About DBT
Dialectical Behaviour Therapy (DBT) is recognised as the gold standard psychological treatment for people with Borderline Personality Disorder (BPD).
It was originally developed by Dr Marsha Linehan.
Research has shown that DBT is also effective in treating a wide range of other problems such as substance dependence, depression, PTSD, eating disorders, and anger.
DBT involves a number of elements, which are called modes:
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Skills training in groups
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Individual therapy
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Between-session coaching
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Consultation team (DBT treating team)
Who can benefit from DBT?
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People with Borderline Personality Disorder (BPD)
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People experiencing difficulty managing anger and other intense emotions
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People with intense interpersonal difficulties
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People with problems with impulsive behaviours, such as overspending, overeating, substance use, self-harming
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People with suicidal thoughts and behaviours
DBT is a comprehensive, intensive treatment program that changes lives. It is an investment in yourself and your decision to build a life worth living.
It is important to note that DBT is a structured and long-term treatment, and its success depends on the collaboration between the therapist and the client. Clients typically go through multiple stages of treatment, working on different aspects as they progress.
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DBT involves a significant commitment of time, resources and willingness to prioritise DBT as your primary treatment. This means stopping or pausing other psychological treatments while you are in DBT.
The biosocial theory of emotion dysregulation
DBT assumes that problematic behaviors, emotions, cognitions, and relationships are caused by the interaction between an individual’s biological sensitivity to emotion and an invalidating social environment. A person is most likely to benefit from DBT if the biosocial theory fits that person’s presenting concerns.
Specific behaviours addressed and skills taught in DBT
DBT targets a number of specific behaviours to decrease, by teaching specific types of skills within the skills training group.
Behaviours to decrease
Mindlessness
Emptiness, being out of touch with self and others, judgementalness.
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Up and down, extreme emotions
Mood-dependent behaviour, difficulties in regulating emotions.
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Interpersonal conflict
Interpersonal ups and downs, stress, loneliness, difficulty asking for what you want or saying no, difficulties with change.
Impulsive or destructive behaviour
Acting without thinking, difficulties accepting reality as it is, willfulness, addiction.
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Skills taught in DBT to address these behaviours
Mindfulness
Skills for reducing suffering and increasing happiness, increasing control of your mind, and experiencing reality as it is.
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Emotion regulation
Skills for understanding your emotions, decreasing the frequency of unwanted emotions, decreasing emotional vulnerability, and decreasing emotional suffering.
Interpersonal effectiveness
Skills to help you get what you want and need from others, build relationships and end destructive ones, and walk the 'middle path' in relationships.
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Distress tolerance
Skills for surviving emotional crisis situations without making them worse, and accepting reality when you cannot change it.
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Stages of treatment
DBT is conducted in four stages. They are:
Target hierarchy in DBT - what we focus on, and when
When beginning treatment in Stage 1, DBT follows a clear hierarchy of targets:
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Life-threatening behaviors (eg, suicidality, self-injury)
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Therapy-interfering behaviour (eg, problems with therapist, not doing homework, missing sessions, etc)
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Quality of life-interfering behaviour (eg, depression, anger issues, addiction, eating issues, etc)
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Skills deficits (eg, distraction skills, mindfulness skills, changing emotion skills, etc.) The hierarchy for each subsequent stage is created collaboratively with the client.
Functions and modes of DBT
Individual therapy
Individual therapy typically involves weekly one-to-one sessions with a DBT therapist. Each session lasts approximately 50 minutes. The individual sessions have specific areas of focus, including helping keep you safe, reducing behaviours that interfere with therapy, helping reach your goals and improve your quality of life, and helping you learn new skills.
Phone coaching
Phone coaching is a tool to facilitate your use of skills in “real life” situations.
For example, a brief 5-10 minute call can be useful when you are trying to use your DBT skills and need advice on how to do it.
Phone coaching is not used for emergency situations or as a therapy session.
Skills groups
In these sessions DBT therapists will teach you skills in a group setting. There are typically four sets of skills taught over three modules - mindfulness skills, distress tolerance skills, emotion regulation skills, and interpersonal effectiveness skills. DBT skills training groups are held weekly for 2.5 hours.
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DBT consult team
DBT therapists are highly trained and maintaining their skills is considered an important part of this approach. DBT therapists meet weekly to discuss their clients in treatment, and clients benefit from the collective knowledge and skills of the whole treating team.
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Strategies used in DBT
DBT is a behavioural approach to treatment. As such, it prioritises behavioural strategies to help reduce unhelpful behaviours, and increase more helpful ways of coping.
The main strategies used in DBT are:
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Behavioural analysis - analysing unhelpful behaviours to build understanding and awareness; looking for opportunities to replace unhelpful behaviours with more healthy ones
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Skills training - teaching and modelling behavioural skills to manage problems (mindfulness skills, emotion regulation skills, distress tolerance skills, interpersonal effectiveness skills)
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Behavioural experimentation - trying different behaviours and skills in different situations; homework; self-monitoring between sessions using a diary card
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Practice - support and encouragement to practise new behaviours and skills; problem solving when things don’t go to plan.
If this information fits with your current difficulties, DBT may be a suitable treatment for you.
Eligibility with GlowDBT
Eligibility criteria
Our team see clients for DBT from the age of 18 years old. Adolescent DBT is a different program, which we do not offer at The Glow Centre, and should be sought by persons under the age of 18.
While DBT is effective for clients at risk of harm to themselves, The Glow Centre is a private practice and clients must be low to moderate risk.
If clients are at high risk, they must be engaged with or case managed by a psychiatrist or public mental health team, who can manage medications and arrange for crisis support/admissions when required.
In order to ensure optimal treatment outcomes and prioritise your safety, it is necessary for you to fulfill the following prerequisites:
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be committed to, and motivated for, treatment
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agreement to the DBT Participant Agreements (see Intake Process)
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consent to The Glow Centre’s general prerequisites for engaging with us (by signing Client Consent Form, which will provided prior to your first appointment).
Exclusion criteria
DBT is not an appropriate treatment for all clients, even if eligibility criteria are met. Experience has shown that DBT is unlikely to meet the needs of clients who demonstrate the following:
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intellectual functioning that impairs the ability to understand elements of treatment
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acute psychosis
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behaviours that endanger the safety or wellbeing of other DBT participants, including but not limited to actual or threatened violence, bullying, intimidation and harassment
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severe substance abuse
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disabling organic conditions
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florid antisocial behaviour
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severe dissociation
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medical instability due to an Eating Disorder.