Dialectical Behavioural Therapy

Dialectical Behavioural Therapy is a variant of CBT which is intended to help individuals alter negative behaviour and thought patterns. Therapists aim to help their clients gain better control of their cognitive and emotional urges by increasing their awareness of certain triggers which can lead to reactive states such as depression.

The DBT approach takes as its premise the notion that both positive and negative reinforcement has the potential to interfere with a person’s functioning.

History

Dialectical Behaviour Therapy was developed in the 1970s by Seattle psychologist Marsha M Linehan as a result of her work with women with Borderline Personality Disorder. Linehan initially attempted to apply Cognitive Behaviour Therapy but found that the approach was problematic in a number of areas.

Among other things, Linehan discovered that certain clients withdrew from the CBT treatment because of its intense focus on change, resulting in a high drop-out rate. Also, the sheer amount of issues that clients presented to their therapists left very little time for them to learn and apply more adaptive skills through the CBT process.

As a result, Linehan and her colleagues made a number of modifications. They began by altering the structure of treatment and included validation strategies (Acceptance-Based Interventions) aimed at communicating to the client that they were both acceptable as they were and that their negative behaviours were an understandable reaction to the traumas they had experienced.

In addition, the new approach required that therapists reassure their clients as to the normality of their emotions, to help them realise that they had good judgement and that they were also capable of understanding how and when to trust themselves. Despite this focus on validation and acceptance, clients were still expected to recognise the importance of change, especially if they wanted to build a more positive existence for themselves.

Method

The Dialectical approach is influenced by Behaviourist and Cognitive theory. It consists of four modules:

  • mindfulness
  • interpersonal
  • effectiveness
  • distress tolerance
  • emotional regulation

It is based on the notion that problems can develop as a result of a person’s physiological makeup as well as the environment they grew up in. In order to overcome problems, the individual must recognise and accept their emotions – in turn this will help reduce their intensity and enable them to unburden themselves and live fuller lives.

DBT practitioners employ various acceptance techniques to help their clients achieve better self-awareness and to understand why they behave in certain ways. For example, a therapist might convey to their client that although their drug abuse is understandable in light of their past experiences, continuing to misuse drugs would not be beneficial in the long-term.

Therefore, Dialectical Behavioural therapists aim to balance empathy and validation with behaviour modification and change. Much emphasis is also placed on mindfulness and inner wisdom.
How can it help?

Although primarily intended for Borderline Personality Disorder, Dialectical Behaviour Therapy is also used to treat other problems such as eating disorders. Many practitioners believe it has a wider relevance and can be used to encourage people to gain insight into their behaviour and provide motivation to change it. Treatment usually consists of one-to-one and group sessions, once weekly.

Useful DBT Resources

Behavioural Tech

National Institute For Mental Health