How effective is dialectical behaviour therapy?

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Dialectical behaviour therapy (DBT) refers to a comprehensive cognitive behavioural treatment that mental health professionals often recommend to patients with severe mental health problems.

What is Dialectical behaviour therapy?

Typically, DBT treatment focuses on acceptance-based strategies and problem-solving techniques.

Uniting opposite concepts

The term ”dialectical” describes the processes that unite opposite concepts, such as acceptance and change.

Dialectical behaviour therapy works within a framework that includes dialectical methods and strategies to treat those with severe mental illness.

Treating patients through dialectical behaviour therapy

Many people requiring DBT treatment often get described as being ”challenging to treat,” meaning that conventional therapies such as psychotherapy or cognitive behavioural therapy have been unsuccessful.

Improving patients’ quality of life

DBT therapists focus on helping clients improve their well-being, develop specific techniques to reach their goals, and help create long-lasting positive change.

What mental health conditions does dialectical behaviour therapy treat?

When dialectical behaviour therapy first got developed, it was designed to treat patients with borderline personality disorder and chronic suicidal thoughts.

Conditions

Today, DBT is an effective treatment used to treat people with severe or chronic mental health disorders, such as:

  • Addiction
  • Post-traumatic stress disorder (PTSD)
  • Eating and food issues
  • Self – harm
  • Borderline personality disorder
  • Attention-deficit/hyperactivity disorder (ADHD)
  • Obsessive-compulsive disorder (OCD)
  • Generalised anxiety disorder (GAD)
  • Bipolar disorder
  • Major depressive disorder (including chronic depression and treatment-resistant major depression)
Social Alienation Concept

How does DBT get delivered?

Dialectical behaviour therapy is an interactive treatment that involves individual therapy, phone coaching, a skills training group, and a therapist consultation team.

People undergoing DBT attend therapy and skills training groups every week.

Effectiveness of DBT and skills training

Skills training groups allow people in treatment the platform to develop behavioural skills through homework assignments and group work.

The above assignments allow people to practice learned skills developed in therapy and apply them to their daily lives.

Telephone coaching

Another vital aspect of DBT treatment is phone coaching. 

It allows people in treatment to reach out to a therapist in times of distress or when challenging situations arise between therapy sessions.

Consultation team

Dialectical behaviour therapy is often recommended for people with complex mental health challenges. 

Thus, a consultation team is imperative for DBT therapists and providers.

The above team consists of individual therapists and group leaders who offer motivation, guidance, and therapy to those working with complex issues.

The five principles of DBT

Dialectical behaviour therapy is effective within many therapeutic settings and combines the following five principles:

1. Capability enhancement

In DBT therapy, four basic skills are taught to patients: mindfulness, emotion regulation, distress tolerance, and interpersonal effectiveness.

Dialectical behaviour therapy also encourages the development of existing skills.

2. Generalisation

Since DBT is an interactive therapy, people in treatment are encouraged to practice learned skills at home, work, school, and other environments.

For example, a patient may get encouraged to deal with a family conflict where they use emotion regulation before and after issues have been discussed.

3. Motivational enhancement

Dialectical behaviour therapy incorporates individualised treatment plans to reduce challenging and problematic behaviours that adversely affect a person’s quality of life.

Therapists often address the most severe issues first and work their way down using self-monitoring tracking sheets.

You are not alone

4. Motivational and capability enhancement of therapists

Since DBT is recommended for patients with profound mental health issues, therapists are closely monitored and receive much support and guidance to prevent burnout and vicarious traumatisation.

DBT therapists receive a great deal of support, such as regular treatment – team meetings to give therapists a safe space to give and receive support, clinical guidance, and relevant training.

5. Structuring of the environment

DBT aims to provide a suitable environment for all patients to meet treatment goals.

For instance, therapists ensure that positive adaptive behaviours get established and reinforced across various environmental settings.

If a patient participates in various treatment programs, the therapist ensures that each program gets individualised to reinforce the positive behaviours and skills learned in therapy.

Dialectical behaviour therapy techniques

Over the years, DBT has evolved and is considered an evidence-based psychotherapy approach used to treat various mental health conditions effectively.

DBT settings

There are various settings in which dialectical behaviour therapy gets delivered. They include:

  • Individual treatment is where an individual works with a trained professional and learns practical behavioural skills that can get adapted to their personal and professional lives.
  • Group therapy is where patients can air any concerns or worries related to their health openly and are taught behavioural skills in a group setting.
  • Phone coaching allows patients to call their therapist when in a crisis or when challenging situations arise between sessions. Support and guidance get offered to patients where they learn adaptive coping skills.

When did the concept of DBT first get developed?

Dialectical behaviour therapy was first developed in the 1980s by Dr. Marsha Linehan and colleagues.

Linehan et al. discovered that cognitive-behavioural therapy wasn’t as effective in treating borderline personality disorder patients as people thought.

Treating borderline personality disorder and other complex conditions

The above discovery prompted Linehan and colleagues to explore additional techniques. 

Thus, they developed a treatment to meet the individual needs of people in complex treatment groups.

Effectiveness of DBT treatment

Since DBT’s approach to therapy enables patients to improve their coping skills successfully, patients get the opportunity to express and manage strong feelings and emotions.

Researchers noted that dialectical behaviour therapy is effective across all patient groups regardless of gender, age, background, gender identity, race or ethnicity, and sexual orientation.

Mental health conditions

Researchers found that DBT is an effective treatment for certain conditions, including:

Suicidal behaviour: One study found that treatments incorporating skills training as a therapy component appeared more effective in reducing suicidality than DBT without skills training.

Borderline personality disorder: The research found that DBT is an effective treatment for patients diagnosed with a borderline personality disorder – such therapy also reduces the risk of suicide in people with BPD. Studies have shown that over 75% of patients no longer meet the diagnostic criteria for BPD after a year of treatment.

Other mental health disorders: Although most research focused on borderline personality disorder and suicidality, studies have shown that DBT is effective for other mental health disorders such as depression, anxiety, and post-traumatic stress disorder.

Despair

Advantages of dialectical behaviour therapy

There are various strategies that a patient learns in DBT.

For example, in DBT, the therapist and patient work to address the apparent contradiction between change and self-acceptance to cultivate positive changes within people in treatment.

Validation

Providing validation to patients is an integral part of treatment.

Studies show that people who receive validation from therapists are more likely to cooperate in treatment and less likely to experience distress at the idea of change (What is Dialectical Behaviour Therapy (DBT)? Nancy Schimelpfening, November 2021).

Effectiveness of dialectical behaviour therapy

The validation process involves the therapist validating a person’s actions.

A therapist may iterate that such actions make sense given the context of a patient’s experiences without the therapist agreeing that the patient’s actions are necessarily the right approach.

Therapeutic settings

Although dialectical behaviour therapy typically involves group skills training, phone coaching, and individual therapy, each clinical setting has its objectives and structure.

Settings

Such settings include:

  • Cognitive –Patients address thoughts and beliefs that are unhelpful or non-effective and seek to modify them.
  • Behavioural – Individuals learn to analyse and explore problems and destructive behavioural patterns, replacing them with healthier, more constructive ones.
  • Collaboration – Patients learn improved communication skills as part of a team – i.e., in therapy, group therapy, and other settings.
  • Acceptance and change – Individuals learn techniques to tolerate and accept their emotions, life circumstances, and themselves. Additionally, patients learn adequate skills to encourage positive changes in their behaviours and interactions with others.
  • Support and guidance – Individuals are encouraged to identify their positive attributes while developing and using them to improve their quality of life.
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Getting started

Studies show that the best way to determine if dialectical behaviour therapy is suitable for you is to speak to a trained professional.

Evaluation

A licensed professional may assess your treatment history, symptoms, and treatment goals to evaluate whether DBT is suitable.

Reaching out

If you or someone close to you needs help finding adequate treatment, the Centres for Health and Healing specialist team is happy to assist.

We specialise in various mental health disorders and treatments, including dialectical behaviour therapy.

Taking the first steps toward healing

We recognise how challenging it can be to take the first step toward treatment.

However, taking these initial steps is imperative to begin the process of feeling better and living the fulfilling life you deserve.

Contact a member of our team today to find out how we can help.

Lisa Davies - Program Director of Vaughan Recovery and Kirby Estate

About Lisa Davies

Lisa is the Program Director at Centres for Health and Healing. She lived for most of her life in the Durham region, before moving to Peel five years ago.

Lisa is a Master Hypnotist and is certified in Hypnotherapy (2008), Self-Hypnosis and in 5-phase Advanced Therapeutic Healing. As a Member of National Guild of Hypnotists, she is also specialized in hypnosis training in pediatrics, pain management, neuro-linguistic and stage programming.

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