What is DBT?

DBT is a modified version of cognitive behavioural therapy that was specially adapted for people who feel emotions very intensely. Originally designed to support people with
Borderline Personality Disorder, DBT can also be used to treat other conditions, like suicidal behaviour, self-harm, substance use, post-traumatic stress disorder, depression and eating disorders, among adolescents and adults.

DBT is often used with individuals who experience emotion dysregulation and/or impulse control, with the primary focus of therapy being for individuals to build emotion regulation skills, gain behavioural control, and learn distress tolerance skills. DBT teaches individuals how to avoid conflict, be more organised, restrain impulses, delay gratification, and tolerate distress.

While the overall goal of DBT is for individuals to learn how to change their behaviours,
emotions, and thoughts linked to problems in living and are causing them distress, there are also specific goals related to behaviours to decrease and skills to increase.

Behaviours to decrease:

• Mindlessness; emptiness; being out of touch with self and others; judgmentalness
• Interpersonal conflict and stress; loneliness
• Absence of flexible thinking; difficulties with change
• Up-and-down and extreme emotions; mood-dependent behaviour; difficulties
  regulating emotions
• Impulsive behaviours; acting without thinking; difficulties accepting reality as it is;
  willfulness; addiction

Skills to increase:

• Mindfulness skills – Become aware of your thoughts and emotions. Observe yourself without judgement.
• Interpersonal effectiveness skills – Ask for what you want. Say no. Manage conflict. Create relationships.
• Emotion regulation skills – Manage emotions. Change unproductive emotions. Create positive emotions.
• Distress tolerance skills – Deal with difficult situations. Cope with pain. Become confident and resilient.

DBT often involves individual therapy as well as a skills group program. Clinicians may also use a DBT informed approach in individual treatment.

There are seven assumptions that underpin DBT:

1. People are doing the best they can.
All people at any given point in time are doing the best they can.

2. People want to improve.
The common characteristic of all people is that they want to improve their lives and
be happy.

3. People need to do better, try harder, and be more motivated to change.
The fact that people are doing the best they can, and want to do even better, does
not mean that things are enough to solve the problems.
(but trying harder and being more motivated may not be needed if progress is steady
and at a realistic rate of improvement)

4. People may not have caused all of our own problems, but they have to solve
them anyway. People have to change their own behavioural responses and alter their environment for their life to change. (parents and caregivers must assist children/adolescents with this task)

5. New behaviour has to be learned in all relevant contexts.
New behavioural skills have to be practised in the situations where the skills are
needed, not just in the situation where the skills are first learned.

6. All behaviours (actions, thoughts, emotions) are caused.
There is always a cause or set of causes for our actions, thoughts, and emotions,
even if we don’t know what the causes are.

7. Figuring out and changing the causes of behaviour work better than judging
and blaming.
Judging and blaming are easier, but if we want to create change in the world, we
have to change the chains of events that cause unwanted behaviours and events.

If you have any questions regarding DBT, having any of the concerns listed above, or think DBT may be a treatment approach that could help you, please contact Prosper Health Collective.