By Jessical Parkes, Aspiring Clinical Psych Content Assistant
Wondering about theory-practice links?
You’ve come to the right place!
This blog will be looking at Dialectical Behaviour Therapy (DBT), an evidence-based approach that trainee and aspiring psychologists are likely to come across and potentially use aspects of, when working with service users.
What is Dialectical Behaviour Therapy (DBT)?
DBT is a type of talking therapy which is based in CBT (Cognitive Behavioural Therapy). DBT is known as a ‘third wave’ therapy because it looks beyond cognitive and behavioural approaches to integrate broader contextual and experiential strategies into the therapy. It was developed by Dr Marsha M. Linehan in the late 1970s following her own experience with mental health difficulties, which she believed to be in line with a diagnosis of BPD (borderline personality disorder). BPD (now more commonly known as EUPD – emotionally unstable personality disorder) is a diagnostic label which encapsulates difficulties with emotional regulation, unstable relationships and impulsivity.
The core of DBT is four modules that provide individuals with a set of skills to manage difficult emotions and interactions. Credit: DBT Center of Long Beach
DBT is formed around the core principle of dialectics, which means trying to balance and synthesise two opposing truths: acceptance and change. In DBT, you might say “I’m doing the best I can, and I need to do better”. This helps service users to find a middle path between extremes and achieve a balanced approach to their thoughts, emotions and behaviours. It also empowers service users to make decisions effectively and make choices that are in line with their recovery goals.
As an aspiring clinical psychologist, you might work with individuals who are presenting in crisis or who struggle with regulating intense and distressing emotions, or who have received a diagnosis of EUPD. You might use DBT-based skills and interventions to support service users and empower them to regain control over their emotions, or to provide them with skills to tolerate distress during a crisis.
Who is DBT well suited for?
DBT was originally developed for individuals with a diagnosis of BPD or EUPD. However, DBT-based skills can be useful for individuals presenting with suicidal ideation, self-harming behaviours, depression, substance use and eating difficulties.
DBT is an intensive intervention requiring a commitment to the therapy as well as motivation to change and a willingness to engage in ‘homework’ between sessions.
What does DBT include?
Traditional DBT is a structured treatment approach which involves 1-1 and group sessions and phone coaching. It follows a module-based approach which consists of the following:
- Mindfulness helps individuals to become more aware of the present moment and their internal experiences in a non-judgemental way. This then informs effective decision-making processes.
- Distress tolerance helps individuals tolerate and survive crises without engaging in harmful behaviours, and to accept life as it is in the moment.
- Emotion regulation strategies help individuals understand and manage their intense emotions more effectively.
- Interpersonal effectiveness helps individuals improve their relationships by teaching skills for effective communication, assertiveness and maintaining self-respect in interactions.
Each of these modules help individuals to build a comprehensive set of skills to manage their lives more effectively.
A core skill for therapists to use in DBT is validation, which is the act of recognising and affirming an individual’s thoughts, feelings, behaviours and experiences as understandable within their current context. Validation helps individuals feel heard, understood and respected, which is crucial for building a therapeutic relationship and fostering self-acceptance. This is something you are likely to have built into your work with your service users as an aspiring psychologist.
Does DBT work?
DBT has been extensively studied and found to be effective for various mental health difficulties, particularly for BPD/EUPD. A meta-analysis by Kliem and colleagues (2010) found that DBT was highly effective in reducing self-harm, suicidal behaviours and anger in individuals with a diagnosis of BPD. Research has also found DBT to be effective for reducing substance use (Linehan et al., 1999), episodes of binge eating for individuals with a diagnosis of binge eating disorder (Safer et al., 2001) and in improving depressive symptoms (Pistorello et al., 2012).
Conclusion
As an aspiring clinical psychologist, you are likely to come across individuals who struggle with emotional regulation, and who may have received a diagnosis of EUPD or are experiencing a mental health crisis. You are also likely to become familiar with some of the skills used in DBT, such as mindfulness or distress tolerance skills. Being aware of DBT is helpful so that psychologists can enhance their therapeutic toolkit and offer effective evidence-based interventions for a variety of mental health difficulties.
As with any therapeutic modality, make sure to discuss your cases in supervision and consider the most appropriate approach depending on your service, your skills and your supervisor’s specialities.
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And…
Check out our last blog post in the Theory in Practice series: What is Mindfulness?
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References
Kliem, S., Kröger, C., & Kosfelder, J. (2010). Dialectical behavior therapy for borderline personality disorder: a meta-analysis using mixed-effects modeling. Journal of Consulting and Clinical Psychology, 78(6), 936-951. https://doi.org/10.1037/a0021015
Linehan, M. M., Schmidt, H., Dimeff, L. A., Craft, J. C., Kanter, J., & Comtois, K. A. (1999). Dialectical behavior therapy for patients with borderline personality disorder and drug-dependence. American Journal on Addictions, 8(4), 279-292. https://doi.org/10.1080/105504999305686
Pistorello, J., Fruzzetti, A. E., MacLane, C., Gallop, R., & Iverson, K. M. (2012). Dialectical behavior therapy (DBT) applied to college students: A randomized clinical trial. Journal of Consulting and Clinical Psychology, 80(6), 982-994. https://doi.org/10.1037/a0029096
Safer, D. L., Telch, C. F., & Agras, W. S. (2001). Dialectical behavior therapy for bulimia nervosa. American Journal of Psychiatry, 158(4), 632-634. https://doi.org/10.1176/appi.ajp.158.4.632
