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Dialectical behaviour therapy (DBT) is a modified version of cognitive-behavioural therapy (CBT) designed to treat borderline personality disorder (BPD). It can also be used to treat other conditions, like suicidal behaviour, self-harm, substance use, post-traumatic stress disorder (PTSD), depression and eating disorders.
The term ‘dialectical’ means ‘working with opposites’. DBT uses seemingly opposing strategies of ‘acceptance’ and ‘change’. The therapist accepts you just as you are, but acknowledges the need for change in order for you to recover, move forward and reach your personal goals.
During a course of DBT, the therapist works with you to help you move away from harmful coping behaviours and towards a life that you find personally meaningful and fulfilling.
DBT involves developing two sets of acceptance-oriented skills and two sets of change-oriented skills.
Learning how to focus your awareness on the present moment, and to acknowledge and accept your thoughts, feelings, behaviours and bodily sensations as they occur, without the need to control or manipulate them.
Related: Mindfulness
Learning how to manage and cope during a crisis, and to tolerate distress when it is difficult or impossible to change a situation. Learning to accept any given situation just as it is, rather than how you think it should be, or want it to be. Learning new skills like distraction and self-soothing, for both coping with and improving distressing moments.
Learning how to effectively manage your emotional experience, and not allow your emotions to manage you.
Learning assertiveness strategies to appropriately ask for what you want or need. Learning how to say no, and how to manage interpersonal conflict in a way that maintains respect for yourself and others.
DBT is typically run as a 24-week program, often taken twice to create a one-year program. In its standard form, there are three ways you receive DBT during the program. There are also shorter versions of DBT such as 12 week courses depending on the setting, and some versions do not include telephone coaching. DBT has been adapted for different needs.
A group facilitator teaches specific skills in a classroom setting, and sets tasks for the group members to practise between sessions. The skills training group typically meets once weekly, usually for around 2½ hours, across the 24-week program.
Running at the same time as the group, individual therapy typically occurs weekly to enhance your motivation and commitment to the program. It’s also an opportunity to discuss and apply specific DBT skills to your current everyday life.
On-the-spot telephone coaching from your therapist can be available at times during the week when you’re struggling. Your therapist guides you and encourages you to apply your new DBT skills to address and manage your issues.
In most Australian states, DBT programs can be accessed through both the public and private mental health system.
Some hospitals may run public DBT programs. Talk to your case manager, mental health professional or GP about referral options.
Private DBT programs require payment. Prices will vary depending on the specific service you choose. If you have private health insurance, check that it covers psychiatric admissions.
If you don’t have private health insurance but you’re eligible for the National Disability Insurance Scheme (NDIS), you may be able to allocate funds to access a DBT program within the private system.
To join a private DBT program, a psychiatrist from the specific hospital or clinic can provide a referral for you.
To find services providing BPD treatment in Australia or New Zealand, visit Project Air Strategy’s Service Directory.
For state-based mental health assistance:
This SANE factsheet was reviewed by industry professionals.
This SANE resource was created with support from The Vizard Foundation.
Treatment for mental health issues, trauma, and distressing experiences can include psychological treatments, medication, support in the community, or a combination of these.
Psychotherapy helps by giving an opportunity to talk to a specially-trained health professional in order to understand your symptoms, and to help you adapt how you feel, think and act in response to them.
Psychotherapy helps you to understand why you feel, think and act in ways which are distressing and affect your life, and to work towards changing these. This can be challenging but it means you play an important part in your own therapy, and this in itself is empowering.
Psychotherapy does not work quickly, but over a period of months will help you to learn new ways of thinking, behaving and even feeling. You may notice, for example, that you are better prepared to handle things that used to worry you or get you down. Eventually you may find the whole way you think of yourself and the way you perceive and respond to the world changes for the better.
Psychotherapy is often effective on its own for people with depression and anxiety disorders. Sometimes it is also useful to combine therapy with other treatments. For people with illnesses such as schizophrenia and bipolar disorder, for example, medication, ongoing rehabilitation, accommodation and employment support are often needed.
There are many types of psychotherapy which are proven to be effective. These may be provided individually, as part of a group, as a couple or even as a whole family – depending on the nature of the problem.
Some common therapies are:
CBT helps people discover how their feelings, thoughts and behaviour can get stuck in unhelpful patterns. They are encouraged to try new, more positive ways of thinking and acting. Therapy usually includes tasks to try between sessions. CBT is a well-established treatment for depression and most anxiety disorders. It can also be an effective part of treatment for other conditions, including post-traumatic stress disorder (PTSD), eating disorders, bipolar disorder and schizophrenia.
IPT looks at the way someone has related to significant people in their life, and how this may have affected other relationships and how they feel, think and act generally. It then looks at finding more positive ways of interacting with others. IPT can been especially effective in treating depression and anxiety disorders.
DBT is a form of treatment specifically for people with borderline personality disorder (BPD). DBT is based on an understanding that a key problem for people with BPD is extreme difficulty in handling emotions, and the distress associated with this. DBT helps people learn to handle their emotions better and re-learn the way they typically respond to situations and other people. DBT generally combines individual and group therapy. Read more on our factsheet about DBT here.
These treatments aim to support families and other carers by fostering calm and constructive family relationships where a member of the family has a psychotic illness such as bipolar disorder or schizophrenia. Family intervention sessions typically focus on education about mental illness, solving of problems encountered as a result of the illness, and improving communication and relationships where these are strained or stressful. Family interventions can reduce relapse rates for people with psychotic illness while also supporting everyone involved.
Psychotherapy varies in the length of time it takes to work, depending on the particular treatment and the person’s needs. The benefits of therapy often happen at a different rate for different people. Sessions usually last between 45 and 90 minutes. Most people receive up to ten sessions, with some attending further sessions if required.
A GP is always the best place to start if concerned about your physical or mental health. As well as making an assessment and diagnosis, a GP can prescribe a Mental Health Care Plan, which may include referral for psychological treatment to a psychiatrist, psychologist or other mental health professional. With a referral from a GP, the cost of this treatment is largely covered by Medicare. Health professionals at Community Mental Health Services and public hospitals do not charge fees
Psychiatrists are medically qualified doctors who specialise in the study and treatment of mental illness. They can therefore prescribe medication as well as provide psychological treatments.
A psychologist is a health professional trained to provide treatments to people with emotional and mental health problems.
Other mental health professionals may also be able to provide psychological treatments: for example, social workers and occupational therapists who have received specialised training.
Use these tips to get what you need.
As well as your GP, ask other health professionals, local pharmacists or trusted family and friends about providers of psychotherapy they would recommend.
The APS has a referral service that gives contact details of privately-practising psychologists in your area who work with particular mental health problems.
It’s important to be engaged as much as possible yourself in the psychotherapy. When making an appointment, or during an early session, ask the provider what the goals of therapy are and what it will involve.
The more you speak out and are frank with yourself as well as with the person providing the treatment, the more successful it is likely to be. If you feel concerned, confused or uncomfortable with the treatment, let the provider know, so they can work with you to address the reasons for these feelings. If you feel that they are not the right person to help you, then explain this and ask for another referral. A good therapist will want what is best for you and will not hesitate to refer you to someone more appropriate.
Ask your doctor about any concerns you have, or contact the SANE Helpline 1800 18 SANE (7263).
SANE also produces a range of easy-to-read publications and multimedia resources on mental illness. For more information related to this topic see:
Being physically active has many physical, mental and emotional benefits.
Related: Healthy living • Ten tips for sleep hygiene
Eating fresh, healthy food is important for our mental as well as physical health. Evidence is poor, however, that consuming herbs or other substances makes a significant difference to the symptoms of mental illnesses.
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Yes, mental illness can be treated. This means that many people who have a mental illness, and are treated, recover well or even completely. However, because there are many different factors contributing to the development of each illness, it can sometimes be difficult to predict how, when, or to what degree someone is going to get better.
When you or someone you know starts to feel mentally unwell, the first step in obtaining treatment is to see a doctor or other health professional for diagnosis. After a thorough assessment, a doctor can make a diagnosis based on a particular pattern of symptoms. A decision can then be made about the best treatment for these symptoms and their underlying causes.
Treatment means all the different ways in which someone with a mental illness can get help to minimise the effects of the illness and promote recovery.
It can involve psychological therapy, medication, and various supports in the community, as well as people with the mental illness helping themselves.
Further information about these different approaches is available in the Guide (see tab above).
These days, clinical treatment generally takes place in the community rather than in a hospital. Anyone who has been diagnosed with a mental illness which needs treatment, should be able to receive a range of clinical services in their own community. If necessary, ongoing support can be provided by a community mental health service clinic, where there are a range of mental health professionals.
There are lots of things that people with a mental illness can do for themselves, to help recover a balanced life. Healthy eating, getting plenty of sleep, and regular physical activity are all important to good mental health. Learning skills which help deal with stress, feeling down, relationships or the symptoms of the illness, are also ways in which someone with a mental illness can look after themselves.
If you have any concerns about your treatment speak to your doctor.