While most people have heard of CBT or Cognitive-Behavioural Therapy, they may not have heard of the closely related option of DBT. DBT or dialectical behaviour therapy has been used since the late 1970s and early 1980s, making it one of the more recent therapeutic approaches used by any of the type Harley Street psychotherapist services.
DBT was first developed by Marsha Linehan, a psychologist, as a treatment for patients with borderline personality disorder, particularly those engaging in self-harm and suicidal behaviours. More traditional types of therapy, including CBT, were found to be only moderately effective for many of these patients.
This partially due to the nature of this mental health condition which includes a pattern of unstable relationships, impulsivity, self-harm, high-risk behaviours and feels of separation and rejection that result in extreme fear of abandonment and anger.
It is important to realise that with borderline personality disorder these feelings of abandonment, anger and isolation is not accurate. Instead, they perceive everything, even slightly negative that happens being a reflection on themselves as a “bad” person, regardless of the specifics of the situation.
Since the introduction of the DBT approach to the treatment of borderline personality disorder, self-harm and suicidal behaviour, the use of the treatment has expanded. It is now used to treat addiction and substance abuse, PTSD, eating disorders as well as depression.
What is DBT?
DBT uses the cognitive approach, which means that the client and the Harley Street psychotherapist work together to determine which emotional situations are most likely to trigger or result in the extreme reactions by the client.
The theory is based on dialectics, which are the abstract concepts that form our ability to understand and perceive what is going on around us. To understand concepts humans see in opposites and variations between the two. For example, there is only dark if we understand light, and there are only feelings of peace if we understand feelings of conflict.
For people with mental health illnesses, it is very common for perception and thought to be distorted by only being able to see one possible solution, option or meaning, without any grey areas. For example, a person with a mental health issue such as depression or bipolar disorder may see the cancellation of a luncheon by a friend as a complete rejection of them as a person. They have no ability to see that there may just be a traffic issue or that perhaps the friend is not feeling well. They may easily fly into a rage at the person if they call to explain being late, or perhaps they simply don’t pick up the phone.
In DBT, the Harley Street psychotherapist will work with the client to help to identify emotional triggers and then develop a method for the client to regulate their emotions around those triggers by changing their thoughts. This is like CBT, but with DBT there are very specific methods used.
Teachings on mindfulness, distress tolerance and acceptance all come into DBT. There is always a component in the therapy to translate this self-learning and awareness into being more effective on an interpersonal level, allowing the individual to build healthy relationships that can be sustained over time.
The four modules of DBT include:
- Mindfulness – the ability to observe and describe emotions and behaviours experienced without judging and with an open mind.
- Distress tolerance – the ability to accept the situation in the moment without judging or interpretation. It is also the ability to be in distress and remain calm and trying to escape the situation by moving to an extreme emotional level or use a destructive behaviour.
- Emotional regulation – understanding emotions and learning how to mindfully change the response
- Interpersonal effectiveness – the ability to not just understand how to interact with others but to learn how to apply these skills in real world situations.
It is common in DBT for the Harley Street psychotherapist to work one-on-one with the client in individual sessions as well as recommend group sessions. Groups are also very helpful in developing interpersonal effectiveness in a safe and supportive environment.