Dialectical behaviour therapy is a type of therapy that combines standard cognitive behavioural techniques with concepts derived from Buddhist meditative practice. DBT was developed to treat people with borderline personality disorder and indeed, is the first therapy that has been demonstrated to be effective for treating this disorder.
DBT emphasises the following four skills:
- Core mindfulness
- Interpersonal effectiveness
- Emotion modulation
- Distress tolerance.
The aim of DBT is to create a practical way to help those who otherwise may remain resistant to treatment. DBT is a hybrid approach consisting of elements such as cognitive behavioural therapy (with the emphasis on the here and now), dialectical thinking (emphasising the limitations of linear ideas), Zen Buddhism (with the key concept of mindfulness) and metaphorical thinking (with the goal of viewing the situations practically).
DBT accepts and works with the fact that some people, due to environment and/or biology, react abnormally to emotional stimulation. Their levels of arousal rise very quickly and peak at a higher level than the average individual, because due to their past experiences they do not have a method of coping with these intense and often sudden surges of emotion. DBT targets behaviours in a descending hierarchy in the following order:
- Decreasing high-risk suicidal behaviours
- Decreasing responses or behaviours that interfere with therapy
- Decreasing behaviours that interfere with quality of life
- Decreasing and dealing with post-traumatic stress responses
- Enhancing respect for self
- Acquisition of the behavioural skills in group therapy (four shown above)
- Additional goals set by patient.
DBT is effective in treating patients with borderline personality disorder. It is also effective in treating people who suffer with ‘spectrum mood disorders’, including self-harm. Recent research also suggests its effective use in treating people with chemical dependencies and sexual abuse survivors.