DBT is a psychological and behavioural therapy which combines aspects of Eastern Meditation Practices with Western Cognitive and Behavioural techniques. It is based on what is known as the “Biosocial” Model which proposes that individuals develop according to a complex set of interactions between their unique biological temperament, the demands and features of their immediate environment, and the broader social context in which they exist.
DBT is an “evidence-based” treatment which means that research has shown it to be effective in decreasing life-threatening behaviours in people who use self-harm and/or suicidal acts, or impulsive behaviours such as substance abuse or binge eating as a way of coping with extreme, intense and/or unstable emotions.
One of the main principles of DBT involves identifying and resolving natural tensions (dialectic) between acceptance and change. That is, both developing an acceptance that oneself/life/people/situations are as they are, whilst also identifying the need and opportunity for change. A fundamental assumption of DBT is that due to their particular biosocial conditions, some people do not have the opportunity to learn the skills necessary for tolerating distress, regulating their emotions, or being able to communicate and interact in ways that are effective for attaining their goals. DBT is therefore a skills-based therapy which encourages and supports people to learn and strengthen these essential skills.
DBT has a number of primary aims or targets:
- To reduce suicidal and self-harming behaviours.
- To reducing behaviours that interfere with the process of therapy such as not turning up to appointments, not addressing problems etc. (known as “therapy interfering behaviours”).
- To reduce behaviour that seriously interferes with the quality of one’s life such as frequent hospitalisations, interpersonal problems, alcohol/drug abuse, etc. (known as “quality of life interfering behaviours”).
- To increase behaviour that makes life worth living, such as spending time with supportive people, engaging in activities that bring satisfaction, achievement or pleasure, or contributing through work or volunteering.
As a means to achieve these targets, DBT involves learning a range of skills across four different “modules”:
Core Mindfulness
Distress Tolerance
Emotion Regulation
Interpersonal Effectiveness
Core Mindfulness
Involves learning to become a skilled observer of ones thoughts, emotions and actions – including ways in which we habitually judge or label events or situations such that we may miss opportunities for change, or create or prolong distress. Mindfulness involves becoming aware of oneself and one’s surroundings, and learning to focus and attend to what is occurring in the present moment rather than in some other place or time. Core Mindfulness skills encourage flexible rather than rigid thinking, and connection to ones best interests. Core Mindfulness skills are central to all aspects of DBT.
Distress Tolerance
The Distress Tolerance module involves skills training in:
- Learning how to recognise and reduce situations that elicit distress.
- Assessing those aspects of a distressing situation where change may be possible, and acting skilfully to effect those changes – or accepting situations where change is not currently possible and learning to skilfully tolerate the associated distress.
- Learning skills to tolerate distressing situations and emotions without taking action that may ultimately increase distress (i.e. self-harm or self-destructive behaviour).
Interpersonal Effectiveness
The Interpersonal Effectiveness module teaches skilful ways to increase the likelihood of achieving one’s objectives with others, in ways that enhance and maintain self-respect. This may include learning to ask for one’s needs to be met, setting limits with others or saying “no”, and having one’s opinions taken seriously. It also involves skills training in identifying, strengthening and maintaining supportive relationships, and ending or managing conflict in hopeless or unsupportive relationships.
Emotion Regulation
The Emotion Regulation Module involves learning to reduce emotional vulnerability and emotional suffering through increased understanding about what emotions are, what purposes they serve, and how they function. It also involves learning ways to observe and experience emotions in a more objective way, in addition to skilfully acting to reduce the likelihood of experiencing distressing emotional states.
Referrals for individual DBT are accepted at the Psychology, Trauma & Mindfulness Centre and are assessed on an individual basis subject to suitability.