Explains what DBT is, what problems it can help with and what sessions are like. Includes links to find a therapist.
The aim of DBT is to help you:
‘Dialectical’ means trying to understand how two things that seem opposite could both be true. For example, accepting yourself and changing your behaviour might feel contradictory. But DBT teaches that it's possible for you to achieve both these goals together.
Watch Debbie and Lechelle talk about getting a BPD diagnosis, and their experience of DBT as treatment.
"Before DBT, I felt like the only solution was suicide... through learning various skills from DBT I can ride the waves of my depression rather than letting them swallow me."
Research shows that DBT can be helpful in tackling problems like:
It was originally developed for borderline personality disorder (BPD), so most of the evidence for it so far is in treating people with this diagnosis. Some NHS services are also starting to offer DBT for:
But regardless of your diagnosis or problems, DBT might not be right for you.
DBT is more likely to work for you if:
It's important to remember that everyone experiences therapy differently. See our page on getting the most from any therapy for more tips, including things to try if you're on a course that isn't working for you.
"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."
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. They might offer you several sessions where you will learn about the DBT model. Then if you decide it is the right therapy for you, they will ask you to make a commitment to the treatment.
Individual therapy usually 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:
Your DBT therapist is likely to ask you to fill out diary cards as homework, and bring them to sessions. This is for you to track your emotions and actions, and look for patterns and triggers 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."
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 sessions might be weekly. 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:
In group sessions your therapist might ask you 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.
DBT often uses telephone crisis coaching to support you in your day-to-day life. This means that you can call your therapist for support between sessions. For example:
But you can expect your therapist to set some clear boundaries around this. For example:
"At first it was really tough, and I wondered what the point of it was going to be. Some of the DBT skills seemed silly to me, but I had committed myself to the process and as time passed, it started to make more sense."
During sessions DBT therapists will use a balance of acceptance and change techniques.
Acceptance techniques focus on:
For example, a DBT therapist might suggest that this has been your only way of coping with intense emotions. So even though it’s damaging in the long-term, and may alarm other people, your behaviour makes sense.
"Finally someone is saying 'yes, it makes sense' rather than 'no, that's wrong’."
Change techniques focus on replacing behaviours that harm you with behaviours that help you. This may mean your therapist:
"It’s not a short term thing... you have to work at it every single day. It’s hard to do, and even now, some 2 years after I completed the therapy, I’m still having to work at it."
The main ways to seek DBT are through the NHS with referral from your doctor or mental health team, or through the private sector.
There is currently no official register of DBT therapists in the UK. But some directories may let you filter your search by diagnosis or type of therapy.
Unfortunately, many people find that accessing DBT can be quite difficult. DBT isn't available everywhere, and NHS waiting lists can be very long. And many of us can't afford to go private.
If you're in this situation, our page on facing barriers to seeking help has ideas on how to cope.
"I was referred to a Personality Disorder clinic but found out only group DBT is available is this area and the waiting list was approximately 6 months long... I’m left here with no hope of ever receiving individual DBT therapy."
Unlike CBT, it can be difficult to learn DBT techniques by yourself. It can also be overwhelming when you start doing DBT. So doing it by yourself doesn’t usually work as well as going to sessions run by trained therapists.
Doing a formal course can help you:
But you may be able to find DBT self-help materials available online. This might include diary cards, exercises and behavioural analysis sheets. You could use these to brush up your DBT training alongside or after finishing a formal course. The DBT Self Help website offers these resources.
"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."
This information was published in April 2017. We will revise it in 2020.
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