Dialectical behaviour therapy (DBT)

Dialectical behaviour therapy (DBT) is a type of cognitive behaviour therapy or 'psychological therapy'.

Dialectical means ‘working with opposites’. Dialectical behaviour therapy involves learning both 'acceptance-oriented' and 'change-oriented' skills — seemingly opposite skills.  

It’s useful for people:

• with borderline personality disorder (BPD)
• with a tendency to self-harm
• who often think about suicide
• who have regular difficulties with relationships 

Research shows that psychological therapy is the best treatment for personality disorders.

In DBT, your therapist will accept you as you are and help you do the same. They will also help you understand the need to make positive changes so that you can manage some of your strong emotions and make progress towards your goals.

DBT can help you understand and manage unhelpful ways of thinking and behaving.

Skills learnt through DBT can help you to build a satisfying and meaningful life.

By doing DBT you learn to manage your behaviour and emotions. It teaches you new skills to cope with day-to-day life and to replace harmful coping behaviours with healthier ones. It helps you understand why you struggle with the things you do.

DBT sessions may happen in a group or one to one with your therapist. You may do exercises that will help you manage intense emotions when they arise. 

DBT is used to treat mental health problems with symptoms such as:

• feeling a sense of emptiness or hopelessness
• low self-esteem or feelings of self-hate
• managing strong emotions or intense mood swings
• risk-taking or impulsive behaviour
• unstable relationships
• self-harm
• suicidal thoughts or suicide attempts

People with borderline personality disorder have difficulty regulating their very strong emotions. This may cause troubled relationships and a disturbed sense of self. They may experience self-harm or have suicidal thoughts. DBT can help a person gain skills to manage their strong emotions in the moment. This has positive flow on effects in other parts of their life.

Therapists may also offer DBT for:

• alcohol or drug problems
• depression
• eating disorders, such as binge-eating or bulimia
• post-traumatic stress disorder (PTSD)

DBT is provided by mental health professionals, such as:

• psychologists and psychiatrists
• doctors with training in mental health
• mental health nurses
• counsellors

Your doctor can refer you to a DBT provider. Your doctor can also create a mental health treatment plan if you need one. This plan can help you access Medicare rebates to help pay for your therapy. You can also ask your doctor about telehealth or online providers.

If you don’t know how to raise the topic with your doctor, here are some tips for talking to your doctor about mental health.

DBT is available through public or private mental health providers. Sessions may take place at a public hospital or a private clinic.

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 some NDIS funds to a DBT program.

The Australian Psychological Society (Opens in new tab) lists registered psychologists in Australia.

Project Air has a directory of personality disorder services (Opens in new tab).

You can also visit the healthdirect mental health services page to find a therapist in your area.

If you need to talk to someone sooner, you can find a list of mental health helplines here.

You can also consider online therapy or DBT via telehealth.

With DBT, you learn to:

• accept yourself as you are
• build skills to regulate your emotions
• improve interpersonal relationships

DBT usually involves:

• sessions with a therapist — these might be 50 to 60 minutes each
• skills training in groups — each session may last 2 to 3 hours
• telephone coaching sessions with a therapist, if you are struggling between sessions
• your family — they may also get support to help care for you

What will happen in my DBT sessions?

There are 4 main skills you will learn during DBT:

• Mindfulness is being self-aware and present in the moment (the 'here and now'). When you are mindful, you are aware of what's going on around you and this helps ‘unhook’ your mind from worrying about the past or the future. Mindfulness helps you notice and respond to the present, rather than automatically reacting to it.
• Distress tolerance is learning to accept your emotions in difficult or stressful situations and manage them without using harmful behaviours.
• Emotional regulation is being more aware of your emotions. By understanding your emotions, you have more control over them.
• Interpersonal effectiveness is learning how to ask for what you need. It involves setting boundaries whilst being respectful towards yourself and others.

When doesn’t DBT work?

You will need to actively participate in the sessions to get the most out of DBT.

How long does DBT take to work?

A typical course of DBT involves weekly sessions. These may continue for 6 months to a year. How long it takes will depend on your needs.

For advice and to get connected to local mental health services, call Medicare Mental Health (Opens in new tab) on 1800 595 212. Check the operating times (Opens in new tab).

If you are having a personal crisis, try:

• Lifeline (Opens in new tab) call 13 11 14 or chat online 
• Suicide Call Back Service (Opens in new tab) call 1300 659 467 

Visit Project Air at the University of Wollongong (Opens in new tab) to learn more about the treatment of people with personality disorders and find support for their carers.

Other mental health support organisations are:

• Beyond Blue (Opens in new tab) — they can help if you are feeling depressed or anxious — call 1300 22 4636 or chat online (Opens in new tab).
• ReachOut (Opens in new tab) has information about different types of therapy (Opens in new tab). They also provide online mental health services for young people and their parents.
• Black Dog Institute (Opens in new tab) — they offer help for people with mood disorders — visit their online clinic (Opens in new tab).
• Jean Hailes for Women's Health (Opens in new tab) has fact sheets (Opens in new tab) on a range of health issues, including anxiety (Opens in new tab).
• SANE Australia (Opens in new tab) they have a range of free mental health support services (Opens in new tab).
• This Way Up Clinic (Opens in new tab) helps anyone with stress, anxiety or depression — find an online program that best suits your needs.
• Lifeline has information about cognitive behaviour therapy (Opens in new tab). 

Languages other than English

Healthy Horizons (Opens in new tab) has information in Arabic and Chinese for understanding mental health (Opens in new tab).

Information for Aboriginal and/or Torres Strait Islander peoples

• 13Yarn (Opens in new tab) is a free and confidential crisis support service run by Aboriginal and/or Torres Strait Islander People — call 13 92 76.