What is dialectical behaviour therapy (DBT)?

Considered part of the 'third wave' cognitive therapies, dialectical behaviour therapy (DBT) is a type of cognitive behavioural therapy (CBT) that aims to help individuals manage negative emotions. DBT theory suggests that some people are prone to react much more strongly to emotional situations, particularly those triggered in relationships (whether romantic, family, or platonic), and secondly that it takes longer for these individuals to return to a 'baseline' level and so the emotional experience is both more intense and more pervasive. 

DBT aims to help individuals learn to regulate their thoughts and feelings by learning about what triggers them. By learning to identify what kinds of situations and triggers lead to reactive states, individuals can learn how to assess what coping skills they can apply in order to help themselves manage difficult situations. 

Initially developed in the 1980s by Dr Marsha M. Linehan as a treatment for borderline personality disorder, DBT is now recognised as being useful to support a range of mental health difficulties that may be characterised by overwhelmingly negative emotional experiences and the resulting behaviours. The aim of DBT is to help people regulate intense emotions that may usually lead to harmful behaviours, such as substance abuse, disordered eating, or self-harm. 

Dr Linehan and her colleagues developed DBT as a means to help their patients who did not appear to respond to other available therapeutic treatment. Linehan noticed that many of her chronically suicidal clients were raised in neglectful, invalidating environments. Linehan found that validation was key along with working towards positive change. Without validation of the present experience and feelings, change could not occur. Secondly, Linehan found that positive change was also reliant on the clients accepting the severity of their emotional dysfunction. 

What does 'dialectical' mean?

Dialectics, in essence, is the concept that everything is composed of opposites, and that change can happen when there is a meeting between, a dialogue, between opposing forces. Dialectics makes the assumption that all things are interconnected, that change is inevitable and continuous, and that opposites can be integrated to form something helpful. In DBT, the central opposing concepts are acceptance and change, which is explored further below. 

How does DBT work?

In order to help clients learn to regulate their emotions and behaviours, therapists use a combination of acceptance and change techniques. The key idea here is to encourage both acceptance – accepting yourself as you are – and, fostering change – helping clients move forward and make positive changes to their behaviour. The focus on self-acceptance is one of the ways DBT differs from CBT. In dialectical behaviour therapy, there is a strong focus on the relationship between the therapist and client, one where the therapist is seen as an ally in therapeutic treatment. This relationship is designed to become an active, motivating force for positive change. The therapist will validate and affirm the client's experience, whilst working to help them understand that some reactions and behaviours may be maladaptive or unhealthy. 

Dialectical behaviour therapy focuses on teaching skills in four key areas: 

  • mindfulness – learning to live in the moment, paying attention to the present and any physical sensations and feelings in a non-judgemental way
  • distress tolerance – teaching acceptance of both oneself and the present situation. This may involve techniques like distraction, self-soothing, thinking of the pros and cons of not tolerating / accepting the situation i.e.: the pros and cons of reacting.
  • emotion regulation – identifying and labelling your emotions, increase positive emotions and overcome blocks to changing your emotions
  • interpersonal effectiveness – learning to become more healthily assertive in relationships, learning to listen and communicate effectively, learning self-respect and respect of others

DBT often has more than one component. As well as individual therapy, DBT treatment may also involve group sessions and phone coaching. DBT may also involve homework, such as being asked to track and write down their emotions and behaviours in-between sessions, or practising new skills agreed in therapy. Clients may be asked to role-play different ways of interacting with others, or practising skills to self-soothe.

Who benefits from dialectical behaviour therapy?

DBT was originally developed as a treatment for borderline personality disorder, however it has been found to be helpful for other mental health challenges too, particularly those related to extreme emotions or behaviours, such as self-harm, suicidal ideation, eating disorders and substance abuse. 

DBT may be challenging in the beginning – as outlined above, it requires the client to accept their problems and work in an active way to change them. DBT may be appropriate for anyone who sees changing their behaviour as a priority. 

Relevant associations

Society for Dialectical Behaviour Therapy UK & Ireland

Last updated on 25 March 2020