Dialectical Behaviour Therapy

What is DBT?

Dialectical Behaviour Therapy is a specific type of cognitive behavioural therapy, initially developed to help people with borderline personality disorder or self-harming behaviours. However, more recent research has demonstrated its efficacy for people with eating disorders, post traumatic stress disorder and depression.

Within DBT, eating disordered behaviours (particularly binge eating and purging) are seen as a form of emotional regulation - used when people are trying to manage or avoid negative emotions. There is an overlap between this and how people use self-harm to manage emotions - suggesting that an approach in which people find different ways to manage difficult emotions might be helpful.

‘Dialectics’ means trying to balance opposite positions and look at how they go together. In DBT you will work with your therapist to find a good balance between acceptance and change; learning to manage difficult emotions by letting yourself experience, recognise and accept them. As you learn to accept and regulate your emotions, you also become more able to change any unhelpful behaviours. To help you achieve this, DBT therapists use both acceptance and change techniques - finding a balance between accepting yourself as you are, and making positive changes in your life.

what does dbt involve?

Full DBT includes a number of components, including individual therapy and a group skills training programme. The skills training programme consists of four key skills:

• Mindfulness (the practice of being aware and in the present moment)

• Interpersonal Effectiveness (how to be assertive and deal with interpersonal conflict)

• Distress Tolerance (how to tolerate distressing feelings)

• Emotion Regulation (how to identify and change emotions that you want to change)

These skills can also be incorporated into individual therapy.

Within the London Centre, DBT is most likely to be offered as an individual treatment (learning skills within your one-to-one weekly therapy sessions) or as an adjunct to CBT. The individual sessions will usually follow a targeted treatment plan, beginning with the most risky behaviours. Time will be taken to look at any difficulties over the week, to identify triggers and consequences and to think about what skills were used, or could have been used. DBT is a collaborative therapy, with a focus on developing skills that you can continue to use beyond therapy.

who benefits from DBT?

Initial research trials of the use of DBT for eating disorders do appear to indicate that DBT is effective in reducing or stopping eating disordered behaviours. It can also be a useful approach for people looking for skills to help them manage difficult emotions, particularly when these trigger binge eating. However, the research is still fairly new, and more research is necessary. Current research findings focus on the benefits of DBT for people with bulimia nervosa or binge eating disorder. It is also likely to be useful for clients who also have borderline personality disorder, experience intense emotions, or self-harm alongside their eating disorder.

There is also a version of DBT for people with anorexia nerovsa: Radically Open-DBT (RO-DBT). This has been designed for those who are struggling with issues of over-control.

DBT skills training can be an effective adjunct for anyone in individual therapy for eating disorders. Some of the skills that a person with an eating disorder might work on include mindful eating, learning to identify triggers, and improving responses to negative emotions or stressors.