Dialectical behaviour therapy (DBT) is a form of cognitive behaviour therapy. It was the brainchild of Marsha M. Linehan. Linehan’s experience of treating individuals with borderline personality disorders formed the basis of her efforts to develop this therapeutic approach. Its important to understand the word dialectics to understand the core essence of this therapeutic approach. Dialects refers to the essential idea that each statement of a position (thesis) contains an opposing position with its own self (antithesis). In the DBT framework dialectics highlights two assumptions; a client is functioning to the best of one’s abilities but also need to change and that the root cause of all their issues may be external to them, but they have to take the responsibility of resolving them. Thus, this approach helps clients to deal with their limitations and focus on their potential for change.
The main components of DBT are1,2:
Problem Solving: Under this paradigm DBT applies the behavioural principles and assessments based on cognitive behaviour therapy. For example, cognitive restructuring which focuses on dealing with maladaptive thought patterns. After identifying problem behaviours, the therapist and client collectively conduct an in-depth review of the issues at hand and the situational factors surrounding them. This is followed by discussing the application of alternative responses for improved problem solving.
Validation: Validation is the process of providing a supportive base to the client’s thoughts and feelings by providing feedback and reinforcement. This process is considered as a helpful method of bolstering self validation and the therapeutic alliance.
Skills Training: This mode of treatment is included in DBT in order to assist clients in improving their capabilities to live better lives. It includes the following:
Emotional regulation: Includes cognitive and behavioural strategies for dealing with maladaptive emotional responses.
- Distress tolerance: Aims at training clients in impulse control and developing functional ways to deal with crisis situations.
- Mindfulness skills: Includes attending to awareness of surroundings, being non-judgemental in disposition, focusing on the present context, etc. This training helps clients to develop effective ways of living their lives.
- Interpersonal effectiveness: Focuses on teaching assertiveness skills. In addition, building interpersonal skills assist in maintaining relationship priorities and demands along with strengthening self respect.
Core strategies applied in the DBT framework are as follows:
- Behavioural Analysis: This is a joint effort between the therapist and client to identify units of behaviour forming the basis of problem behaviour. A chain analysis is conducted starting from the antecedents, to the final consequences of behaviour. The aim during this analysis is to uncover maladaptive elements that result in emotional dysregulation.
- Solution Analysis: The results of behavioural analysis are further applied by attempting to identify the client’s goals, needs and desires. The client is assisted in finding alternative solutions to their problems.
- Problem Solving: Contingency procedures in DBT focus on removing elements that reinforce non-constructive behaviour. For example, acts of self injury are often reinforced by the attention and care that follow from family. DBT sessions also help clients develop useful behavioural skills that are then strengthened during sessions gradually.
DBT as a therapeutic approach has been the most effective module applied to the treatment of borderline personality disorder. DBT has also garnered strong empirical support in reducing suicidal behaviour in clients with BPD and other disorders. In addition, self injurious behaviours can also be addressed under DBT. DBT has also been found useful in the management of eating disorders, substance use and depression2.
1. Koerner, K. & Dimeff, L.A. (2007). Overview of dialectical behaviour therapy. In Dimeff, L.A. & Koerner, K. (Eds.). Dialectical behaviour therapy in clinical practice: Applications across disorders and settings (pp.1-18). New York;NY:Guilford Press.
2. Gabbard, G.O. (2009). Textbook of psychotherapeutic treatments. Arlington;VA:American Psychiatr
Dialectical Behavior Therapy