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Alexander Ingram

Page medically reviewed by Alexander Ingram, Therapist at Priory Hospital North London

What is dialectical behaviour therapy (DBT)?

Dialectical behaviour therapy (DBT) is a type of evidence-based psychotherapy - a type of 3rd wave cognitive behavioural therapy (CBT). CBT focuses heavily on changing our thoughts, whereas DBT focuses on accepting and changing our behaviours. It was developed by Dr Marsha Linehan and colleagues in the late 1980s. Its basic principles help develop healthier thought patterns and strategies for regulating emotions.

Originally developed as a treatment for those with borderline personality disorder (BPD/also EUPD), DBT has now developed into a leading treatment for people who struggle with emotional instability. If you’ve been struggling with a mental health condition, DBT here at Priory could be an effective way to take control of your condition and improve your wellbeing.

How does DBT Work?

The word ‘dialectical’ gets to the core of how DBT works. It comes from the idea that two different beliefs or thoughts, that seem to be the opposite of each other, can both be simultaneously true. In DBT, these opposing ideas are acceptance (accepting yourself) and change (changing your behaviour). DBT teaches us that these two goals are both achievable at the same time.

DBT’s other focus area is borrowed from CBT. Both DBT and CBT can help you to change destructive, damaging or otherwise unhelpful ways of thinking or behaving. In essence, the acceptance strategies of DBT are added to the behavioural change strategies that are central to CBT.

For people who have been struggling with conditions such as personality disorders, anxiety or eating disorders, DBT can be an effective treatment that helps you manage your condition and continue to thrive. It can be thought of as a type of cognitive and emotional rehabilitation for people who have suffered exposure to long term stress or sudden acute trauma.

Skills learnt with DBT

DBT skills and techniques will teach:

Mindfulness: A therapeutic method that encourages you to focus on the present. With skills in mindfulness, you’ll be more aware of your feelings, thoughts, emotions and impulses in the moment. Mindfulness can help you to stay calm and avoid negative thought patterns and behaviours. Mindfulness is the cure for an agitated mind. It is a skilful way to take hold of the mind, so the mind does not take hold of you.  In other words, mindfulness is a form of attention retraining.

Distress tolerance: An ability to recognise and accept intense emotions, such as anger and frustration, without feeling the need to react in an extreme or impulsive way. Distress tolerance uses techniques such as distraction and self-soothing to cope with intense feelings in the moment, so that we do not make our problems worse.

Emotional regulation: Being able to recognise, label, and adjust your emotions. With better emotional regulation, you are more able to cope with intense negative emotions, harnessing a more positive long-term emotional outlook, and solve your problems effectively in ways that stand the test of time.

Interpersonal effectiveness: Focuses on improving your ability to communicate effectively, helping you to foster healthy relationships. You’ll learn to speak more assertively, how to say ‘no’, be a better listener, and deal with challenging people more effectively.  

DBT can be adopted in many different settings. Group therapy, where these skills are developed in a group setting, is common in DBT, but it is also often delivered in one-to-one and online therapy sessions.

What is the difference between CBT and DBT?

CBT: Helps you to tackle your problems by breaking them down into smaller, more manageable parts, and changing the way that you think, behave and respond to them.

DBT: Does what CBT does, but also focuses on the individual and how they can learn to understand and accept themselves, in order to reduce dysfunctional and distressing emotions and return to a healthier way of life.

In essence, the goal of CBT is to think your way into a new way of behaving; whereas in DBT the goal is to behave your way into a new way of thinking. 

What are the benefits of DBT?

Since DBT was first used as a therapeutic technique, it’s shown that it can produce a whole range of benefits for those with mental health problems. These include:

  • Acceptance of the circumstances around you and of yourself as an individual, while still being able to make positive changes in your life.
  • Letting go of painful events from the past so you can move forward with your life.
  • Heightened ability to recognise extreme emotions, thoughts and beliefs and the strategies to cope with them and ultimately replace them with more positive thoughts
  • Identify harmful or destructive behaviours and urges, plus the strategies to cope with them. An ability to replace those behaviours with healthy, positive and effective ones that improve your wellbeing
  • Learn to communicate more effectively within your existing relationships. Speak with greater authority and learn how to deal with potentially fractious verbal exchanges
  • Develop lifelong skills that can be applied to many real-world scenarios, enhancing your personal capabilities
  • Improve your mental health and wellbeing with a more positive and less destructive mindset

Who benefits from DBT?

Patients who benefit from DBT are often individuals who appear to be living chaotically, seem to be in a constant state of ‘crisis’, or those who feel emotions very strongly.

Typically, people who benefit from DBT can struggle with:

Sudden changes in emotion

You find sudden changes in emotions are common and have difficulty returning to a calm emotional baseline. For example, you might feel devastating grief where sadness would be expected, humiliation in place of disappointment and destructive rage instead of anger. You may also experience extreme feelings of rejection, failure, isolation and a sense of victimisation.

Impulsive behaviours

You might attempt to cope with emotional dysregulation in ways which are frequently harmful, or that do not stand the test of time. Impulsive behaviours are common, including substance or alcohol abuse, reckless spending, risk-taking, self-harm and suicidal behaviour. Impulsive behaviours might lead to ending of friendships and relationships or losing your job. Individuals who struggle to regulate their emotions may enter a harmful cycle of engaging in the above behaviours leading to intense shame and guilt, which leads to further unhelpful attempts to soothe their emotional pain.

What conditions can DBT treat?

Despite its roots as a treatment for BPD/EUPD, DBT is also used to successfully treat a variety of mental health conditions, such as:

  • Attention-deficit/hyperactivity disorder (ADHD)
  • Bipolar disorder
  • Problems with Eating disorders
  • Anxiety
  • Depression
  • Obsessive compulsive disorder (OCD)
  • Post-traumatic stress disorder (PTSD) & Complex post-traumatic stress disorder (cPTSD)
  • Addictions
  • Suicidal behaviour & Self-Harm

How to get started with DBT

If you’re struggling with one of the conditions above, and think that DBT could be an effective treatment option, it’s important that you speak to a trained medical professional to get their opinion on your symptoms and treatment options. The best place to start is your local GP.

Alternatively, you could contact the Priory and speak to our highly trained mental health professionals about the difficulties you’ve been having. At Priory, we offer the very best in mental health treatment, helping you to get your life back on track. DBT is just one of the many available treatment options, delivered by the very best in their field. DBT can be delivered by Priory at one of our many hospital sites around the UK.

Remember, you don’t have to suffer with a mental health condition. Treatment is available and help is at hand here at Priory. Call us on 0800 691 1378 or make an enquiry today, where we can assess your symptoms and work with you to outline the best possible course of treatment.  

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