10 Things You Should Know About... Dialectical Behaviour Therapy (DBT)


1. Dialectical Behaviour Therapy (otherwise known as DBT) was designed by an American Psychologist, Marsha Linehan. If is the recommended treatment for Borderline Personality Disorder (BPD) as it aims to change behaviour, yet has a focus on accepting who you are.
2. You can engage in DBT through a number of ways. One is on a one-to-one basis, which will usually be a weekly appointment with a mental health professional who is specifically trained in DBT. You could also participate in group DBT; these two options are mostly used for outpatients: those in the community. There's also hospitals that specialise in DBT, this is usually on the wards that are designing for those with a Personality Disorder diagnosis. This is how I went through my DBT. We had 1:1 sessions once a week as well as group sessions once a week. We'd be given 'diary sheets' where you had to keep a record of which days you used which DBT skills and why you used them. The method of DBT you might be offered can depend upon the services available in your area; hence why I ended up in Bradford!
3. When you begin DBT it's important to remember that not all professionals have any knowledge of DBT. This means that you may learn coping strategies in Therapy that they've not heard of. This can be difficult for many reasons. Firstly, their basic knowledge might mean that they advise you to use a DBT skill that either isn't relevant or which you don't find helpful. Even though the hospital I was sent to specialised in DBT there was a limited amount of staff who were actually trained it and ran the 1:1 and group sessions. One thing that always annoyed we service users, was when a member of staff that wasn't trained, used some of the phrases that they'd overheard. We felt patronised that we had to sit through a mandatory DBT course for 12 months and they were trying to advise us on something that they knew less about than we did!
4. Because DBT is predominantly used on those with BPD, it focuses on the key areas that sufferers are most affected by and which perhaps cause the most disturbance to their every day life. The section of DBT that is thought to be its foundation, is 'Mindfulness.' This, has the aim of promoting that a BPD sufferer live in the moment by experiencing their emotions rather than feeling overwhelmed and avoiding them.
5. There are two sets of skills taught in order for this to be achieved, the first set are known as the 'what' skills. These are three ways in which you can experience your emotions; by observing them, by describing them, and by participating fully in the situation causing your emotions. The second set of skills, are known as the 'how' skills. These are three approaches you should taken when fully experiencing your emotion; by being nonjudgmental, focusing on one thing alone, and being effective.
6. Another key part of DBT is in Distress Tolerance, which is an empathy on learning to bear painful emotions through distraction, self-soothing, and improving the moment. Recommended methods of distraction are taking part in a positive activity, contributing to others, comparing yourself to those who are worse off, provoke a different emotion in yourself, pushing the situation away, forcing yourself to feel another emotion or use something to cause a different sensation. Self soothing is more of an individual method with different things working for different people. Some might enjoy doing physical activity such as running, others may prefer to put on a face mask and watch a movie. Ways to improve the moment are by using imagery, finding a purpose in how you feel, prayer (if relevant/appropriate), using relaxation, and encouraging yourself to get through the difficult moment.
7. A third area which DBT concentrates on is emotion regulation as BPD sufferers often experience intense emotions such as uncontrollable anger or suicidal ideation. In order to ensure that you have a healthy body which will then aid in your ability to have healthy emotions, DBT advises attending to your physical health, having a balanced diet, avoiding mood-altering drugs and getting enough sleep and exercise. The first steps in emotion regulation, are learning to identify and label an emotion, improving your good emotions by increasing positive experiences, and use skills learnt in distress tolerance to manage negative emotions e.g. anger, depression and anxiety.
8. Finally, interpersonal effectiveness is used to aid BPD sufferers in having others meet their needs in specific situations without damaging the relationship. In an interaction where you're trying to get something from another person, DBT advises that you appear confident whilst describing your situation, expressing how you feel, asserting yourself, reinforcing your point, and negotiating (if necessary) with the other person. To aid in maintaining relationships, DBT suggests that you use gentle language and an easy manner whilst showing an interest in and validating the other person. And when it comes to maintaining your self-respect you should be fair to both yourself and the other person, resist feeling the need to apologise more than once, be truthful, and stand by your values.
9. Like most things in mental health, DBT is an extremely individual matter. Do not feel disheartened if you feel that some of the skills don't work for you. Personally, I've never been able to utilise the mindfulness skills because I feel that spent six years of my life keeping myself out of the moment in order to protect myself; and so staying in the moment was a terrifying and daunting thought. On the other hand, I found interpersonal effectiveness very helpful as being better at interacting with others largely meant that more people could understand why I would self-harm. And that understanding was overwhelming after the years of feeling judged had led me to deeper self-hatred.
10. DBT can be a long process but even if it only has the smallest or positive changes on your life, that time was worth it. And it's true what they say; once you get the hang of it, you don't even know your using the skills.
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