Talking therapies such as cognitive behaviour therapy (CBT) are well-known treatments for some mental illnesses including anxiety and phobias. Today’s post is about a type of CBT which isn’t as well known: dialectical behaviour therapy, or DBT.
CBT focuses on changing unhelpful thoughts and behaviours which cause the continuity of illness – for example changing the obsessive thoughts in OCD through talking and challenging beliefs in therapy (for more about CBT, read my post here). DBT also does this, but with an additional focus on accepting who you are as a person at the same time. ‘Dialectical’ just means to resolve differences and find a balance in patterns of behaviour. It has been developed to treat individuals who experience intense emotions, and is one of the recommended treatments for symptoms of Borderline Personality Disorder such as self harm, impulsivity, and unstable relationships (Mind, 2014).
The figure below from the Psychiatric Times shows the 4 sets of primary skills taught as part of DBT: mindfulness, emotion regulation, distress tolerance and interpersonal effectiveness. This training is usually in groups, in addition to 1 to 1 therapy sessions.
DBT has been shown to be more effective at reducing symptoms associated with borderline personality disorder than standard group therapy (Soler et al, 2009). In this experiment, participants were randomly assigned to either receive standard group therapy or DBT over 13 weekly sessions. The group who received DBT had greater improvement in depression, anxiety, emotion regulation, irritability and anger than the group who received standard therapy. It also showed almost twice as high retention rate of participants throughout the programme, suggesting it is an acceptable intervention for the treatment of borderline personality disorder.
Another study which compared DBT to usual treatment for women with borderline personality disorder found that participants in the DBT group showed lower levels of self harm than those who received standard treatment (Verheul et al, 2003). The authors hypothesised that this result could be due to specific features of DBT such as monitoring of self-injury with early sessions focusing on modifying these behaviours, patients being encouraged to phone their therapist before carrying them out, and more support for the therapists themselves resulting in less burnout (and so improved patient outcomes).
Overall, this evidence shows the effectiveness of DBT in treating symptoms of borderline personality disorder. More recently, research has moved to test whether DBT is an effective treatment for other conditions such as traumatic brain injury, substance abuse, depression, eating disorders and conduct disorders. However, one recent review concluded that more evidence needs to be collected to establish whether it is the best treatment for other types of mental illness (Valentine et al, 2014).
Thanks for reading this overview of DBT, if you’d like to find out more then Mind have some great online resources – see the link below.
Mind (2014) https://www.mind.org.uk/media/1594506/ms_dbt_2014.pdf
Soler, J., Pascual, J.C., Tiana, T., Cebrià, A., Barrachina, J., Campins, M.J., Gich, I., Alvarez, E. and Pérez, V., 2009. Dialectical behaviour therapy skills training compared to standard group therapy in borderline personality disorder: a 3-month randomised controlled clinical trial. Behaviour research and therapy, 47(5), pp.353-358.
Valentine, S.E., Bankoff, S.M., Poulin, R.M., Reidler, E.B. and Pantalone, D.W., 2015. The use of dialectical behavior therapy skills training as stand‐alone treatment: A systematic review of the treatment outcome literature. Journal of clinical psychology, 71(1), pp.1-20.
Verheul, R., Van Den Bosch, L.M., Koeter, M.W., De Ridder, M.A., Stijnen, T. and Van Den Brink, W., 2003. Dialectical behaviour therapy for women with borderline personality disorder. The British Journal of Psychiatry, 182(2), pp.135-140.