Dialectical behaviour therapy (DBT) was developed by Marsha Linehan. It has a different focus to Cognitive Behavior Therapy but ultimately shares most of the same postulates. While CBT focuses more on the role of thoughts in “creating” or impacting on emotions Dialectic Behaviour Therapy does not deny this role but focuses more on accepting the feelings that the person is experiencing and rather working with these feelings to make them less overwhelming and enable new, functional behavioural responses. DBT thus strengthens a person’s ability to handle distress without losing control or acting destructively.
Not unlike CBT, DBT research has shown that the development of intense, overwhelming emotions can be hardwired from birth or be strongly affected by early environmental predisposing factors. Trauma / neglect at critical points especially in early development alter our brain structure in ways that make us more vulnerable to intense, negative emotions.
Many people feel overwhelming emotions and tend to do their best to suppress or avoid these feelings. Unfortunately though – and this is very similar to part of the understandings of Schema Therapy or Acceptance and Commitment Therapy – trying to suppress these feelings both doesn’t work and creates more problems through the behavioural acting out that occurs.
Dialectical behaviour therapy (DBT) tends to focus on the following 4 groups of skills in order to manage these overwhelming feelings and their default dysfunctional behavioural responses:
- Distress tolerance enables better coping with painful events by increasing resilience and giving the person new ways to moderate the effects of upsetting circumstances.
- Mindfulness enables them to experience the present moment more fully whilst also reducing focus on painful or shameful experiences from the past or anxieties anchored to the future. Mindfulness in DBT thus enables the person to overcome habitual, negative judgments about the self and others.
- Emotion regulation skills enable clear recognition of what someone is feeling and thinking and to observe each feeling without getting overwhelmed by it. This allows for emotional moderation / regulation and a reduction in the old “mindless” destructive behaviours.
- Interpersonal effectiveness provides an assortment of tools to aid with expression of the person’s needs and beliefs, as well as aiding in limit setting and problem solving. Much of DBT was designed in order to help people suffering from Borderline Personality Disorder, where interpersonal relationships are intense and destructive, and DBT effectiveness skills help to protect interpersonal relationships and to treat the self and others with respect.