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Dialectical Behaviour Therapy (DBT) – Information leaflet

Dialectical Behaviour Therapy (DBT) is a treatment developed for people who experience difficulties in managing their emotions and who have found unhelpful ways of coping which include self-harm, attempted suicide, chaotic and risky behaviours.

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This leaflet explains the four main elements of DBT, how it works and the benefits and risks of therapy.

  • What does Dialectical mean?

    Dialectical means: Arriving at a middle ground or agreement when there are oppositional views.

  • What is Dialectical Behaviour Therapy (DBT) and what is it for?

    Dialectical Behaviour Therapy (DBT) is a treatment developed for people who experience difficulties in managing their emotions and who have found unhelpful ways of coping which include self-harm, attempted suicide, chaotic and risky behaviours.

    It is based on the view that in order to improve their lives, a person needs to accept themselves as they are, whilst at the same time working to change.

    People who may benefit from DBT are likely to have behaviours consistent with the diagnosis of Emotionally Unstable Personality Disorder (EUPD) such as:
    • Reacting more easily to stress
    • Self-harm or suicidal behaviours
    • Staying upset for longer before calming down
    • Problems with anger, can have problems with positive emotions as well
    • Fear of abandonment
    • Difficulties in communicating when emotionally upset
    • Sense of emptiness or not being sure who you are
    • May dissociate or become paranoid when under stress

  • What are the main elements of DBT?

    Full programme DBT is made up of all the components listed below:

    1. DBT individual therapy is focused on decreasing self-harming and suicidal behaviours and helping you to apply new skills to specific situations in your everyday life. Individual therapy generally takes place once a week for as long as you are in therapy and runs alongside the skills training group.

    2. DBT skills training group is focused on teaching behavioural skills. The group is run like a class where the group facilitator teaches skills and sets homework for you to practise these skills in everyday life. Groups meet once a week for 2.5 hours

    3. DBT phone coaching is when you can telephone your therapist between sessions to access help to use your skills effectively to cope with challenging situations that can arise in your everyday life.

    4. Therapist consultation. Consultation is where therapists receive supervision from other clinicians. Supervision allows the therapists to engage with each other to reflect on their clinical practice and helps them to maintain and improve their own skills.

    The provision of DBT differs across CNTW services. If you are interested in this therapy, your care team will be able to advise you on what is available in your locality.

  • How does it work?

    Some people’s lives can feel unbearable. DBT aims to help people decrease their emotional suffering and help build a life worth living.

    DBT is a structured therapy which includes a focus on cognitions (thoughts), emotions and beliefs incorporating a dialectical philosophy.

    DBT works by teaching people specific skills to deal effectively with themselves and with the world around them. In particular, DBT treatment focuses on:

    Core Mindfulness
    Mindfulness is central to DBT. It focuses on states of mind known as “emotional mind” and “rational mind” and attempts to balance these two to create a third state of mind known as “wise mind”. Mindfulness helps people observe and label their emotions and feelings and develop an understanding of their own behaviours.

    Interpersonal Effectiveness
    This is learning how to be effective in getting your needs met, saying no, making relationships work and being able to deal with people whilst maintaining self-respect and meeting goals.

    Emotion Regulation
    This helps people get to know and understand their emotions. It also teaches skills to enable people to deal with intense and painful emotional states, and helps people put things in place that will bring about more positive emotions in the longer term.

    Distress Tolerance
    This teaches what to do when things are difficult but can’t be changed. It also teaches how to tolerate difficult feelings, without resorting to impulsive strategies or ways that only make things worse in the long term.

  • What will I be expected to do?

    If DBT is available in your area, you can discuss your interest in DBT, or it may be suggested to you as a treatment option.

    If agreed it is a suitable time, a referral to your local DBT service will be made. There is a period of pre-treatment so you and a DBT therapist can further explore if it is a suitable time for DBT, and an appropriate therapy for your needs.

    It is then hoped that you would commit to treatment, to attend regular one to one sessions with an individual therapist and to attend group skills training sessions.

    You may also get telephone coaching with your one to one therapist if they are able to provide this.

    To get the most from therapy the use of a weekly diary card is used as well as there being an expectation that you try out new skills.

  • What are the benefits and risks to therapy?

    Participating in therapy may result in a number of benefits. Primarily the aim of therapy is to enable you to engage in more helpful behaviours instead of suicidal and self-harming behaviours and develop a life worth living. Participating in therapy may also involve some discomfort and sometimes you can feel you are getting worse before you are getting better.

  • How effective is DBT?

    DBT has been found to be effective for people with Emotionally Unstable Personality Disorder (EUPD). DBT is also recognised as being effective for other disorders such as substance abuse, depression, eating disorders and post-traumatic stress disorder.

  • References

    A full list of references is available on request from the Patient Information Centre
    Tel: 0191 246 7288

  • Interpreters

    Staff can arrange an interpreter if you need one.

  • What if I have a comment, suggestion, compliment or complaint about the service?

    If you want to make a comment, suggestion, compliment or complaint you can:
    • talk to the people directly involved in your care
    • ask a member of staff for a feedback form, or complete a form on the Trust website www.cntw.nhs.uk (click on the ‘Contact Us’ tab)
    • telephone the Complaints Department 0191 245 6672
    • email complaints@cntw.nhs.uk Please note that information sent to the Trust via email is sent at your own risk
    • We are always looking at ways to improve services. Your feedback allows us to monitor the quality of our services and act upon issues that you bring to our attention.
    You can provide feedback in the following ways:
    - the quickest way for you to do this is to complete our short online survey at www.cntw.nhs.uk/poy
    - complete a Points of You survey, available from staff.

  • Contact information

    Please contact your care co-ordinator for further information.

  • Other formats, references and review

    Further information about the content, reference sources or production of this leaflet can be obtained from the Patient Information Centre. If you would like to tell us what you think about this leaflet please get in touch.

    This information can be made available in a range of formats on request (eg Braille, audio, larger print, easy read, BSL or other languages). Please contact the Patient Information Centre Tel: 0191 246 7288

    Published by the Patient Information Centre
    2019 Copyright, Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust
    Ref, PIC/770/0519 May 2019 V2
    www.cntw.nhs.uk Tel: 0191 246 7288
    Review date 2022