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Dialectical Behaviour Therapy
DBT – Dialectical Behaviour Therapy – is an enhanced type of Cognitive Behaviour Therapy (CBT).
DBT was developed by an American clinical psychologist, Marsha Linehan. It helps people with enduring difficulties and self-destructive coping strategies to enjoy greater wellbeing.
Linehan observed that CBT required some additional strategies and a special approach to help people with serious difficulties, in particular people who used self-harm and suicidal behaviour to cope with their difficulties. She developed a new therapy for this purpose.
DBT focuses on developing alternatives to self-destructive behaviour so that people can develop worthwhile lives. It also helps people to look at how their behaviour may help or hinder their ability to make use of therapy, and think about how to ensure the best chance of working through any difficulties that might be interfering with therapy.
DBT includes a significant learning component, where people are taught skills for interpersonal relationships, emotion regulation, distress tolerance and mindfulness in order to better manage the challenges of life.
Who is DBT for?
DBT is for people who have difficulties managing their emotions, who find distress intolerable, who struggle to have stable relationships, or who use self-destructive coping strategies to manage their distress.
People usually develop these difficulties through a combination of biological and social influences. Infants who are born with sensitive nervous systems, who react a lot to their environments, and have difficulty settling are more likely to develop these difficulties.
Infants who are born into families that invalidate infants’ and children's emotions are also more likely to develop these difficulties. Invalidating family environments have several effects on the children who are raised there.
First of all, these children are not taught to understand, label or settle their emotional reactions. Children are not taught about how regulating emotions can be a complicated process. They may end up feeling inadequate because they think that there are simple solutions to complicated problems, but they are somehow unable to make the simple solutions work. Children may learn that in order to get any help regulating their emotions, they may need to express their emotions very forcefully so that people pay attention to them. Finally, a child whose emotional reactions to the environment are not validated may learn that their responses to situations are not trustworthy, and may end up very confused about what is happening inside them.
What Does Dialectical Mean?
A dialectic is a rational discussion between two opposing points of view that leads to a synthesis of the two opposites.
Dialectics are built into reality – we can contrast one point of view, for instance that society requires strong labour laws to protect workers, with an opposing point of view, that strong labour laws cause industrial stagnation which damages society. A dialectic finds a combination of these views in a dynamic, more accurate reality: that we need a dialogue between industrial and labour power that balances both in order to have a healthy society.
Marsha Linehan observed that people with emotional regulation difficulties who grew up in invalidating families often have difficulty reaching a synthesis when two opposing points of view are evident – for instance, accepting that a person can be both kind and unkind to them. This leaves them using all-or-nothing thinking, and having difficulty dealing with the natural complexity and contradictions in themselves, others, and the world around them.
DBT works to help people to think more dialectically, and resolve some of these natural contradictions into a synthesis.
DBT emphasises the need to reduce and eliminate self-destructive and therapy-interfering behaviour in order for people to get better. This work is usually achieved over time in sessions with a therapist.
There is also an important skills component of DBT, in which a person is taught skills they may require to cope with interpersonal relationships, to regulate emotions, and to tolerate distress.
A key skill that is woven throughout the therapy is mindfulness, the ability to focus on the present moment, and let the past be the past and let the future wait to become the present. When we are being mindful, we are fully aware of the present moment, without judging it or try to change it, and we choose, deliberately, effective actions that help us reach our goals, rather than reacting to and trying to escape the situation we are in.
Over time, these skills and techniques can help to reduce distress and improve coping and wellbeing for people with enduring difficulties.
Linehan, Marsha (1993). Cognitive-behavioural treatment of Borderline Personality Disorder. New York: Guildford Press.