What is Dialetical Behavioural Therapy (DBT), and how it works with PTSD and other therapies?

Dialetical Behaviour Therapy (DBT) was devised by Dr. Marsha Linehan in the 1980s in response to shortcomings and a high drop out rate experienced when using conventional, existing Cognitive Behaviour Therapy (CBT) techniques to treat patients with suicide ideation disorders. In order for DBT trials to proceed, a more specific disorder had to be used. Linehan used the newly-conceived DBT techniques to work with patients who had been diagnosed with Borderline Personality Disorder (BPD), because suicidal ideation is a commonly recognized element of BPD, occurring in approximately 70% of cases.

Results from initial DBT trials used to treat BPD demonstrated that although the programme of treatment might last up to a year, DBT was nevertheless proven effective in the treatment of those with BPD who displayed suicidal ideation. An average of a 77% drop in patients no longer meeting requirements for a BPD diagnosis As for the efficiency of DBT specifically to treat suicidal ideation as an independent condition, positive conclusions were drawn. There was a marked decrease in patient drop out numbers which was positive in itself, in addition to which, DBT is recognized as the first well-established empirically supported treatment for reducing suicide attempts.

Ironically, the use of DBT in the treatment of BPD, something for which it was not originally devised, led to trials being carried out to treat a variety of disorders. These included, but were not limited to Post Traumatic Stress Disorder (PTSD), eating disorders and substance use, through which the use of DBT showed positive results of varying degrees across these conditions, even though the reasons behind the success are yet to be fully studied and understood.

It is however, believed that a contributing factor in the success of DBT is the clear stages without the imposition of a strict timeline when a patient embarks upon a course of DBT. There are 4 defined stages in DBT each of which serve to assist the patient in their evolvement back to a fulfilling and meaningful life through the acquisition of goals. The first of these is to regain control of one's behaviour, the second is the expression of emotion as patients at this juncture suffer in silence. This stage is of particular benefit for those with PTSD. The third stage involves learning to live and function absorbing life's ups and downs without upset or deregulation. Finally the fourth stage is an element which sets DBT well and truly apart from other therapeutic approaches is the search for deeper meaning in life through spirituality and the connectness with the world around us with the goal of achieving joy and freedom.

Additionally, DBT promotes the therapeutic alliance between the client and the counsellor, within the boundaries of DBT treatment criteria. It is also not the role of one counsellor to oversee the treatment of a DBT patient, but rather involves a team of counsellors, each of whom can provide appropriate focused interventions, depending on the stage of DBT treatment for the patient. Moreover. treatment is not confined to sitting face to face with a counsellor but includes group work and telephone and webcam counselling as well. something that has become increasingly common in recent years.

The past 25 years have shown DBT to be an effective, adaptable and relevant therapeutic approach, of which the use and implications for the future development in counselling are far from being fully realized.

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