotion dysregulation, resulting from mixing biology (e.g., genetic and other biological risk factors) and an emotionally unstable childhood environment (e.g., where caregivers punish, trivialise or respond erratically to the child’s expression of emotion) together. The focus of DBT is on helping the client learn and apply skills that will decrease emotion dysregulation and unhealthy attempts to cope with strong emotions
What to Expect in Dialectical Behaviour Therapy.
Usually, DBT includes a combination of group skills training, individual psychotherapy and phone coaching, although there are exceptions. Patients in DBT are asked to monitor their symptoms and use of learned skills daily, while their progress is tracked throughout therapy.
There are four main types of skills that are covered in DBT skills training.
Mindfulness Meditation Skills. These skills centre on learning to observe, describe and participate in all experiences (including thoughts, sensations, emotions and things happening externally in the environment) without judging these experiences as “good” or “bad.” These are considered “core” skills that are necessary in order to implement the other DBT skills successfully.
Interpersonal Effectiveness Skills. The focus of this skill module is on learning to successfully assert your needs and to manage conflict in relationships.
Distress Tolerance Skills. The distress tolerance skills module promotes learning ways to accept and tolerate distress without doing anything that will make the distress worse in the long run (e.g., engaging in self-harm).
Emotion Regulation Skills. In this module, patients learn to identify and manage emotional reactions.