Dialectical Behaviour Therapy (DBT) is a type of psychotherapy that was originally developed to treat individuals with Borderline Personality Disorder (BPD) who were experiencing suicidal thoughts or engaging in self-harm behaviours. Since its development in the 1980s, DBT has been applied to treat a range of mental health conditions that involve emotional dysregulation, including depression, substance use disorders, eating disorders, and post-traumatic stress disorder (PTSD). DBT is a comprehensive treatment approach that aims to help individuals learn skills to manage their emotions, tolerate distress, and improve their interpersonal relationships.
DBT is based on a dialectical philosophy, which suggests that seemingly opposing concepts can both be true at the same time. For example, DBT recognises that individuals with BPD may have intense emotional experiences that are difficult to manage, while also acknowledging that these individuals have a strong desire to change and improve their lives. By accepting these seemingly opposing ideas, DBT encourages individuals to develop a more balanced perspective and to find ways to tolerate emotional distress without resorting to self-harm or other maladaptive behaviours.
DBT is typically delivered in a group therapy format, although individual therapy sessions may also be included. Treatment usually lasts between six months and one year and involves several stages. In the first stage, individuals learn skills to manage their emotions and reduce impulsive behaviour. The second stage focuses on improving interpersonal relationships and building a sense of mastery and self-respect. The third stage involves exploring issues related to identity and meaning in life. Finally, the fourth stage involves consolidating the skills learned throughout treatment and preparing for life after therapy.
DBT is a skills-based treatment that emphasises four key areas: mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness. Mindfulness involves paying attention to the present moment in a non-judgmental way. Distress tolerance involves learning to tolerate uncomfortable emotions without engaging in self-harm or other maladaptive behaviours. Emotion regulation involves learning to identify and manage intense emotions in a healthy way. Interpersonal effectiveness involves improving communication and relationship skills.
DBT incorporates several specific techniques to help individuals develop these skills. These techniques include:
DBT has been shown to be effective in treating a range of mental health conditions, including:
Dialectical behaviour therapy is a comprehensive treatment approach that has been shown to be effective in treating a range of mental health conditions. By teaching individuals skills in mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness, DBT aims to help individuals manage their emotions, improve their interpersonal relationships, and lead a more fulfilling life.
Linehan, M. M. (2015). DBT® skills training manual. Guilford Publications.
Lynch, T. R., Trost, W. T., Salsman, N., & Linehan, M. M. (2007). Dialectical behavior therapy for borderline personality disorder. Annual review of clinical psychology, 3, 181-205.
Swales, M. A., & Heard, H. L. (Eds.). (2018). Dialectical behaviour therapy: Distinctive features. Routledge.
Neacsiu, A. D., Rizvi, S. L., & Linehan, M. M. (2010). Dialectical behavior therapy skills use as a mediator and outcome of treatment for borderline personality disorder. Behaviour research and therapy, 48(9), 832-839.
Bohus, M., Dyer, A. S., & Priebe, K. (2019). DBT for substance use disorders. Current opinion in psychiatry, 32(5), 370-375.
Chen, E. Y., Matthews, L., & Allen, C. (2016). Dialectical behavior therapy for eating disorders: state of the research and future directions. International journal of eating disorders, 49(2), 150-162.
Kliem, S., Kröger, C., Kosfelder, J., & Heinrichs, N. (2010). Dialectical behavior therapy for borderline personality disorder: a meta-analysis using mixed-effects modeling. Journal of consulting and clinical psychology, 78(6), 936-951.
Linehan, M. M., Korslund, K. E., Harned, M. S., Gallop, R. J., Lungu, A., Neacsiu, A. D., … & Murray-Gregory, A. M. (2015). Dialectical behavior therapy for high suicide risk in individuals with borderline personality disorder: a randomized clinical trial and component analysis. JAMA psychiatry, 72(5), 475-482.
Safer, D. L., Telch, C. F., & Agras, W. S. (2001). Dialectical behavior therapy for bulimia nervosa. American Journal of Psychiatry, 158(4), 632-634.\
Linehan, M. M., Comtois, K. A., Murray, A. M., Brown, M. Z., Gallop, R. J., Heard, H. L., … & Lindenboim, N. (2006). Two-year randomized controlled trial and follow-up of dialectical behavior therapy vs therapy by experts for suicidal behaviors and borderline personality disorder. Archives of general psychiatry, 63(7), 757-766.
