Dialectical Behaviour Therapy (DBT) – Community and Inpatient CYPS Services

Dialectical Behaviour Therapy, or ‘DBT’ as it is called for short, is a form of psychological therapy that can successfully help young people experiencing a wide variety of emotional difficulties, stresses, and problems.

DBT has been shown to help young people who are experiencing the following difficulties:

• Suicidal and/or self-harm thoughts, urges and behaviours
• Intense and unstable relationships
• Substance misuse
• ating disorders
• Impulsiveness
• nxiety and low mood
• Low self-esteem

 
‘Dialectical’ because…
Dialectics is about seeking helpful solutions when there are several different points of view. DBT aims to help people get unstuck from extreme positions.

‘Behaviour’ because…
Specific behaviours a person wants to change or reduce are targeted to help them solve problems in their lives and achieve their goals.

• Sometimes people experience emotions which are too intense and last too long which make it very difficult to cope. At these times, we can end up using behaviours which provide short-term relief, but which are unhelpful and not effective in the long-term (e.g. self-harm).
• In DBT the aim is to help people to cope with distress by learning more effective strategies. There is a focus on ‘Acceptance’ and ‘Change’ strategies.

 
‘Acceptance’ Strategies
Acknowledging areas we cannot change in our lives and learning ways to tolerate and move past them.

‘Change’ Strategies
Focussing on changing unhelpful behaviours by using existing skills and learning new ones.

DBT involves three main forms of therapeutic contact – individual therapy sessions, skills training sessions, and telephone skills coaching. If you undertake DBT, you can expect the following:

Individual Therapy
You will be assigned an individual DBT therapist who you will meet once a week. The therapist will work with you to work out when you find things more difficult and what triggers these feelings. You will work together to practice using the skills you will learn in Skills Training (see below) to help you manage strong emotions and urges, and to act in different ways.

Skills Training
You will participate in skills sessions every week. In the community this will occur once a week and will be as part of a group with other young people. In inpatient settings, you will do skills teaching sessions on a one to one basis, and may be offered the opportunity to do more than one session per week. Details of the skills you will learn are on the next page.

Telephone Coaching
You will be provided with a telephone number which you can call or text between sessions to receive in-the-moment coaching when you need support. The aim of this is to coach people on how to use their DBT skills to effectively cope with difficult situations that arise in everyday life. In inpatient settings staff are available 24/7, and a telephone number may also be given when you are on leave.

In DBT Skills training for young people there are five modules taught. The modules and the types of skills you will learn and practice with your therapist are as follows:

Mindfulness: How to focus our minds on the present, and notice when we are spending time not being ‘in-the moment’ due to worrying about the past or future.

Distress Tolerance: Learning to accept and tolerate distress, survive crises and accept life as it is in the moment, without trying to change it.

Emotional Regulation: How to cope with difficult emotions and how to change emotions we want to change.

Interpersonal Effectiveness: Learning effective ways of asking for what we want and saying no, while improving relationships with others.

Walking the Middle Path: Learning to replace “either-or” thinking with collaborative “both-and” thinking, and to make room for compromise.

Typically, each module lasts for four weeks, and between each module, two weeks of mindfulness skills practice is done. The modules may be done more quickly or more slowly in inpatient settings depending upon the person’s needs.

Pre-Treatment: Before you start, your assigned therapist will meet with you for what is called ‘pre-treatment’ sessions. In these sessions you will learn more about DBT and exactly what it entails so that you and your therapist can better decide whether DBT is the best ‘fit’ for you at this time. If you are happy with starting DBT, you and your therapist will make a commitment to working towards your goals using the DBT format.

Questionnaires: During pre-treatment, and at the end of the full DBT programme, you will be asked to fill out some questionnaires. This is done at the start to help develop your goals for treatment, and at the end as a way of measuring whether the treatment has been effective for you.

Parent/carer involvement:Parents/carers can be involved and DBT is more effective when they are. This will typically involve parents/carers being invited to meet the therapists at the start of each new module to get an overview of the skills that will be taught and to identify ways that they can support their young person. How you want your family to be involved will be discussed with you.

You can access a number of resources online and apps for your phone which are related to DBT.

stem4 targets commonly occurring mental health issues in young people. They have a lot of helpful information on their website, and also have an app that you can download for free for your smart phone.

You can also access loads of resources through the charity MIND. They can give you information and support as well counselling and crisis helplines.

• Rathus, J.H., & Miller, A.L. (2015). DBT skills manual for adolescents. New York, NY: Guildford Press.
• Swales, M.A. (2019). The Oxford handbook of Dialectical Behaviour Therapy. New York, NY: Oxford University Press.

If you want to make a comment, suggestion, compliment or complaint you can:

• talk to the people directly involved in your care
• ask a member of staff for a feedback form, or complete a form on the Trust website www.cntw.nhs.uk (click on the ‘Contact Us’ tab)
• telephone the Complaints Department 0191 245 6672
• email [email protected] Please note that information sent to the Trust via email is sent at your own risk
• We are always looking at ways to improve services. Your feedback allows us to monitor the quality of our services and act upon issues that you bring to our attention.
  You can provide feedback in the following ways:
  – the quickest way for you to do this is to complete our short online survey at
  www.cntw.nhs.uk/poy
  – complete a Points of You survey, available from staff.

Further information about the content, reference sources or production of this leaflet can be obtained from the Patient Information Centre. If you would like to tell us what you think about this leaflet please get in touch.

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Tel: 0191 246 7288

Published by the Patient Information Centre
2022 Copyright, Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust
Ref, PIC/767/1222 December 2022 V3
www.cntw.nhs.uk Tel: 0191 246 7288
Review date 2025