Dialectical Behaviour Therapy (DBT): Benefits and How It Works

Dialectical Behaviour Therapy is a structured talk therapy that teaches you to manage intense emotions while still moving toward the life you want. Also written as dialectical behavior therapy DBT in the US, it was built for people whose feelings rise fast and take a long time to settle. In an NIMH-funded randomized trial, 23.1% of women treated with DBT attempted suicide, compared with 46.7% of those treated by community experts. Below, you will find how the treatment is organised, the skills it teaches, techniques you can practise at home, and who benefits most.

What Is Dialectical Behaviour Therapy (DBT)?

Dialectical Behavioural Therapy is a type of cognitive behavioural therapy which uses skills to maintain an equilibrium between acceptance and change. It was developed by Marsha Linehan, a psychologist from the University of Washington, who published a trial in 1991 among people with chronic suicidal tendencies and no improvement after normal treatment procedures.

The meaning of dialectical in DBT is the combination of two truths. You make sense of yourself with what you've been through, and yet you can still learn to do things differently.

How Does DBT Therapy Work?

DBT treatment works through the use of multiple forms of therapy to ensure that the patient acquires different skills in a well-timed manner. The basic treatment plan consists of four parallel components.

• Individual therapy sessions: Weekly one hour sessions that will involve setting the goals for the session, reviewing the diary card (record of daily emotions, urges, and skills usage), and problem-solving.

• Skills training group: A weekly training group consisting of two to two and a half-hour sessions that will work on teaching and practicing one skill at a time.

• Coaching calls or texting: Brief communications between therapy sessions aimed to provide assistance during a difficult time.

• Consultation among therapists: Consultations among therapists to maintain consistency in treatment.

The treatment occurs according to a certain hierarchical structure of goals. The top priority is safety, followed by disruptions in therapy, and then building of regularity of daily routine.

How Long Does DBT Take?

A full DBT program usually runs 6 to 12 months, with about 3 to 3.5 hours of scheduled time each week. Since the time commitment matters when you are deciding, the table below shows the weekly load and the overall length.

What Are the 4 DBT Skills?

The four DBT skill modules are mindfulness, distress tolerance, emotion regulation and interpersonal effectiveness. Each answers a different daily struggle, and skills are taught in small steps so you can use them when stress makes clear thinking hard.

• Mindfulness: Observe thoughts, feelings and physical sensations without evaluating them. A Wise Mind enables you to balance emotions and reasoning before making decisions.

• Distress tolerance: Endure a difficult situation without making it more difficult. TIPP (temperature alteration, intense physical exercise, paced breathing, and paired muscle relaxation) and radical acceptance are primarily used for this.

• Emotion regulation: Identify emotions, pinpoint the triggers and minimize the frequency of emotional hijacking. “Checking the facts” and “opposite action” fall into this category.

• Interpersonal effectiveness: Request things from others, refuse requests, and preserve relationships. DEAR MAN, GIVE and FAST are examples of step-by-step scripts used for this purpose.

Dialectical Behaviour Therapy Techniques to Practise Daily

These dialectical behaviour therapy techniques are simple enough to try on small, everyday stress before a bigger moment arrives. They are a starting point and do not replace professional treatment.

1. Cold-water reset: Hold a cold, damp cloth to your face for 30 seconds while breathing out slowly. This can bring a racing heart down quickly.

2. Name and rate it: Say the feeling aloud and score it from 0 to 10, such as "ashamed, about a 6."

3. Check the facts: Write what happened, what you assumed, and what you would tell a friend in the same spot.

4. Opposite action: When an emotion pushes you to withdraw or lash out, take one small step in the other direction.

5. Script the hard talk: Before a tough conversation, write one line each for describing, expressing, asserting and reinforcing, then say it aloud once.

What Are the Benefits of DBT Therapy?

The main benefit of DBT is that it gives you something to do in the moment, not only something to understand afterward. The gains people most often describe are practical and easy to notice.

• Emotional spikes that pass sooner and feel less overwhelming

• Fewer episodes of self-harm and suicidal behaviour

• Less impulsive behaviour such as bingeing, drinking or angry outbursts

• Calmer conflicts and clearer boundaries with family and friends

• A written plan for hard days, so you are not starting from zero

• Skills that stay with you after sessions end

Does DBT Work? Success Rates and Research

DBT has some of the strongest research support among therapies for emotional dysregulation. The figures below come from a two-year randomized trial of 101 women with borderline personality disorder.

Reviews that pooled many studies point the same way. One analysis found less self-directed violence and fewer crisis service visits, and a review of 21 studies with 1,673 teenagers found lower self-harm and fewer suicidal thoughts. Results differ from person to person, and the size of the benefit depends on what DBT is compared against.

Who Is DBT Therapy Best For?

The main problem that DBT addresses is BPD, which is said to occur among 2% to 6% of American adults, as reported in prevalence studies. More information about the symptoms and guidance concerning the matter can be found at the National Institute of Mental Health's overview of BPD. DBT has also been developed to cope with other disorders characterized by strong emotions.

• Self-injury and suicide ideation

• Major depression with mood swings

• PTSD

• Bulimia

• Anxiety that causes avoidance and panic

• Teenagers and their parents, via adolescent DBT

DBT vs CBT: What Is the Difference?

DBT is a branch of CBT, so the two share many methods but differ in emphasis. CBT targets unhelpful thought patterns and behaviours, and studies on how cognitive behavioral therapy rewires your brain show why it works well for anxiety and depression. DBT keeps that base and adds acceptance, mindfulness and group skills training for people whose emotions feel too intense for thought-based work alone.

Can You Take Medication Alongside DBT?

Yes. DBT is a talk therapy and does not include medication by itself. Some people progress with skills alone, while others also need medicine for depression, anxiety, mood swings or sleep problems. When that is the case, many people pair therapy with outpatient psychiatry so prescribing and skills training follow one plan.

Borderline Personality Disorder Treatment at Athena Behavioral Health

At Athena Behavioral Health, we provide borderline personality disorder treatment for adults who live with intense emotions, fear of being left, unstable relationships or impulsive behaviour. Care is built around your symptoms and goals, with evidence-based therapy and psychiatric support planned together. You are treated as a whole person, not a label, and your plan changes as you progress.

How to Start DBT in 4 Steps

Starting DBT is a simple process that can be broken down into four parts from initial assessment to consistent weekly schedule. Breaking down the first step into components makes it seem less intimidating.

1. Book yourself an assessment with a qualified mental health practitioner to determine if DBT is appropriate for you.

2. Inquire about training and format, particularly whether skills group and session coaching are provided.

3. It will take several months since the skills get automated through repeated practice.

4. Practice on a weekly basis, complete your diary card and learn one new skill at a time.