Dialectical Behavioural Therapy (DBT)

What Is DBT?

DBT, also known as dialectical behavioural therapy, is a therapeutic approach developed by Dr. Marsha Linehan. It was initially developed for people living with borderline personality disorder (BPD) and recurrent suicidal ideation.

However, its scope has since expanded to address several other mental health issues. These include issues like eating disorders, self-harm tendencies, depression, and substance misuse.

DBT focuses on four primary skills – mindfulness, distress tolerance, interpersonal effectiveness, and emotional regulation. Through DBT therapy in Singapore, experts help clients develop these four core skills in their lives.

Additionally, while there are similarities between DBT and cognitive behavioural therapy (CBT), DBT focuses more on creating a balance between acceptance and change.

In the following sections, we will explore the stages of DBT, differentiate it from CBT, and explain the core skills it teaches to help you create a more balanced and happier lifestyle.

How Does DBT Work?

DBT focuses on managing emotions and changing negative or unhelpful thoughts and habits. The idea behind DBT is that many mental health issues occur due to emotional dysregulation.

To address this, DBT has tools that can help you comprehend, label, and control your emotions. The tools are especially helpful during challenging interpersonal situations and improving relationships.

Moreover, in therapy sessions, you may fill out a diary card weekly, either through an app or by writing it down in your therapy workbook or on paper.

The card tracks moods, behaviours, and skills. It prompts you to track daily emotions like fear, sadness, or anger and their intensity. Additionally, online therapists may suggest having a checklist.

Whenever you take positive actions, such as engaging in self-care tips for mental health or radical acceptance, therapists will encourage you to check the box on your card.

The card guides therapists in structuring sessions. The therapist and client then delve into behavioural analysis, exploring the root causes of specific challenges faced that week.

Given DBT’s intensity, Therapists often collaborate with other mental health professionals like social workers, psychologists or psychiatrists.

Working with other professionals helps incorporate diverse insights into individual sessions. While many clients show progress within a year, some may also need long-term therapy.

The duration of therapy usually depends on the issue one is dealing with and the number of sessions one takes in a week.

What Is the Difference Between CBT and DBT?

CBT, or Cognitive Behavioural Therapy, helps you recognise and challenge negative thought patterns.

For example, if you often think, “I’m not good enough,” CBT helps remove this belief and replace it with a more balanced perspective. This type of therapy usually requires you to work with a therapist in Singapore to get the most out of it.

DBT, or Dialectical Behaviour Therapy, is a subset of CBT but with certain distinct features. DBT primarily helps you manage intense emotions.

For example, if you feel overwhelmed by anger or sadness – DBT provides tools to navigate these emotions without being consumed by them.

It was developed around four main ideas: emotional regulation, mindfulness (staying present), distress tolerance (handling crises), and interpersonal effectiveness (improving relationships). The next section will explain in detail about these four skills.

In essence, while both therapies aim to improve mental well-being, their methods and focal points are different. Your choice between CBT and DBT should align with your specific needs and challenges.

Visit this page if you want to learn more about CBT and how it can help you improve your quality of life.

What Are the 4 Skills Taught in DBT?

In DBT, therapists will help you understand and learn the four essential skills to manage emotional distress and improve your interpersonal interactions.

These skills — Mindfulness, Distress Tolerance, Emotion Regulation, and Interpersonal Effectiveness — serve as the foundation to develop more stable emotional responses.

By learning these, you can navigate life’s challenges with greater ease and confidence.

1) Distress Tolerance

Distress tolerance is an important skill Singaporean Therapists may talk about during DBT therapy. Rather than eliminating pain or complex emotions, DBT helps you learn how to manage them effectively.

For example, imagine you have had a tough day, and everything seems to be going wrong. Your instinct might be to shut down, lash out, or resort to maladaptive behaviours. This is when distress tolerance can help you.

Below are some of the ways you can use this skill to manage your emotions:

• Instead of ruminating on what is bothering you, try to engage in a different activity. For example, if you are anxious about a presentation, take a short walk or listen to music. It helps you shift focus temporarily.
• Engaging in self-care activities can help you look inward to calm yourself. For example, try sipping a warm cup of tea if you are stressed. Turn your focus on its aroma and warmth, or wrap yourself in a soft blanket.
  While you cannot always change a situation, you can change your perspective. If you are stuck in traffic, for instance, use that time to listen to a podcast or practise deep breathing. Alternatively, you can also listen to your favourite music or stretch your shoulders.
• Reflect on what works for you and what does not. By listing the pros and cons of each strategy, you can make informed choices in stressful situations.

2) Mindfulness

Mindfulness is the practice of being fully present in the moment. It is about anchoring yourself to the here and now without judgment.

Imagine you are in a bustling cafe, lost in a lot of thoughts about past regrets or future anxieties.

Mindfulness encourages you to tune into the present. For example, listen to the hum of conversations, feel the warmth of your cup, and observe the colours around you. You can pick any one of the five senses and focus on them.

Here are two ways you can engage in mindfulness:

1. Internal Awareness: Mindfulness helps you become attuned to your inner world. Identify your thoughts, feelings, and sensations without being overwhelmed by them. For instance, if you feel anxious, simply acknowledge it: “I’m feeling anxious right now.”
2. External Awareness: Engage with your surroundings using your senses. Notice the textures, sounds, and scents around you – no matter where you are. By doing so, you ground yourself and pull away from unhelpful thoughts. 
   When your emotions become uncontrollable, mindfulness acts as an anchor. It allows you to pause, reflect, and choose a constructive response rather than reacting impulsively.

Below are some examples of mindfulness exercises:

• Focus on your breathing.
• Feel the cool air as you inhale and the warmth as you exhale.
• Observe the rhythmic rise and fall of your chest.

Counselling for anxiety can help if you need more guidance. 

3) Emotion Regulation

Emotional regulation is about understanding and managing your emotions effectively.

Consider a situation where a colleague’s comment triggers frustration in you. If you ignore or suppress that feeling, the primary emotion of frustration may spiral into feelings of inadequacy or resentment.

Below are some tips that can help you regulate your emotions:

• Identify what you are feeling. Is it sadness, joy, anger, or something else? By naming the emotion, you can better understand it.
• Focus on activities or thoughts that uplift you. If listening to music brings joy, make it a regular part of your routine.
• Create an environment that supports your emotional well-being. This might mean establishing boundaries or seeking supportive relationships.
• Approach your emotions with curiosity, not judgment. If you are feeling anxious, instead of chastising yourself, gently ask yourself, “Why might I be feeling this way?”
• Allow yourself to experience your distressing or complex emotions instead of avoiding them. This approach often reduces the intensity of the emotion.
• Pause for a few minutes before reacting to your emotions. Reflect on whether your immediate response will help your long-term well-being.
• Look for constructive solutions when faced with challenges. Instead of ruminating on what went wrong, brainstorm ways or solutions to rectify or move on from the situation.

By learning emotional regulation skills in counselling, you will start to understand and regulate your emotions with intention and clarity. 

4) Interpersonal Effectiveness

Interpersonal effectiveness focuses on nurturing fulfilling relationships while staying true to oneself. It is about understanding and asserting your needs, all while respecting those of others.

Imagine you are in a situation where a colleague consistently oversteps boundaries. Instead of bottling up resentment or lashing out, you can think of a constructive approach through interpersonal effectiveness skills.

The three main subsets of this DBT skill are:

• Objective Effectiveness: This skill empowers you to articulate your needs and desires. For instance, if you need more autonomy in a project, through DBT therapy, you will learn how to voice out that need clearly and constructively.
• Interpersonal Effectiveness: Relationships often have their own challenges. This skill teaches you to navigate conflicts, create mutual understanding and compromise. For example, if a friend cancels plans repeatedly, you will learn how to address the issue while being empathetic to their reasons.
• Self-Respect Effectiveness: At the heart of interpersonal relationships is self-respect. Online Therapists in Singapore will help you recognise your worth and stand by your values. If someone belittles or undermines you, this skill encourages you to address it without compromising your self-esteem.

What Is DBT Therapy Best Used For?

Dialectical behaviour therapy was developed by Dr. Marsha Linehan and her colleagues.

Dr. Marsha recognised that traditional CBT was not fully addressing the needs of people with borderline personality disorder (BPD).

To bridge this gap, the scholars included additional techniques and developed DBT.

While DBT was initially developed to treat BPD, the approach is now used to treat a broad range of mental health conditions.

Some of the issues DBT can help with include:

• Attention-Deficit/Hyperactivity Disorder (ADHD)
• Bipolar Disorder
• Eating Disorders
• Generalised Anxiety Disorder (GAD)
• Major Depressive Disorder
• Non-Suicidal Self-Injury
• Obsessive-Compulsive Disorder (OCD)
• Post-Traumatic Stress Disorder (PTSD)
• Substance Use Disorder
• Suicidal Behaviour