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Marsha Linehan, the creator of DBT:

Dialectical behaviour therapy (DBT) was developed through the findings of the American psychologist Marsha Linehan. She began working with people who experienced intensely fluctuating emotions, were acutely suicidal and frequently engaged in self-harming behaviour. She trialled different approaches including cognitive, behavioural and humanistic forms of therapy however found that each of these alone were not sufficient. She experienced her own poor mental health which helped drive her to help find a way 'out of hell' for others.

Marsha developed DBT in the 1980s to synthesise a number of different approaches so that people could have a wider palette of skills and a broader understanding of their emotions and experiences. DBT has gone on to be used for a wide variety of different populations across the globe and has built extensive evidence base that it is an effective intervention. DBT was originally developed to follow a defined format, however the approach has also been adapted to meet the needs of a multitude of settings and is beneficial for anyone who experiences emotional distress. DBT is a commonly recommended therapy, however there is frequently a disparity between the need and the availability. While there is adaption from the original model to provide DBT individually, through experience I know that this can remain greatly beneficial.

DBT has been split into four distinct modules:

Mindfulness is a foundation of the DBT approach. Mindfulness is a core skill to develop as it helps to build awareness of things occurring in the present moment - thoughts, emotions, urges or physical sensations - and to develop more of a sense of control in life, to help balance out times when we feel out of control emotionally and stuck in painful events in the past and the future. Mindfulness is practiced at the start of every DBT session and helps to develop an understanding of acceptance and change, both of which are key in DBT.

Distress tolerance skills are for getting through moments when emotions are too painful and it can feel too overwhelming to deal with or think about them straight away. Distress tolerance skills can help to manage these periods (which always pass, even if they frequent and intense) without making things worse or doing things which we may later regret and can cause unwanted consequences alongside more painful emotions.

Emotion regulation skills are for using when the emotion can be tolerated however still requires understanding and management. Emotion regulation helps to develop understanding and naming of emotions and the constituent parts that form our emotional reactions, including patterns of emotions that we can find ourselves stuck in. By developing a deeper understanding to these patterns and our own vulnerabilities we can improve our ability to act more wisely when we encounter similar situations again, which in turn leaves us less susceptible to distress.

Interpersonal effectiveness is all about relationships. We do not live in isolation and we live around others who can have thoughts, emotions, needs and opinions that differ from ours. When we do not actively tend to the balance of our relationships, unhelpful dynamics can develop which can be a frequent source of distress. Interpersonal effectiveness addresses getting what we want out of relationships, maintaining balanced relationships and developing self-respect.

Each of these core sets of skills are to be utilised in different situations, however also link with each other to form a coherent whole. Individual DBT sessions help to relate the skills to real life experiences and distress. DBT also has a focus on the practice of skills between sessions as the approach recognises that the hard work is done throughout the 24 hours of the day, not just in an hour of therapy.

About DBT: About Me
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