By Alexandra Wilson (AMHSW; CSW; MAASW; BSW Usyd)
Dialectical Behavioural Therapy (DBT) is an evidence– based therapy that’s been shown to provide excellent outcomes for lots of mental health concerns.
Originally developed for the treatment of borderline personality disorder, DBT now has evidence that shows it’s effective for any condition that results in difficulty regulating emotions and behaviours.
It’s important when you’re looking for mental health treatment, that you find a treatment that is designed to treat your particular issues. At our practice (Mindful Recovery Services), we see many teenagers and young adults for DBT treatment.
Common issues that our young people experience include:
- Intense emotions that feel out of control
- Self harm
- Disordered eating
- Drug and alcohol abuse
- Problems making and maintaining relationships
- Difficulties with self image and self esteem.
Here are 10 ways DBT could benefit you
Emotion regulation skills
Traditional cognitive behavioural therapy (CBT) is one of the most common therapies practiced, and chances are if you’ve had therapy before, you’ve done some CBT. CBT can be very effective for the treatment of anxiety and some other mental health conditions, however, for some people, the focus on thoughts and perceptions only goes so far. Some people can get very skilful at identifying problematic thoughts and beliefs, but it still doesn’t change how they feel.
DBT goes a few steps further than traditional CBT, in that emotion regulation skills are at the core of the therapy. It still covers traditional CBT concepts, such as the role of thoughts and how they interact with emotions– but it goes even further.
Emotion regulation skills are actually mostly emotion acceptance skills. We try to build our acceptance of emotions, whilst changing our relationship with those emotions– particularly the uncomfortable ones. In DBT we learn to observe and describe our emotions– without judgement. This allows us to choose how we want to respond, rather than engaging in an automatic reaction.
Balancing acceptance and change
Many western psychological therapies focus heavily on change. In other words, we identify some problem in our lives, and try to change it or ourselves to feel better.
In DBT, we recognise that there are some things that need to change. It may be that we need to learn new skills to stop problem behaviours, and create the quality of life that we want. However, if we only focus on change we are likely to encounter a problem… there are some things in life we can’t change (a lot actually)!
Acceptance skills are a core part of DBT, and we recognise that in some areas we need to push for change but in other areas we need to try to accept it. Acceptance skills are widely acknowledged in eastern philosophies as the key to emotional growth and inner peace.
DBT is a skills based therapy, which means we acknowledge that to change and accept more in our lives, we need to learn and practice new skills. Nothing changes if we don’t change our actions!
DBT teaches specific skills in how to get through times of very high distress. We often need to learn what to do to help our body chemistry first, in order to be able to get through times of very high distress.
It’s well known that our brains function differently when we are highly distressed, so we have to address the brain issue at a body level, then we can apply more sophisticated psychological skills as we start to calm down. But if we don’t learn how to change our body chemistry, we will continue to struggle to get through high distress.
Strong therapeutic relationship
Research shows conclusively that the best predictor of improvement through therapy is a good relationship with your therapist. DBT recognises the importance of this relationship, and focuses on establishing and keeping a strong therapeutic relationship– even if therapy gets tough some times.
Some people have had difficult or traumatic interactions with others in the past, so forming a relationship with a therapist can feel really scary. In DBT, the therapist aims to have ‘unconditional positive regard’ for the client and focuses strongly on validation.
DBT is a great form of therapy for anyone who has had negative experiences in seeking help in the past.
Support between sessions
DBT is unique in that it encourages contact between sessions between clients and their therapist. The client can contact their therapist for brief, skills focused assistance.
This support acknowledges that it’s the application of skills in real–life situations that is often most difficult to do. DBT participants find this very helpful in creating real change in their patterns of behaviour.
Mindfulness as a core skill
Mindfulness is a term that is being talked about in many different contexts lately, and it means different things to different people. I like to define mindfulness as paying attention in the present moment, with awareness, and without judgement.
This attitude of mindfulness underpins everything we do in DBT, and we aim to bring mindfulness to all the skills as we learn and practice them.
Building awareness of thoughts, emotions and physical sensations is vital in order to consider how we want to respond to them. If we’re not aware of what our thought, emotions or body is doing, we have no chance to change our patterns of response and reaction.
Non–judgment is certainly the more difficult part of mindfulness practice, however it is often where true healing starts to happen. In DBT we draw attention to how often and easily we make judgements, about ourselves, and others– and how this can create rigid patterns of thinking that keep us stuck in harmful patterns.
By learning how to bring a non–judgemental attitude to our daily lives, we create space for greater acceptance of ourselves and others.
DBT is a very validating therapy. We explore how there are always reasons why we do things, even if we feel like we don’t know what those reasons are!
Sometimes emotional patterns can feel confusing, or we feel our emotions get triggered for no reason. In DBT, we build awareness to how our emotions work, and come to realise there is always a trigger for an emotion, we just need to know what to look for.
Learning to validate our emotional experiences leads to significant improvements in how we feel about ourselves and our experiences.
DBT has a strong evidence base behind it. It has been studied thoroughly in a multitude of research settings, and has been shown to be very effective for the treatment of borderline personality disorder, drug and alcohol addiction, eating disorders and mood disorders.
Evidence is important when deciding to embark on therapy. You want to know that independent research shows the therapy works and that is has a strong scientific and ethical basis.
You don’t have to be 100%
committed to change
Many people come to DBT with mixed feelings about change. They may recognise that change is needed, in that their lives have become unmanageable. However, they may be reluctant to let go of certain behaviours that, although have negative consequences, they feel help them cope with daily life and times of stress.
DBT does not insist that someone has full commitment to change– but asks that they be willing to explore different possibilities, including what the trade–off might be between change vs non–change.
A different approach
I commonly see clients who have tried lots of different psychological treatments and therapies in the past, but none have really helped creating lasting and meaningful change. Most of them do very well in DBT.
DBT is a different form of therapy which blends concepts from western and eastern psychologies to provide a different approach.
If you have tried other treatments, but are still not where you want to be in your life, give DBT a go!
Mental Health Access Line (Central Coast): 1800 011 511 Lifeline: 13 14 24
Mindful Recovery Services: www.mindfulrecovery.com.au or (02) 4660 0100
Alexandra (Alex) Wilson holds a Bachelor of Social Work from the University of Sydney (2003) and is the owner of Mindful Recovery Services. Mindful Recovery Services is a private practice providing psychological treatment and support for adolescents and adults. Alex is passionate about dispelling myths about mental illness,& is highly skilled in dialectical behavioural therapy. She is an experienced public speaker and provides consultation to other professionals on managing difficult behaviours in teens. Alex lives on the NSW Central Coast with her partner, 2 young boys, and a cheeky puppy named Axel.