Dialectical Behaviour Therapy (DBT)
Dialectical Behaviour Therapy (DBT) was created by Dr. Marsha Linehan for the treatment of Borderline Personality Disorder (BPD) and other severe mental health conditions. Since its inception in the late 1980s, DBT has been widely recognized for its abundant skills training in the four modules of treatment:
- Mindfulness
- Emotion regulation
- Distress tolerance
- Interpersonal effectiveness
Many clinics and mental health professionals offer DBT-informed treatment. However, it's important to recognize the difference between clinicians that use a DBT-informed approach vs. clinics that offer Standard DBT.
Standard DBT is a structured delivery of DBT treatment as it was designed. Standard DBT involves the following:
- Four modes of treatment: (1) individual therapy, (2) group skills training, (3) peer consultation meetings between DBT therapists, and (4) intersession contact between therapist and client (i.e. phone coaching).
- Four skills modules: (1) mindfulness, (2) emotion regulation, (3) distress tolerance, (4) interpersonal effectiveness.
- Weekly individual and group sessions for a period of at least six months, depending on the stage of treatment
- Treatment stages:
- Pre-treatment:
- Determine 'life-worth-living' goals and behavioural targets
- Review agreements that are a part of treatment
- Stage 1: The aim is behaviour stabilization through group skills training, phone coaching, and individual therapy. Suicide ideation and self-harm behaviours should not be imminent and should be better managed if they are present before moving to Stage 2.
- Stage 2: Aims to treat PTSD and reduce PTSD symptoms through trauma treatment, if applicable.
- Stage 3: The aim is to help people integrate their skills and newfound understanding of themselves into their life. The focus is on living life, trusting oneself, and achieving personal goals.
- Stage 4: The aim is to enrich life through finding deeper meaning and attending to one's spirituality, if applicable.
- Pre-treatment:
Standard DBT was designed for people suffering from severe mental health conditions and who exhibit significant trouble functioning in work, personal and/or social spheres of their life. In contrast, DBT-informed therapy does not require the modes of treatment found in Standard DBT. Instead, a DBT-informed therapist should have a working knowledge of trauma and the biosocial model of BPD. They will also draw upon DBT skills, including the skills training handouts. Currently, our clinic offers DBT-informed therapy only.
Clinics that offer Standard DBT in Ontario:
"The bottom line is that if you are in hell, the only way out is to go through a period of sustained misery. Misery is, of course, much better than hell, but it is painful nonetheless. By refusing to accept the misery that it takes to climb out of hell, you end up falling back into hell repeatedly, only to have to start over and over again." - Marsha M. Linehan, DBT Skills Training Manual
References
- Linehan, M., M., (2014). DBT Training Manual. New York, NY: The Guilford Press.
Benefits:
- Effectiveness. Research shows that online therapy can be just as effective as in-person therapy for issues related to mental health.
- Accessible. Accommodates those living in rural or remote areas, people living with disabilities that prevent them from leaving the home, and eliminates transportation barriers.
- Convenience. No need to schedule time for a commute.
- Cost Effective. Eliminates cost of parking and transportation.
Considerations:
- Coverage. Some insurance companies may not cover it. We encourage you to check with yours.
- Confidentiality and Privacy. Although we use encrypted, HIPAA-compliant software and abide by telehealth guidelines, communicating over the Internet entails a greater risk for security breach compared to in-person. It also means possible Internet connectivity issues.
- Distractions. Possibilities for disruption depending on your living circumstances and others in the home.
Benefits:
- Trust and Body Language. Some people may prefer viewing the entire body language of their therapist for more effective communication.
- Severe mental health or psychiatric concerns. A more appropriate and accommodating option for people that may need crisis intervention that is better supported with in-person care.
- Participation. It is an opportunity to engage in an activity outside of your home.
Considerations:
- Time consuming. Ensuring commute time may be challenging for busy schedules.
- Expenses. Possible parking and transportation fees.
All virtual sessions are conducted using secure, HIPAA-compliant software. Research has shown that psychotherapy offered through telehealth is an effective solution for mental health treatment. The efficacy of either option depends on individual preference and comfort level.