Dialectical behaviour therapy (DBT):
What is it, how does it work and treatment

Clinically reviewed by: Sumitra Patel, Lead for Day Therapy Services at Nightingale Hospital

What is dialectical behaviour therapy (DBT)?

Dialectical behaviour therapy, also known as DBT, is a form of talking therapy. It is a considered third wave of cognitive behavioural therapy (CBT). DBT does not reject CBT; It expands upon CBT with the inclusion of mindfulness and acceptance developed to help those struggling with difficult and intense mental health conditions and emotions.

The word ‘dialectical’ means finding a balance or blend between two opposing ideas. DBT works in a similar way, by practicing acceptance whilst making behavioural changes. These two opposing forces work together to aid recovery and promote a healthier way of living.

It is an effective and evidence-based treatment that can support those experiencing:

• Personality disorders, especially Borderline Personality Disorder (BPD)/ Emotionally Unstable Personality Disorder (EUPD)
• Mood disorders
• Suicidal thoughts
• Self-harm
• Substance abuse
• Eating disorders

How does DBT work?

DBT is a structured therapy that promotes skills acquisition and implementation to regulate emotions, tolerate distress, improve relationships and build a life worth living.

The main goal of DBT is to help people move towards living a healthy and fulfilling life, in a way that is unique to them. An important part of this is learning to identify, address and combat negative and disruptive thinking patterns and behaviours.

What are the four components of DBT?

The DBT skills are tools which are developed to manage intense emotions.

At its core, DBT focuses on four areas: mindfulness, distress tolerance, interpersonal effectiveness, and emotional regulation.

Mindfulness

Mindfulness skills help us to stay present in the moment, without judgement. Mindfulness helps a person notice their thoughts and feelings without immediately reacting impulsively.

Distress tolerance

Distress tolerance skills are incredibly important when in a crisis. Distress tolerance skills allow a person to tolerate their distressing emotions without making the situation worse using a range of techniques include distraction, soothe and radical acceptance.

Interpersonal effectiveness

Interpersonal skills help us to communicate more effectively using skilful strategies. The strategies focus on communicating personal and maintaining healthy relationships with boundaries to respect ourselves and other people.

Emotional regulation

Emotional regulation skills help us to identify, name, and challenge the way we deal with our emotions. When we are able to recognise emotions, it allows us to deal with them in an accepting and non-judgemental way, navigating them in a healthier way whilst reducing our emotional vulnerability.