Dialectical Behaviour Therapy or DBT is a form of group therapy primarily used to treat patients with Borderline Personality Disorder (BPD). It has also been helpful in treatments of other mood disorders and suicidal ideation. DBT is often done alongside individual counselling and other treatments that have been deemed necessary.
Over the course of sixteen sessions, DBT covers four modules. These modules are mindfulness, distress tolerance, emotion regulation and interpersonal effectiveness.
Mindfulness focuses on being fully present during the moment. It is intended to help patients pay attention and be non-judgemental in the present. This is done through various mindfulness exercises that focus on the five senses and acceptance skills. One of the exercises done in this module is focusing on doing things either one mindfully, non-judgmentally or effectively. One mindfully is based on focusing on a singular action and not allowing emotion to cause you to stray away from the action. Non-judgementally means describing in facts instead of describing in terms of something being “good and fair” or “bad and unfair.” Effectively is just doing what works.
Distress tolerance is about accepting one’s situation and oneself as is. It is about learning to calmly recognize negative scenarios and what their impact is instead of being overwhelmed and attempting to hide from them. This skill focuses on distracting from strong emotions, alleviating distress, self-soothing and more. One of the more popular distress tolerance skills is called TIP. TIP stands for Temperature, Intense exercise, Paced breathing & Paired muscle relaxation. Temperature is practiced by exposing the body to an extremely cold temperature, which forces your attention to be solely on it and your body to slow down. A common way to practice this is by submerging your face in cold water or holding an ice cube in your mouth. Intense exercise is as the name states and is typically done for twenty minutes. Paced breathing is done by slowing down and focusing on your breath, with exhales lasting longer than inhales. Paired muscle relaxation is probably the oddest of the four skills. It includes holding all the muscles in your body tensely for about ten seconds and then allowing them to relax.
Emotion regulation is learning to control strong emotions, as individuals with BPD tend to have extreme emotions and difficulties regulating them. In this module, you are taught to identify the emotions you are feeling and label them, notice obstacles towards changing emotions, be mindful of your emotions, increase positive emotional events and use distress tolerance skills. The idea here is that intense emotions are a response you are conditioned to have and thus can be altered. A common skill used is PLEASE. PLEASE is a self-care skill. PhysicaL illness, Eating, Avoid mood-altering drugs, Sleep, Exercise.
Interpersonal effectiveness focuses on how we interact with others. It teaches skills for saying no, asking for what you need and coping with conflict between people. The focus of this module is situations where you are trying to change something or resist changes made by someone else. One of the skills used is called FAST, which is focused on maintaining self-respect during interactions. FAST stands for Fair, few Apologies, Stick to values, Truthful. Fair simply means being fair to yourself and whoever you are interacting with. Few apologies means not apologizing when an apology is not needed and not over apologizing for mistakes. Sticking to values means not compromising your beliefs for someone else’s convenience, and truthful is simply not lying.
While DBT is typically sixteen sessions long, patients are encouraged to participate longer to further strengthen the skills they are learning. With the right treatment plan, DBT can help individuals with BPD reach a point where they no longer have enough symptoms to meet the clinical requirements for diagnosis.