Dialectical Behaviour Therapy

Dialectical Behavioral Therapy (DBT)

Originally developed for people with Borderline Personality Disorder, DBT has proven itself effective for a number of different emotional concerns. It’s focus is on developing mindfulness, regulating strong emotions, on learning how to deal with emotions rather than escaping from them, and on learning how to communicate.

You’re taught to avoid extreme positions, and how to learn to consider positions other than your own. This can help you navigate the complexities of relationships in a positive way.

DBT does require as much work on your part as on the part of the therapist. You are literally changing your own behavior, and that’s not always easy! But the work you put in will pay off in spades.

Who does DBT help?

DBT helps with anxiety, depression, PTSD, and a number of other conditions. It can also help with relationship issues and conflict management. DBT is highly effective any time changing your behavior is the best way to manage your concerns. It focuses on learning four specific skills to help you manage your life: distress tolerance, mindfulness, emotional regulation, and interpersonal effectiveness.

For example, when you start to get stressed, I would teach you to notice your breath, notice your surroundings, and be mindful of the here and now. Instead of becoming paralyzed by worrying about tomorrow’s problems, you would instead choose to address the problems you can solve today.

If you start to get angry, I might teach you behaviors of acceptance, like deep breathing while reminding yourself there are certain things you just can’t change. No life is perfect, and so exercising skills which help you accept the things you can’t change can help you spend less energy on them. You could also benefit from consciously adopting a non-judgmental stance when dealing with things that might normally bother you.

You’re not engaging with individual thoughts in DBT. You’re learning specific skills, techniques, and strategies you’ll use in response to certain stimuli. The specific thoughts soon come to matter less than they used to.

DBT Examples

George is having a lot of conflict in his interpersonal relationships. Almost every conversation he has with his loved ones dissolves into an argument.

Through DBT therapy, George learns about a specific communication skill called “DEAR MAN.” This is an acronym which stands for “Describe, Express, Assert, Reinforce the relationship, be Mindful, Appear confident, and Negotiate.”

The next time a conflict arises between George and his wife, he takes a deep breath. He pauses to describe only what he has observed, in non-judgmental language. Then he uses “I statements” to express how he feels about what he’s observed, before clearly and unambiguously asserting his needs and wants.

He makes sure his wife knows that she’s important to him, and that her happiness is important to him. And he stays in the present, avoiding the temptation to bring up past battles, or make promises he doesn’t know he can uphold. He remains calm, confident, and assertive, but looks for ways to compromise so they can both feel heard, loved, and appreciated.

DBT Results

DBT’s focus on skills mastery means it delivers long-term results. Once you’ve learned a skill, it doesn’t go away, but you do have to practice.

As you exercise these skills and see improvement in your life, you should also start to experience improvements in the way you think and feel.

DBT can sometimes be even more effective when combined with other therapies. For example, I sometimes combine DBT with CBT, addressing both your skills in handling stress and the thoughts which are causing upsetting feelings to disrupt your life. This two-pronged approach can create even better outcomes.