for better mental health

Dialectical behaviour therapy (DBT)

Explains what dialectical behaviour therapy is, who it can help, what happens during therapy and how to access it.

What is the treatment like?

The way that DBT is delivered can vary between different providers and across different areas. However, there are typically three different types of DBT sessions that you might have and these are likely to be run alongside each other:

DBT pre-treatment

Some therapists may offer you an assessment or pre-treatment phase of DBT. This is where the therapist will look at how suitable DBT is for you. You will typically be offered several sessions where you will learn about the DBT model and, if you decide it is the right therapy for you, you will be asked to make a commitment to the treatment. (See our page on who DBT can help for more information.)

Individual therapy

Individual therapy typically involves weekly one-to-one sessions with a DBT therapist. Each session lasts approximately 45–60 minutes.

The individuals sessions have a hierarchy of goals, including:

  • To help keep you safe – by reducing suicidal and self-harming behaviours.
  • To reduce behaviours that interfere with therapy – by addressing any issues that might come in the way of you getting treatment.
  • To help you reach your goals and improve your quality of life – by addressing anything that interferes with this, such as other mental health problems like depression or hearing voices, or problems in your personal life such as employment or relationship problems.
  • To help you learn new skills to replace unhelpful behaviours and help you achieve your goals.

Your DBT therapist is likely to ask you to fill out diary cards as homework which you can use to monitor your emotions and actions. You will be asked to bring these cards with you to your therapist each week to help you look for behaviour patterns and triggers that occur in your life. You then use this information to decide together what you will work on in each session. You can find some sample diary cards on the DBT self-help website.

"I’ve learned that emotions are not the enemy. They are useful and have functions. I still feel emotions intensely, but I can now identify them and know how to manage them without using harmful behaviours."

Skills training in groups

In these sessions DBT therapists will teach you skills in a group setting. This is not group therapy, but more like a series of teaching sessions. There are usually two therapists in a group and the sessions typically occur every week. The room is sometimes arranged like a classroom where your skills trainers will be sat at the front. The aim of these sessions is to teach you skills that you apply to your day-to-day life.

There are typically four skills modules:

  1. Mindfulness – a set of skills that help you focus your attention and live your life in the present, rather than being distracted by worries about the past or the future. The mindfulness module may be repeated between modules and sessions may often start with a short mindfulness exercise. (See our pages on mindfulness for more information.)
  2. Distress tolerance – teaching you how you can deal with crises in a more effective way, without having to resort to harmful behaviours such as self-harm.
  3. Interpersonal effectiveness – teaching you how to ask for things and say no to other people, while maintaining your self-respect and important relationships.
  4. Emotion regulation – a set of skills you can use to understand, be more aware and have more control over your emotions.

In these group session you may be asked to do group exercises and use role-play. You are also given homework each week to help you practise these skills in your day-to-day life. By completing the homework weekly, you might find that these skills gradually become second nature and you become better at dealing with difficult situations.

"I was really nervous about the group aspect of DBT. When I started group I wouldn’t speak or make eye contact, but everyone was supportive and by the end I was much more confident and even taught a skill session to the other group members."

Telephone crisis coaching

DBT often uses telephone crisis coaching to support you in using new skills in your day-to-day life. This means that you can call your therapist between your therapy sessions when you need help the most, such as in the following situations:

  • When you need help to deal with an immediate crisis (such as feeling suicidal or the urge to self-harm).
  • When you are trying to use DBT skills but want some advice on how to do it.
  • If you need to repair your relationship with your therapist.

However, you can expect your therapist to set some clear boundaries. For example, calls are usually brief and the hours that you can call them will be agreed between you and your therapist. They may also agree some other rules with you where, in particular circumstances, you may be asked to wait 24 hours before contacting your therapist.

"At first I didn’t think DBT was for me, but I quickly learnt you really do get out of it what you put in, and after a few months I found that although how I felt and a lot of my symptoms did not change, I was managing them all so much better. I could actually get through days without a crisis and without the support of the crisis coaching."

(To find out more about how DBT is delivered you can visit the official DBT website, BehavioralTech.)

This information was published in April 2017. We will revise it in 2020.

References are available on request. If you would like to reproduce any of this information, see our page on permissions and licensing.

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