The DBT therapy in London is a type of psychotherapy that focuses on high-risk patients, that is, patients who represent a risk to themselves (suicidal ideation) or to others.
Developed by Marsha M. Linehan, this therapy initially focused on patients with borderline personality disorder, characterized by, among other factors, intense and explosive emotions, as well as high impulsivity and chronic suicidal ideation.
The term “dialectic” in the name of this therapy refers to the dialectical perspective on which this approach is based. In this sense, it is considered that everything is interrelated and follows a relational logic, that is, a behavior always occurs in relation to a context.
Therefore, analyzing a behaviour in isolation from the interrelation it presents with other behaviors, with the environment, with the culture and the moment in history that the person is living, brings a limited understanding of this behavior, bringing damage to therapy as a all.
Dialectics is a philosophy in which there is a thesis, an antithesis and a synthesis. Reality is composed of internal opposing forces (thesis and antithesis), and the synthesis is a response to this battle of opposing forces. When a person acts in an extreme way, as is the case with suicidal and impulsive patients, for example, one might think that there was a dialectical failure there, as an adequate synthesis of these internal forces was not possible.
Dialect-behavioural therapy is also called DBT after its
What is dialect behavioural therapy indicated for?
As mentioned earlier, when creating this therapy, Marsha Linehan was thinking about patients with borderline personality disorder, who are often involved in risky situations because of the symptoms of the disorder. However, this is not a therapy just for patients who are at high risk.
Patients with bipolar disorder or unipolar depression with suicidal ideation can also benefit greatly from this therapy, learning the skills it has to teach and achieving a behavioral repertoire that allows them to solve their problems adequately and without complicating their lives so much.
DBT has techniques that can help anyone who has a problem with emotional regulation, regardless of diagnosis. It can also help people who exhibit self-destructive behaviors, such as people with eating disorders and substance use disorders.
How can therapy be done?
DBT is an extremely versatile therapy and can be applied in different contexts. While some types of therapy need very specific conditions, DBT can be done in the following scenarios:
- Group Skills Training: In this scenario, group participants learn new behavioral skills through “homework,” i.e., practicing at home what they learn in sessions, as well as through role-playing new ways of interacting with others. the other members of the group;
- Individual therapy: Individual therapy consists of a therapeutic relationship involving only the patient and the therapist and has some advantages and disadvantages compared to group therapy. As a disadvantage, we can highlight the lack of role-plays that can help participants understand how that new skill would work, but as an advantage, it is possible to make an individualized treatment plan focused exactly on the biggest challenges that the patient must overcome;
- Coach by phone: Often during the months in therapy, issues arise that need to be resolved on the spot and the patient cannot wait until the next session to be able to bring this issue to the office. To deal with this demand, DBT allows phone calls so that the patient can receive guidance to deal with the difficulties they are experiencing at the moment. It does not replace therapy as a whole, but it can “break a branch”, especially when it comes to high-risk patients who also have high levels of impulsivity.
In the book “DBT Skills Training: Dialect-Behavioral Therapy Manual for the Therapist”, Linehan points out that several clinical trials are showing that skills training alone, without other types of treatment, is quite effective in several disorders and problems, such as depression, anger, emotional dysregulation, affective instability and emotional intensity.
This does not mean that it is indicated that a person who is in need of help seeks only skills training. Each case is different, and although training alone can be effective, to get the most out of the treatment, it is essential to carry out an evaluation with a qualified mental health professional, in order to outline the strategies that are most suitable for the treatment of specific demands. .
DBT’s biggest flagship is definitely the skills training, which takes place both in groups and individually. These skills are separated into 4 categories:
Mindfulness is a technique that aims to engage with the present moment, that is , the focus on the here and now. The purpose of mindfulness is to get in touch with the world around you in the moment, as well as your own feelings, thoughts and sensations, in a non-judgmental way.
This skill is usually the first to be trained, as it is important for learning and training all other skills brought by DBT. Being able to focus on the present moment is extremely important to be able to establish this dialectic relationship between hot cognition and cold cognition, to be able to find new, more adaptive ways of dealing with difficulties and challenges.
To teach this type of skill, the therapist can ask the patient to try to describe what he is seeing at the moment, avoiding judgments, as well as what he is hearing, what he is feeling in his body, etc. You can even train mindfulness at home, on a daily basis, for example by eating and contemplating the flavors, textures, temperatures and colors of food, or by taking a walk, paying attention to the path being traced, to the nature that surrounds you. appears, in the sounds that can be heard, in the smells that arise, etc.
To practice mindfulness , it is necessary to pay attention to what is happening around us, instead of paying attention only to our thoughts and disconnecting ourselves from the present moment.
Discomfort tolerance skills
Tolerance for discomfort is a skill that all people need to learn, because things don’t always go the way we want and discomfort is a reality that eventually affects everyone.
People who have difficulties with emotional regulation, for example, may have tremendous difficulty tolerating feeling unwell and, to deal with this feeling, they end up doing something harmful to themselves, such as using substances or ending up engaging in some self-destructive behavior.
Discomfort tolerance skills consist of identifying the discomfort, accepting its presence and finding ways to deal with the crisis without causing further damage. Some discomfort tolerance techniques involve distraction, looking for alternatives to improve the moment, trying techniques to calm down, such as wrapping yourself in a warm blanket or petting a pet, for example.
When feeling angry, turning on music at a good volume and dancing to release that anger can be a technique for tolerating discomfort, for example. Exercising when feeling anxious can also fall into this skill category, as well as going up and down the stairs in times of restlessness. The idea is to allow the body to deal with the emotion while the person is distracted and allow the body to process these intense emotions naturally.
Interpersonal Effectiveness Skills
Interpersonal effectiveness is important for maintaining healthy relationships, regardless of the type of relationship. Often, our emotions can make us say things that hurt others, or interpret what we are told in a harmful way, causing a series of unnecessary conflicts.
Because of this, interpersonal effectiveness skills can go a long way toward maintaining good relationships. With these skills, the individual is able to impose limits, say no when he doesn’t feel comfortable, express his needs and desires in a positive and healthy way, avoiding judgments and blaming.
These skills are often evoked in the form of acronyms that help people remember how to act in certain situations. For example, the acronym GIVE helps keep people in good conversations, even about sensitive topics, and stands for:
- Be Gentle ( Gentle ): Do not attack, threaten or judge people;
- Show interest ( Interest ): Be involved when listening to the other, do not interrupt, demonstrate that there is interest in what the person has to talk to you;
- Validate: Validating the other’s speech is the key to making him feel understood, which greatly increases the quality of interpersonal relationships. Therefore, seek to understand and validate the thoughts and feelings that the other person expresses;
- Adopt a calm style ( Easy ): Having a calm and relaxed style also helps the relationship to develop in a healthier way. Try to smile often and maintain a cheerful and carefree posture as much as possible.
Emotion regulation skills
Finally, the last skill to be worked on in DBT is emotional regulation. People who do not have good emotional regulation often have difficulties in controlling impulsive behaviors, may have physiological reactions to very intense emotions, as well as may have difficulties in maintaining adequate functioning in the face of intense emotion, that is, their ability to function depends on the your emotional state.
With emotion regulation skills, the idea is to inhibit these impulsive behaviors linked to intense emotions (both positive and negative), try to reduce the intensity of the physiological reaction to emotions, as well as help the person to organize himself so that he can do what he wants to do. need to do regardless of your mood. Finally, there are also techniques for changing the focus of attention in the face of very intense emotions.
One should not confuse regulation with emotional control. Often, people believe that they need to learn to control what they feel, and this is not only not possible, but ends up harming them even more. Accepting your emotions is the first step towards being able to learn to regulate yourself emotionally. It’s not about controlling emotions, because you keep feeling everything, but about learning not to be controlled by them.
Emotion regulation techniques help the individual to recognize, name and deal with their own emotions in a healthy way, reducing emotional vulnerability and allowing the person to cultivate a good relationship with their own emotions.
An example of an emotion regulation technique is identifying what you are feeling and doing the opposite. A person who is sad and feels that they should isolate themselves from friends and family, for example, is actually sabotaging themselves and allowing that sadness to persist for longer. Going to see friends and/or family can help shift the focus of attention, allowing that sadness to process in the background while you connect with the people you love, which in turn helps to combat more negative feelings in the future.
DBT therapy in London is a therapy that aims to help patients with severe disorders to better deal with their symptoms by learning skills. This text aimed to briefly present this therapy, so it does not replace a consultation with a psychologist or psychiatrist and should not be taken as an absolute recommendation.
If you feel that you are dealing with emotional or psychological issues that may be causing you distress or harm in any way, be sure to contact a mental health professional!