What is DBT?

Dialectical Behaviour Therapy was developed by Dr Marsha Linehan. She was interested in finding a treatment that worked for people with more complex problems who often did not benefit from more traditional therapies.

Dr Linehan had direct personal experience of these problems as well as professional training and experience in well-researched behavioural therapies (see link re: Linehan’s personal history with this).  When she found that traditional behavioural treatments did not seem to work for certain clients she started incorporating eastern psychological theory and practices into her treatment. Through feedback from clients and observations about what worked in the treatment she developed DBT.  The resulting treatment was shown to be highly effective in reducing hospitalisations, helping people stay in treatment (preventing drop out) and reducing suicidal and self harm behaviours, and helping with problems such as depression, anxiety, drug and alcohol use issues, and many other problems.

Initially the treatment was researched as an effective treatment for Borderline Personality Disorder. Over time, however, DBT has been shown to be effective for other groups, such as adolescents with complex, multiple problem behaviours, binge eating, substance abuse and gambling.

In general, DBT tends to be applied when the core problem seems to be emotion regulation.  In DBT many problems, such as ongoing life threatening or self-harming behaviours are viewed as a person’s attempt in the moment to solve the problem of painful emotions. These and other behaviours develop in response to feeling overwhelmed, confused, or lost in emotions, or alternatively being cut off from them. The person learns ways of managing these emotions that may be effective in the short term, drugs for example, but cause more problems in the long term.

At present researchers are trying to work out which bits of DBT make it work and who is it most effective for. In Australia and around the world there are both comprehensive DBT programmes and programmes that have incorporated some of the principles of DBT into their treatment. Similarly, there are clinicians who have extensive, formal training in DBT, and those who incorporate some ideas from DBT in their work. The research indicates that therapists with extensive formal training in DBT achieve better outcomes for their clients, and that people who engage in one-on-one DBT therapy while also attending a DBT group get better outcomes. Furthermore, it appears that when family members and significant others attend a DBT group as well, outcomes are further improved.