Dialectical behaviour therapy (DBT)

What is dialectical behaviour therapy (DBT)?

DBT is a type of talking therapy aimed at helping people to learn how to achieve behavioural stability, that is, to replace impulsive, risky or somehow damaging ways of coping with less harmful and more skilful ones. It is adapted for people who feel emotions intensely.

It is usually aimed at treating people who engage in life threatening behaviours (self harm; suicidal thoughts and behaviours) and those who experience their emotions very intensely. The aim being to help a person to develop a life worth living.

The aim of DBT is to help you:

understand and accept your difficult feelings
learn skills to manage them
become able to make positive changes in your life

Dialectical means trying to understand how two things that seem opposite can be true, for example accepting yourself and changing your behaviour. DBT teaches you it is possible to achieve these goals together. During DBT, the therapist will use a balance of acceptance and change techniques.

What help can I expect?

You will be offered an assessment or pre treatment phase of DBT. This is where the therapist will look at how suitable DBT is for you. You will be asked to make a commitment to the treatment.

The DBT treatment has four elements:

individual therapy, this consists of weekly sessions with an individual therapist, working towards goals to help achieve a life worth living. You will be required to complete weekly diary cards to monitor problem behaviours, emotions and urges. This information helps to decide what you will work on in each session
skills training, this consists of weekly teaching sessions that cover four modules and the group is run like a class where the leader teaches skills, it involves weekly homework and skills practice. The behavioural skills taught in the modules are:
- mindfulness, the skills of focusing on the present
- interpersonal effectiveness, learning to work with, and respond healthier to others
- emotion regulation, skills to understand, increase awareness, and have better control of your emotions
- distress tolerance, learning to deal with crisis without harmful behaviours
Telephone coaching, this is offered by individual therapists and involves offering structured support to help teach people to use their new skills in real life situations. It is focused on providing people with in the moment coaching on how to cope effectively between sessions. It is offered when people contact services in periods of distress, when they want to use the skills but need advice on how to do it, or if you need to repair your relationship with the therapist. You can expect clear boundaries with these calls for example: calls are usually brief and you may be asked to not call again for 24 hours
Therapist Consultation team: DBT therapists work in teams and meet weekly for supervision. The consult team is designed to help therapists discuss issues and concerns, help them to treat people more effectively, stay motivated and competent and share responsibility. You will not be invited to this meeting but it is part of your overall treatment

Medication

At the moment there is no medication proven to treat emotionally unstable personality disorder or personality difficulties. You may have been offered medication for other related problems and if so, it is best that this is reviewed by a psychiatrist or your GP as required.

You may be encouraged to discuss the medications you are using, if any, to explore the function purpose and effectiveness of these and explore any side effects. It may be necessary to stop or reduce any unhelpful medications.

What is the commitment for?

You will be in the DBT intervention programme for up to 6 to 12 months.

In DBT you are required to complete brief questionnaires; this helps you and us monitor progress.

In order to provide the best care possible, our DBT team has engaged in a benchmarking project that aims to promote the delivery of good quality DBT and help make sure our team is up to the advised quality standards. This project is hosted by British Isles DBT Training and supported by Health Education England. For more information, you can discuss this with the health professional assessing you.

DBT is more likely to work if you are committed to make positive changes in yourself, if you are ready to work hard at therapy and if you are ready to focus mostly on your present and future, not your past.

What about hospital treatment?

The most effective treatment for EUPD or complex emotional needs occurs in the community.

If hospitalisation is required it is recommended that the admissions are short and are focused on a clear goal. For example, an admission may be for assessment (to try and understand what could be causing the current difficulties). Or it may be to help stabilise an acute crisis, for example, by establishing or revisiting a crisis plan or a community care plan.

Questions and answers

What happens in the first session?

The first group session is a way of understanding what happens in the group, considering what your goals are, which problems you will work in in the group and explores the ground rules for the group to keep yourself and others safe within it. You will be given copies of handouts to help you.

What if I don’t like it?

You may not like someone in the group, find other members too talkative or too critical. This is to be expected as it represents what happens in life outside of sessions. You will be encourage to problem solve any difficulties with accessing the treatment in your 1-to-1’s. If you do not think this treatment is beneficial to you, you need to explore this within your 1-to-1.

We meet many people who are nervous about a group and ask for their treatment to be on a individual basis only, the evidence is that this treatment is best delivered in a group for shared learning and peer support. Should you need support to attend the group, we have access to occupational therapy and support workers who can help get you into a group.

What is good about a group?

Everyone is trying their best to learn and deal with life problems in a better, healthier way. You have shared experiences and the opportunity to practice the skills learnt in a safe way. You then try the skill in the outside world so your life improves there too.

Do I have to tell everything about myself and my experiences in the group?

No, many people are worried about this. It is not expected that you bring up childhood experiences, past traumas, or anything you are uncomfortable with. Additionally we encourage participants to be mindful of the level of disclosure as it could impact others. The group is focused on skills and problem solving, you do not have to provide any detail you are not comfortable with.

Useful websites

Page last reviewed: May 22, 2024
Next review due: May 22, 2025

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