Dialectical Behaviour Therapy (DBT)

What Is Dialectical Behaviour Therapy (DBT)?

The Modality Manual / Dialectical Behaviour Therapy

Somatic Psychotherapy is all about integrating our mind and body in the healing process. It focuses on the connection between our physical sensations, movements, emotions, thoughts and behaviours.

Ever notice how when you’re feeling anxious, you might clench your jaw or feel tightness in your chest? – we see you.

DBT is a skills-based therapy that helps us learn ways to manage difficult emotions and experience meaningful relationships.

The dialectical part of DBT is all about the idea that two opposing things can be true at the same time.

You might feel a mix of emotions when something good happens, like getting a promotion at work. E.g., you might be happy about the new skills and higher pay, but also feel sorrow leaving behind your work wife. Similarly, you work towards self-acceptance and positive changes simultaneously, such as accepting your body while pursuing a healthier lifestyle.

The behaviour part of DBT involves learning skills including:

  1. Mindfulness
  2. Distress tolerance
  3. Emotion regulation
  4. Interpersonal skills

These skills help us to develop effective ways of managing difficult emotions, thoughts and behaviours.

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The Four Modules of DBT: What They Are and How They Work

  1. Mindfulness: Here we’re learning to be present without judgment.

E.g., imagine you’re at a party feeling anxious. Mindfulness would involve noticing your thoughts and physical sensations without reacting to them. You might observe your racing thoughts and the tightness in your chest without trying to change them. By observing how anxiety shows up, we become more aware of our internal experience which reduces its intensity.

  1. Distress Tolerance: This is where we learn to cope with difficult situations without making them worse.

E.g., imagine you’re in an argument with your friend and feel frustrated. Distress tolerance skills might involve taking some time-out before reacting impulsively. You might go for a walk or listen to music to calm down before returning to the conversation. This can help us manage intense emotions (that are absolutely valid btw) and prevent things from escalating.

  1. Emotion Regulation: We are learning to manage intense emotions in a helpful way.

E.g., Imagine you’re feeling overwhelmed and want to binge eat. Emotional regulation skills might involve identifying the emotions you’re feeling and finding alternative ways to soothe yourself. You might practice deep breathing or take a warm bath instead of turning to food. This can help us develop more helpful coping strategies that benefit us in the long-term.

  1. Interpersonal Effectiveness: This involves learning to navigate relationships and communicate effectively.

E.g., imagine you’re having trouble setting boundaries with a family member who always asks you for favours. Interpersonal effectiveness skills might involve learning how to say “no” in a kind, yet assertive way. You might practice assertive communication and offer an alternative solution that works for both of you. This can help us build healthier relationships and reduce resentment.

DBT: What Are The Benefits?

DBT is a rad therapy with a range of benefits for our mental health and well-being:

  1. Improved emotion regulation: We all experience intense emotions sometimes. DBT helps us learn to manage strong emotional responses in a helpful way. This can lead to greater emotional stability and reduce impulsive behaviours.
  2. Better relationships: DBT improves our communication skills and helps us build healthier and more fulfilling relationships. This can lead to greater social support and a stronger sense of connection with others.
  3. Increased mindfulness: DBT helps us become more aware of our thoughts, feelings and physical sensations. This gives us the agency to respond to them with a sense of clarity and calm.
  4. Improved quality of life: DBT teaches us emotional regulation skills so we can live a more satisfying and fulfilling life.
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Using DBT to Address Borderline Personality Disorder (BPD)

DBT was specifically designed to help people with BPD, a mental health condition defined by intense emotions, impulsivity, negative self-image and relationship difficulties. Symptoms include mood swings, self-destructive behaviour, fluctuating self-esteem and fear of abandonment.

Here’s how DBT comes into play:

  1. Providing skills to manage strong emotions: People with BPD often experience intense emotions that are difficult to manage. DBT provides skills for emotion regulation, distress tolerance and mindfulness that can help people cope with these emotions in helpful ways.
  2. Addressing self-harm and suicidal behaviour: People with BPD are at an increased risk for self-harm and suicide. DBT includes specific skills for managing these behaviours:
    • Crisis survival skills: e.g., self-soothing activities like taking a warm shower, or distraction like engaging in exercise.
    • Safety planning: e.g., creating a plan that includes steps to take in the event of a crisis.
  3. Improving relationships: People with BPD often struggle with relationships due to difficulties with communication, trust and intimacy. DBT includes interpersonal effectiveness skills that can help people build healthier relationships.
  1. Addressing co-occurring conditions: People with BPD often have other conditions such as depression, anxiety or substance use. DBT can be adapted to address these co-occurring conditions simultaneously.
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Using DBT to Address Other Mental Health Conditions

Although initially designed for people with BPD, the skills taught by DBT therapists can be applied to various mental health conditions:

  1. Depression and anxiety: DBT skills help to manage negative thought patterns, difficult emotions, as well as the physical symptoms related to depression and anxiety.
  2. Eating disorders: DBT skills can be adapted to treat eating disorders. E.g., the skills to effectively manage urges to binge or purge, enhance body image, and promote mindfulness. DBT can be used in combination with other treatments such as nutrition counselling and medication.
  3. Substance abuse: DBT can also treat substance abuse by teaching skills for managing cravings, coping with stress, and improving relationships. DBT can be used in combination with other treatments such as medication-assisted treatment and support groups.

How DBT Differs from Other Forms of Therapy

DBT is a type of therapy that is often compared to Cognitive-behavioural therapy (CBT) and other forms of psychotherapy. Let’s explore it’s unique approach:

  1. Emphasis on validation: DBT places a strong emphasis on validation. Your therapist will accept your thoughts and feelings – no matter what they look like. This can be different from other forms of therapy like Cognitive Behavioural Therapy, that focuses more on challenging negative thoughts.
  2. Skills-based: DBT teaches specific skills for managing your emotions and behaviours. This can differ from other forms of therapy like emotion-focussed therapy which emphasises developing insight and understanding of concerns.
  3. Inclusion of mindfulness: DBT includes mindfulness as a core component of treatment. This involves teaching you to be present and observe your thoughts and feelings without judging them. This differs from other forms of therapy like Motivational interviewing that may not include mindfulness as a specific technique.
  4. Comprehensive treatment: DBT includes individual therapy, group skills training, phone coaching and consultation for therapists. This can be different from other forms of therapy that focus on individual therapy sessions.

At the Indigo Project, we have a number of online therapists qualified in DBT.

To find a therapist, get in touch via (02) 9212 5469 or [email protected] – or get matched to a therapist now.

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eunice cheung, Psychotherapist & Counsellor

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deepika gupta, Clinical Psychologist

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eva fritz, Senior Psychologist

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dr emer mcdermott, Clinical Psychologist

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nicole burling, Senior Psychologist

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dr perry morrison, Senior Psychologist

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sam barr, Clinical Psychologist

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darren everett, Senior Psychologist

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