What is Dialectical Behaviour Therapy?
Dialectical Behaviour Therapy (DBT) is a comprehensive psychological therapy that was created to treat people who were chronically suicidal. It was developed by Marsha Linehan and inspired by her observations that standard forms of cognitive behaviour therapy were not entirely effective for treating her clients with complex needs. Instead of rejecting all the evidence-based behavioural strategies, she added in mindfulness-based components from Zen buddhism and a significant focus on validation. Dialectical theory provided a way of understanding the seemingly opposing therapeutic goals of change and acceptance. Ultimately, the therapy is designed to support individuals to change their problematic thoughts and actions, whilst also accept their emotions, themselves and their various life challenges for how they are.
DBT itself has many different parts and processes and the standard program (which combines four different modes concurrently), goes for a year. The highly structured nature of the therapy assists therapists in navigating and prioritising treatment, which is important when clients have many different problems and may also be suicidal. DBT is a skills based approach and it rests on the assumption that emotionally sensitive individuals may not have learnt the skills required to handle their strong reactions, but that these skills can be taught. DBT teaches skills in mindfulness, distress tolerance, emotion regulation and interpersonal effectiveness. These four topics are typically taught in three 8-week modules. This 24-week cycle is repeated twice to create the full year program.
What can the DBT skills be used to treat?
Published studies have demonstrated the DBT skills have been effective in helping people recover or make clinically significant improvements across a number of disorders including:
Borderline personality disorder
Binge eating disorder
Bulimia nervosa
Attention deficit hyperactivity disorder
Oppositional defiant disorder
Major depressive disorder, including in older adults, and that labelled “treatment resistant”
Bipolar disorder
Post traumatic stress disorder due to childhood trauma
Incarcerated individuals, including youth and adults with intellectual disability, with violent or “difficult to manage” behaviours.
Self-harming behaviours
Emotional dysregulation, including anxiety and depression
Coping behaviours, and self/relationship-management skills in students and carers of individuals with dementia.
DBT is recommended as a treatment for Borderline Personality Disorder
DBT is recommended for treating people with borderline personality disorder by the American Psychiatric Association, the Australian National Health and Medical Research Council and the National Institute for Health and Care Excellence in Britain. It is the treatment with the most evidence (high quality randomised controlled clinical trials) supporting its effectiveness.
It has now been shown to be effective in treating numerous other disorders. It is one of the empirically supported treatments for individuals with bulimia nervosa and binge-eating disorder, backed by Medicare in Australia
Research has shown the DBT Skills are pivotal in these gains.
This video discusses some of the current barriers in accessing DBT programs and highlights the rationale for integrating online learning
New online learning streams now available
What is the current evidence for teaching DBT Skills?
Systematic reviews on the effectiveness of DBT skills (as standalone treatment)
Delaquis, C. P., Joyce, K. M., Zalewski, M., Katz, L. Y., Sulymka, J., Agostinho, T., & Roos, L. E. (2022). Dialectical behaviour therapy skills training groups for common mental health disorders: A systematic review and meta-analysis. Journal of affective disorders, 300, 305–313. https://doi.org/10.1016/j.jad.2021.12.062
Valentine SE, Bankoff SM, Poulin RM, Reidler EB, Pantalone DW (2015). The use of dialectical behavior therapy skills training as stand-alone treatment: A systematic review of the treatment outcome literature. Journal of Clinical Psychology, 71, 1-20.
Selected studies demonstrating the important role of skills use in recovery
Barnicot, K, Gonzalez, R, McCabe, R, Priebe, S. (2016). Skills use and common treatment processes in dialectical behaviour therapy for borderline personality disorder. Journal of Behavior Therapy and Experimental Psychiatry, 52, 147-156.
Linehan, MM, Korslund, KE, Harned, MS, Gallop, RJ, Lungu, A, Neacsiu, AD et al. (2015). Dialectical behavior therapy for high suicide risk in individuals with borderline personality disorder: A randomized clinical trial and component analysis. JAMA Psychiatry, 72, 475-482.
Neacsiu, AD, Eberle, JW, Kramer, R, Wiesmann, T, & Linehan, MM. (2014) Dialectical behavior therapy skills for transdiagnostic emotion dysregulation: A pilot randomized controlled trial. Behaviour Research and Therapy, 59, 40-51.
Neacsiu, AD, Rizvi, SL, & Linehan, MM (2010). Dialectical behavior therapy skills use as a mediator and outcome of treatment for borderline personality disorder. Behaviour Research and Therapy, 48, 832-839.