Reprinted from "Borderline Personality Disorder" issue of Visions Journal, 2011, 7 (1), pp. 24-25
What is DBT?
Dialectical behaviour therapy (DBT) is the leading psychological treatment for borderline personality disorder (BPD). It was developed 15 years ago by Marsha Linehan at the University of Washington in Seattle. DBT has been widely researched and proven to be effective in treating BPD, suicidality, self-injury, problem substance use and eating disorders. The core concept underlying DBT is that clients struggle because they lack essential coping skills. According to John Wagner of the DBT Centre of Vancouver, "DBT's goal is to teach clients better skills for living, including strategies for being more aware of feelings, effectively managing emotions, tolerating distress and improving interpersonal interactions."
The DBT Centre of Vancouver
The DBT Centre of Vancouver was established in 2007 by Alex Chapman and John Wagner, two registered psychologists who trained with Linehan. Chapman, the DBT Centre of Vancouver's president, and Wagner, its director, aimed to fill a service gap by bringing DBT treatment to Vancouver. It was one of the first organizations to bring this therapy to BC.
Since its inception, the centre has grown in size and scope of services. It currently employs 10 therapists working with clients in individual and group settings, and offers a variety of training opportunities for mental health professionals. Examples include a 36-week intensive training course on DBT and a variety of half-day and full-day workshops on topics such as mindfulness and skills training. The staff also provides consultation on a variety of cases for mental health professionals.
What does the DBT treatment involve?
DBT therapists are active, hands-on and very present-oriented. They focus on helping clients "change the way they feel by helping them change their behaviours. They use structured methods to balance changing feelings with accepting them. This degree of attention to and acceptance of feelings is what differentiates DBT from other psychological methods," explains Dr. Wagner.
Standard DBT treatment involves a weekly one-to-one therapy session, a weekly group therapy session, and telephone support as needed. In the group session, clients learn how to:
Manage attention (mindfulness skills)
Manage and cope with emotions (emotion regulation skills)
Deal effectively with relationship situations (interpersonal effectiveness skills)
Deal with emotional distress (distress tolerance skills)
The full course of DBT treatment is one year. In that year, clients repeat the skills group twice. If completing a full course of therapy is not possible, the client might choose to do the skills group alone or alongside another type of individual therapy.
At the end of therapy, success is measured by how much the client's harmful thoughts and behaviours have decreased, to what extent the quality of their relationships have improved, and whether they feel better equipped to face life's challenges.
Finding help at the DBT Centre of Vancouver
Among the DBT Centre’s clients, roughly 50% have a diagnosis of BPD, 20% show traits of BPD, and 20% are dealing with other mental health issues such as anxiety or bipolar disorder.
The DBT Centre of Vancouver accepts clients from all over BC. Many clients self-refer, hoping to benefit from this effective and research-based treatment. Psychologists and counsellors refer clients who are struggling and might benefit from a course of DBT treatment. Psychiatrists also refer clients who are not responding to medications. The waitlist for the DBT Centre is currently just under a month. Individual treatment sessions range from $120–$170 per hour, and group sessions cost $95 per two-hour group. DBT treatment is not covered by the BC Medical Services Plan (MSP), but some extended health plans provide coverage for psychological treatments like DBT.
Future outlooks for DBT treatment
The recognition and adoption of DBT by the mental health community has motivated researchers to focus their efforts on pulling apart the elements of DBT that are most effective. DBT treatment is comprehensive and lengthy, so it would be very useful to find out which components of therapy produce the most significant change in the shortest amount of time. A refined version of DBT would be less expensive and more accessible. The majority of DBT research has examined its effectiveness in treating borderline personality disorder, says Wagner. But new research is examining its how helpful it can be for substance use disorder, depression in older adults, eating disorders and forensic populations [people engaged in the legal system], he says.
Though there are other promising approaches in BPD treatment, though they are too new to have solid research support for their effectiveness. DBT remains the only well-established psychological treatment for BPD.
Here is a dialectical behaviour therapy DBT exercise provided by John Wagner of the DBT Centre of Vancouver: One of the mindfulness skills commonly taught in DBT is Being Non-Judgmental. This involves letting go of the judgments we often have about ourselves or others. This is generally done by first helping clients acknowledge the judgments (good, bad, stupid, fat, et cetera) they are making and then have them restate the judgment in a more factual way. For instance, when someone repeatedly calls themselves "stupid" for saying something hurtful to a partner, they might instead say, "I'm feeling guilty for calling my husband a jerk when I was angry." Restating the judgments in a more factual way often enables people to be more effective in fixing the problem, perhaps with an apology and plan for preventing it from happening again. It also makes it easier to let go of the ruminative (repetitive) thinking, such as, "I'm worthless." This skill is commonly practiced in both individual and group sessions.