Dialectical Behaviour Therapy is not just group!

In Australia, many programs now proclaim to be Dialectical Behaviour Therapy (DBT) programs! But are they really DBT programs?

The short answer to the above question is not all programs that claim to be offering DBT are in fact DBT Programs. Very few DBT programs exist in Australia when compared to the US and UK where the majority of the evidence base for DBT has originated. I make this claim as providing only the skills component of Dialectical Behaviour Therapy or only individual therapy component does not constitute a DBT program as described, researched and evaluated in over 30 Randomised Clinical Trials. These programs may well be competently informed by the evidence based approach, by skilled practitioners, but they are not DBT Programs.

This begs the question… what is a DBT Program? For a program to be using the evidence based approach that is DBT, the program offers an individual all the essential components of DBT including commitment to treatment (3-6 sessions), group skills training (16-24 sessions), individual psychotherapy (16-24 sessions), phone coaching (when needed) and a consultation team meetings for mental health professionals (every week or two) providing the treatment. In such programs individuals with BPD or emotion regulation difficulties are asked to monitor their symptoms and use of learned skills daily, while their progress is tracked throughout therapy.

The five groups of skills for daily use in Dialectical Behaviour Therapy (DBT) as follows:

Middle Path Skills. These skills centre on integrating Dialectics, Behaviouralism and Validation to be able to explore: Core Beliefs, Knowing What You Want, Self-talk, Personal Responsibilities, Boundaries, Cognitive Distortions, Building Structure, Think Dialectically & Act Dialectically

Mindfulness Skills. These skills centre on learning to observe, describe and participate in all experiences (including thoughts, sensations, emotions and things happening externally in the environment) without judging these experiences as “good” or “bad.” These are considered “core” skills that are necessary in order to implement the other DBT skills successfully.

Interpersonal Effectiveness Skills. The focus of this skill module is on learning to successfully assert your needs and to manage conflict in relationships.

Distress Tolerance Skills. The distress tolerance skills module promotes learning ways to accept and tolerate distress without doing anything that will make the distress worse in the long run (e.g., engaging in self-harm).

Emotion Regulation Skills. In this module, patients learn to identify and manage emotional reactions.

What is Dialectical Behaviour Therapy (DBT)?

Dialectical Behaviour Therapy (DBT), developed by Marsha Linehan PhD at the University of Washington, is a cognitive behavioural therapy, meaning it is a therapy that focuses on the role of cognition (e.g., thoughts and beliefs) and behaviours (e.g., actions) in the development and the treatment of BPD. DBT includes some adaptions to traditional cognitive behavioural elements of therapy in order to help specifically reduce the symptoms of individuals with BPD. Dr. Linehan’s theory is that the core problem in BPD is emotion dysregulation, resulting from mixing biology (e.g., genetic and other biological risk factors) and an emotionally unstable childhood environment (e.g., where the environment punishes, trivialises or responds erratically to the child’s expression of emotion) together. The focus of DBT is on helping individuals learn and apply skills that will decrease emotion dysregulation and unhealthy attempts to cope with strong emotions.

The Australian DBT Institute, established in 2004, provides a range of professional development opportunities for Mental Health Professionals seeking to become proficient in dialectical behaviour therapy-informed approaches. Our team is led by experienced DBT clinicians who have received training, mentoring, and development from Marsha Linehan’s team at Behavioral Tech LLC (2004-8). The Australian DBT Institute has led high-fidelity DBT programs since 2004 through the Essentia Health Clinics in Melbourne, Sydney and Online. Our clinical programs have included comprehensive DBT and modified DBT programs for specific populations including youth, carers, Indigenous Australians, correctional settings and psychiatric emergency settings.