What is Dialectical Behavioural Therapy?

In this week’s blog I am going to discuss what Dialectical Behavioural Therapy (DBT) is and what it involves.

Dialectical Behavioural Therapy which is often know DBT therapy was devised by Marsga Linehan who worked at a faculty at the University of Washington in Seattle for the treatment of Borderline Personality Disorder (BPD). According yo Linehan (1993) clients with BPD were notoriously difficult to treat. The reason for this was because they did not always attend regularly or they failed to respond to therapeutic efforts and make considerable demands on emotional resources of the therapist.

There have been many controlled studies across different research groups and the effectiveness of DBT therapy has been shown. Due to the success and similar behavioural patterns, DBT therapy is now being used in many settings as a viable therapy for the treatment of bipolar disorder.

The treatment in DBT has four parts, which are all very important to effective treatment. The four different parts include; individual therapy, telephone contact, therapist consultation which should have good communication between group therapist and individual therapist, this is essential to a successful outcome of the DBT Therapy and skills training which should be conducted by a behavioural technician or another therapist usually in a group context and it should also be conducted in weekly sessions of 2.5 hours with a break half way through each session. The focus is on learning and practicing adaptive skills, not personal or specific complaints of the clients and thus, nay specific or personal issues are redirected to be discussed in individual therapy.

There are four modules in DBT group skills training and these are Core Mindfulness Skills, Interpersonal Effectiveness Skills, Emotion Modulation Skills and Distress Tolerance Skills.

The core mindfulness skills are derived from Buddhist meditation techniques to enable the client to become aware of the different aspects of experience and to develop the ability to stay with that experience in the present moment. The treatment for this lasts for about two to three weeks. The Interpersonal Effectiveness Skills focus on effective ways of achieving one’s objectives with other people; to ask for what one wants effectively, to say no and taken seriously, to maintain relationships and to maintain self-esteem in interactions with other people. This can be compared to assertiveness training. The treatment for this lasts for about eight weeks. The emotional modulation skills are ways of coping with intense emotional experiences and their causes. These skills also allow for an adaptive experience and expression of intense emotions. The treatment for this lasts for about eight weeks. The distress tolerance skills include techniques for putting up with, finding meaning for and accepting distressing situations if there is no conceivable solution at present. The treatment for this also lasts about eight weeks.

People who have Bipolar disorder are also sometimes diagnosed with borderline personality disorder. DBT therapy can be a good treatment for them. DBT is also helping for people who do not have BPD as they find some of the skills taught very useful.

In Wales DBT is also an option for children and quite recently they have started to teach the skills to adults as well. Do you think that DBT skills should only be taught to people who have been diagnosed with BPD or  bipolar? Do you think that it can be useful to children and adults also?







6 Responses to “What is Dialectical Behavioural Therapy?”

  1. DBT therapy is also being used on people with borderline personality disorder. This condition’s main problem is that it’s suffers struggle with relationships. Because of this is it very common for the patient-therapist relationship to suffer, and therefore a lot of therapeutic efforts may lead to very little change in the patient.
    DBT is split into four components; individual sessions, skills training group, out-of-hours telephone contact and the consultation group. These sessions and services all aim to teach the patients how to deal with difficult feelings. They are also successful at managing behaviours in patients which are unwanted. It is also successful at engaging patients who are less likely to engage in other treatments.
    Overall DBT is an expensive and time-consuming treatment for those who provide the service. However, there are claims that it is successful and worthwhile for those patients who are high risk.

  2. A system therapy developed by Marsha. M. Linehan, aiding to treat people with borderline personality, as already known. The system uses cognitive- behavioural techniques. Contemporary studies have found that this therapy aids sexual abuse victims. DBT is known to reduce suicide attempts, and in doing so, becomes effective. (Linehan, Comtois, Murray, Brown, Gallop, Heard, Korslund, Tutek, Reynolds, and Lidenboim, 2006). Participants being aided with DBT were half as likely to commit suicide, than those without it. Therapy is considered beneficial, some of its forms of treatment include consultations, weekly group sessions and one to one therapy talks.

    “National Institute of Health and Clinical Excellence (NICE) suggested DBT as the treatment of choice for women with BPD for whom reducing recurrent self-harm is a priority” (National Institute for Health and Clinical Excellence, 2008).

    DBT has also led to the decrease of feelings of learned helplessness, a huge issue in depression related disorders.

    DBT effectiveness has been assessed in two major trials. The first (Linehan et al, 1991) compared the effectiveness of DBT relative to treatment as usual (TAU). The second (Linehan et al, in press) examined the effectiveness of DBT skills training when added to standard community psychotherapy.

    Linehan, M.M., Comtois, C.A., Murray. A.M., Brown, M.Z., Gallop, J.R., Heard. I.H., Korslund. K.E., Tutek. A.D., Reynolds, A.S., & 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. American Medial Association. 63, 757-766.

    National Institute for Health and Clinical Excellence. Borderline personality disorder: treatment and management. (2008) NICE guideline Draft for consultation (accessed 05/09/08)

  3. I believe that D.B.T could be used as a prevention tool or a trouble shooter In regards to your question : should D.B.T. be taught to adults and children to improve social skills (despite their being no diagnosis of any of the mentioned disorders) .As any kind of educational programme which teaches you how to regulate your emotions effectively would i assume be helpful in environments such as schools and work places.

  4. As mentioned in an earlier comment, DBT is also a treatment for those suffering from borderline personality disorder. Borderline personality disorder is a persistent and severe mental disorder, it is important that treatment interventions have beneficial effects that are sustained beyond the actual treatment period. In one study patients either underwent DBT or continued their treatment as normal. The results of a follow up study indicated that six months after treatment discontinuation, the benefits of DBT over normal treatment were sustained. Those who underwent DBT had lower levels of impulsive and self-mutilating behaviours. They also showed a significantly larger reduction in alcohol use. These findings suggest that DBT is not only an effective treatment for borderline personality disorder, but one whose effects are sustained after termination as well.

    Bosch, L. M., Koeter, M. W., Stijnen. T., Verheul. R., & Brink, W. (2005). Sustained efficacy of dialectical behaviour therapy for borderline personality disorder. Behaviour Research and Therapy, 43(9), 1231-1241

  5. Having read your blog and the other four comments it is clear to see that DBT has significant affects for those with BPD or types of depression, however due to the nature of the treatment it has also been shown to be affective against other disorders including binge eating disorder (BED) and bulimia nervosa.
    Telch, Agras and Linehan (2001) randomly assigned 44 women with BED to either a DBT group or a waist-line control condition. They had an Eating Disorder Examination as well as their weight, mood and affect regulation measured at baseline and post treatment. It was found that there were significant changes in binge eating and eating pathology as the treatment progressed and 89% of the women had stopped binge eating all together when treatment was terminated.
    Similarly, Safer, Telch and Stewart-Agras (2001) analysed the affect of a 20week DBT program on 31 women with bulimia nervosa. Their results were also promising and showed that the therapy caused highly significant decreases in binge behaviour when compared to those in the waist-line condition.
    These studies further highlight the positive uses and effectiveness of DBT.

  6. Interesting blog. To answer your question as to whether DBT should be used with children as well as adults, I believe it should be. As long as the therapists are trained in working with children and the therapy can be explained to the children in a way they will understand and then be able to judge for themselves whether they would want to take part.
    Perhaps a subject that you could talk about in your next blog could be a comparison between the use of therapies such as DBT and the use of medications to treat borderline personality disorder.
    therapies which do not involve the use of medications could be easier to apply to children. Children may find the constant use of medications traumatic, there may also be medications which are not suitable for children of certain ages.
    By using DBT to treat borderline personality disorders, therapists may be more capable to treating the problem at the source or at least as close to the source as they can, whereas medication cannot solve the cause of borderline personality disorder, they can only hope to dampen the symptoms.
    Medications can also have very damaging side effects, and it is usually necessary to take the medications continuously for the rest of the individuals life. Whereas DBT only lasts a few weeks and could give patients a base of knowledge and training by which they can learn to live the rest of their lives without their mental illness being such a burden to them.

    Well done.

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