What is Dialectical Behaviour Therapy (DBT)

Dialectical Behaviour Therapy (DBT) is a great fit for people who are interested in learning skills, it’s a therapy that is useful for all humans, in my opinion.  It was originally developed to treat severe, complex and persistent mental illness, and over time it’s also been proven effective with depression, anxiety, addictions, eating disorders, any much more.  Fundamentally DBT skills help to reduce impulsiveness, enable ‘responding’ rather than ‘reacting’, and develop more effective ways of coping with pain and problems.  

DBT views problem behaviours as a set of learned behaviours that we therapists help people unlearn.  DBT’s perspective is that in our lifetime, there will be an infinite number of painful things that happen to us and problems we will encounter, yet there are only 4 possible responses when pain or problems come into our life:

(1)          Solve the problem

(2)          Feel better about the problem – change or regulate our emotional response to the problem

(3)          Tolerate the problem – accept and tolerate both the problem and our response to the problem

(4)          Stay miserable – do nothing, use no skills, or even make things worse.

One of the main assumptions in DBT is that people may not have caused all their pain and their problems, but they have to solve them anyway.  The skills offer new behaviours to experiment with, I refer to them as a ‘buffet’ of offerings – and just like I’m not going to like every item on a buffet, not all skills will work for all people – but every person I’ve worked with has found some skills that work for them.   

There are 4 ‘Categories’ of skills in DBT:

*Mindfulness: or ways of managing your attention, taming your mind, which is helpful for all of us, since we aren’t born with an instruction manual for our mind, and while it is our greatest asset, an untamed mind can also be our worst enemy;

*Emotion Regulation: understanding the purpose of emotions (because we can’t get rid of them), and managing and coping with emotions. This is extremely helpful for those who feel like emotions get the better of them or run their lives, and make situations worse.

*Interpersonal Effectiveness: a variation of ‘assertiveness skills’, helping people develop more satisfying relationships by asking for what they want, setting and maintaining boundaries, saying no effectively, and managing conflict differently.

*Distress Tolerance: or bearing pain skillfully, how to accept and tolerate a situation that can’t be changed, or which one has no control over;

How is DBT different than CBT

DBT is based on CBT, Cognitive Behavioral Therapy. CBT is related to the interaction among thoughts, emotions and behaviours, it helps people CHANGE their thoughts and behaviours in order to influence CHANGE in their feelings. 

What DBT adds to CBT is it’s focus on ACCEPTANCE and TOLERANCE, this is where the reference to DIALECTICAL comes in. Dialectical refers to balancing opposites – while recognizing the need for change, DBT also emphasizes accepting ourselves in the moment. It’s a focus on both /and, this AND that – rather than either / or, this OR that.

Additional values in DBT include finding meaning in suffering and becoming more adaptable / flexible when it comes to change – the fundamental nature of reality is change, therefore the more flexible we are, the better we are able to manage change.

If you’re interested in learning some of the skills of DBT, please feel free to connect with me, shannon@simmscounselling.com or 604-888-9294.