Dialectical behaviour therapy (DBT)

What is dialectical behaviour therapy (DBT)?

Dialectical behaviour therapy (DBT) is a type of talking therapy that helps people learn how to replace impulsive, risky, or harmful ways of coping with healthier, more effective ones. It is designed for people who feel emotions very intensely.

Dialectical behaviour therapy is often used to treat people who engage in life-threatening behaviours like self-harm and suicidal thoughts. The goal is to help a person develop a life worth living.

The aims of DBT are to help you:

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

Dialectical means trying to understand how two opposite things can be true at the same time, like accepting yourself while also changing your behaviour. Dialectical behaviour therapy teaches you that it is possible to achieve both. During DBT, the therapist will use a mix 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 see if DBT is suitable for you. You will be asked to commit to the treatment.

The dialectical behaviour therapy treatment has four elements:

Individual therapy

Weekly sessions with a therapist to help you achieve a life worth living.
You will complete weekly diary cards to monitor problem behaviours, emotions, and urges. This helps decide what to work on in each session

Skills training

Weekly teaching sessions that cover four modules. The group is like a class where the leader teaches skills, and you have weekly homework and skills practice.

The four modules are:

mindfulness, focusing on the present
interpersonal effectiveness, learning to work with and respond better to others
emotion regulation, understanding, increasing awareness, and better controlling your emotions
distress tolerance, dealing with crises without harmful behaviours

Phone coaching

Offered by individual therapists to help you use your new skills in real-life situations.
Provides in-the-moment coaching on coping effectively between sessions.
Support is available during distress, when you need advice on using the skills, or to repair your relationship with the therapist.
Calls are usually brief, and there are clear boundaries, like not calling again for 24 hours.

Therapist Consultation team

DBT therapists work in teams and meet weekly for supervision.
The team helps therapists discuss issues, treat people more effectively, stay motivated, and share responsibility.
You will not attend these meetings, but they are part of your overall treatment.

Medication

At the moment, there is no medication proven to treat emotionally unstable personality disorder or personality difficulties. You might be taking medication for other related problems. If so, it’s best to have these reviewed by a psychiatrist or your GP.

You may be encouraged to talk about any medications you are using to see how they work and if they have any side effects. It might be necessary to stop or reduce any medications that are not helpful.

What is the commitment for?

You will be in the dialectical behaviour therapy (DBT) program for about 6 to 12 months.

In DBT, you will need to fill out short questionnaires. This helps you and us keep track of your progress.

To give you the best care, our DBT team is part of a project to make sure we are providing high-quality therapy. This project is run by British Isles DBT training and supported by Health Education England. You can ask your health professional if you want to know more about this.

Dialectical behaviour therapy works best if you are ready to make positive changes, work hard in therapy, and focus on your present and future instead of your past.

What about hospital treatment?

The best way to treat emotionally unstable personality disorder or complex emotional needs is usually in the community.

If you need to go to the hospital, it should be for a short time and with a clear goal. For example, you might go to the hospital to understand what’s causing your current problems or to help manage a serious crisis, like setting up or reviewing a plan for your care and safety.

Questions and answers

What happens in the first session?

The first group session helps you understand how the group works. You will talk about your goals, the problems you want to work on, and the rules that keep everyone safe. You will get handouts to help you with this.

What if I don’t like it?

You might not like someone in the group or find others too talkative or critical. This is normal and happens in everyday life too. You will be encouraged to solve any problems during your one-on-one sessions. If you think the treatment isn’t helping, discuss it in your one-on-ones.

Many people feel nervous about group sessions and prefer one-on-one treatment, but studies show that group treatment works best for shared learning and support. If you need help joining the group, we have occupational therapists and support workers who can assist you.

What is good about a group?

Everyone in the group is trying their best to learn and deal with life problems in a better, healthier way. You all share similar experiences and get to practice new skills in a safe environment. Then, you can try these skills in the outside world to improve your life there too.

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

No, many people worry about this. You are not expected to talk about childhood experiences, past traumas, or anything you are uncomfortable with. We also encourage everyone to be mindful of how much they share, as it can affect others. The group focuses on skills and problem-solving, so you only need to share what you are comfortable with.

Useful websites

Page last reviewed: November 27, 2024
Next review due: November 27, 2025

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