Beyond Borderline Personality Disorder: DBT Therapy UK

Emotional dysregulation is a common but challenging mental health concern connected with conditions like attention-deficit hyperactivity disorder (ADHD), borderline personality disorder (BPD), and substance use disorders. Dialectical behavior therapy (DBT) is a form of psychotherapy that can help participants self-regulate and manage symptoms of these disorders and other mental health challenges through acceptance and change. Below, explore an overview of DBT, the benefits of the modality, and options for DBT in the United Kingdom. 

What is dialectical behavior therapy (DBT)?

Emotional regulation is a skill that can improve one’s mental well-being, physical health, and overall ability to function. However, certain mental health concerns can make controlling emotions more difficult, potentially leading to unhelpful behaviors, interpersonal conflict, and worsening psychological challenges. Dialectical behavior therapy is a therapeutic modality that may aid clients in practicing emotional regulation and developing coping skills for stressful situations. 

Dialectical behavior therapy, sometimes styled dialectical behaviour therapy, stems from cognitive-behavioral therapy (CBT), which centers around how one’s feelings, thoughts, and behaviors are linked. Similarly, DBT is meant to help people understand the connections between their emotions and behaviors so that they can control their emotional responses to distress. Originally developed to treat borderline personality disorder, dialectical behavior therapy is specifically designed for individuals who experience strong emotions. 

Psychologist Marsha Linehan developed dialectical behavior therapy in the 1970s and 1980s as a treatment for people who were at risk of self-harm due to borderline personality disorder. In addition to personality disorders, DBT can treat mood disorders, ADHD, eating disorders, substance use disorders, and related mental health conditions. You also don’t need to be diagnosed with a mental illness to benefit from a modality like DBT. 

The term dialectical—meaning oppositional in nature—refers to the seemingly contradictory concepts that form the basis of DBT: acceptance and change. Through DBT, participants are encouraged to acknowledge and validate their emotions while altering their behaviors healthily.  

How DBT compares to other types of therapy for mental health 

Dialectical behavior therapy was developed based on the principles of cognitive-behavioral therapy (CBT). However, certain key skills differ from CBT and other modalities. One of the primary differences between dialectical behavior therapy and its precursor is the focus on acceptance. An overarching goal of DBT is acknowledging and validating intense feelings while also making changes that lead to greater control. 

Dialectical behavior therapy is also unique in its focus on managing complex emotions. In contrast, modalities like cognitive-behavioral therapy often emphasize an individual’s thoughts and behaviors. Through DBT, clients are encouraged to acknowledge and address challenging emotions.

Another difference between DBT and other therapies is the focus on mindfulness. DBT was one of the first forms of psychotherapy to utilize mindfulness, which helps participants develop an increased awareness of the present. Since DBT was developed, several other modalities have been adapted to include mindfulness principles. 

Borderline personality disorder, depression, and beyond: Mental health conditions DBT can treat

Initially created for people living with borderline personality disorder, dialectical behavior therapy has been modified to help people living with varied mental health concerns. The following are some of the most common disorders DBT can treat. 

Borderline personality disorder

Sometimes socially referred to as emotionally unstable personality disorder, borderline personality disorder (BPD) is a serious mental health condition marked by trouble with emotional regulation, impulsive behaviours, and strained relationships. According to the UK’s National Institute of Health and Care Excellence, dialectical behavior therapy is a first-line treatment for individuals with BPD. 

Depression

Depressive episodes often involve intense feelings of sadness, emptiness, and hopelessness. Through greater understanding and acceptance, DBT can help participants better express these difficult emotions. In one study, researchers found that DBT led to a reduction in depressive symptoms through improvements in emotional processing. 

Anxiety

Severe anxiety can cause people to experience powerful feelings of fear, worry, and nervousness. Given its focus on intense emotions, DBT can be a helpful form of therapy for anxiety. However, which anxiety disorders can DBT treat? Evidence points to the efficacy of DBT for generalized anxiety disorder and panic disorder. Additionally, one study found that DBT skills groups helped participants reduce symptoms of social anxiety disorder. 

Principles of DBT

An overarching goal of dialectical behavior therapy is acceptance of one’s strong emotions. DBT therapists help participants achieve this through four primary techniques: mindfulness meditation, emotional coping, interpersonal skills, and distress tolerance. 

Mindfulness

Mindfulness is a form of meditation that helps people remain present and focused. Enhancing awareness of one’s thoughts, feelings, and surroundings can help individuals better identify and regulate emotions. 

An example of a mindfulness exercise involves sitting or lying in a quiet place while focusing on thoughts, physical sensations, or emotions. If the participant’s thoughts wander, they can gently bring them back to the present. If the individual experiences intense emotions, they can note them without judgment. By practicing non-judgmental awareness, participants can learn to identify their emotions, often a constructive step toward self-regulation. 

Emotional regulation

DBT therapists help participants develop tools to identify and manage their emotions. One of the most common emotional regulation techniques involves processing strong feelings through a diary. For example, a therapist may prompt their client to journal about emotions they feel throughout the week. This process can involve descriptions of the event that evoked the feeling, the resultant bodily sensations, the thoughts and behaviors associated with the situation, and the label they’ve decided to give the emotion. 

Interpersonal skills

Because emotional dysregulation can lead to fraught relationships, interpersonal effectiveness is a key component of DBT. Therapists help participants develop skills like meeting their needs, resolving conflict, and being assertive. 

An example of an interpersonal effectiveness technique is DEAR MAN, an acronym meant to help people ask for what they need. Through the DEAR MAN approach, clients are encouraged to: 

• Describe their situation
• Express their emotions regarding these circumstances
• Assert themselves
• Reinforce the benefits of the request
• Mindfully focus on their objectives
• Appear confident
• Negotiate to come to a beneficial agreement

Distress tolerance

Difficulty navigating stressful situations can lead to unhelpful expressions of emotions, negative thoughts, and self-destructive behaviours. Learning to respond to life challenges healthily is a core goal of DBT. For example, a therapist may help their client practice breathing exercises, which they can employ when they’re experiencing anxiety at work.

How treatment through DBT works

Dialectical behavior therapy may be offered via individual and group sessions. The process often begins with an initial assessment. During this session, the therapist and client may discuss the individual’s mental health concerns, review the suitability of DBT, and develop treatment objectives. 

One-on-one sessions with a therapist usually occur weekly and are typically 50 to 60 minutes long. A primary goal of this phase of DBT is to help the participant acknowledge their emotions. This step is often achieved through a diary or diary cards, in which clients can record their feelings throughout the week. During individual therapy, the professional may ask the client to discuss their experiences from the previous week with thoughts of self-harm, emotional dysregulation, or relationship conflict.  

Participants also meet in a DBT skills group each week. These sessions, which are normally one to three hours long, help group members learn coping techniques through exercises and lessons. For example, participants might focus on effective interpersonal communication one week and mindfulness the next.  

DBT therapy: UK options

For residents of the United Kingdom, there are several options for dialectical behavior therapy, including but not necessarily limited to the following. 

Using the NHS to find DBT therapy (UK)

Psychotherapy through the NHS is free, making it a helpful option for many UK residents. You can request a referral from your general practitioner if you’d like to pursue DBT through the NHS. You can also find a therapist through the NHS talking therapy service. 

DBT therapy online

Online therapy platforms allow UK residents to easily connect with mental health providers who can help them utilize DBT skills. With online therapy platforms, participants can engage in DBT exercises without having to leave home. 

Treatment through an individual practice

Though these options may be more expensive, an individual practice or clinic may provide a DBT programme that fits your needs. You can go directly to a mental health professional or find a therapist through your medical insurance provider. 

Work through challenging emotions in DBT

Connect with a therapist

Participating in DBT and other types of therapy online

If you’re looking for a mental health provider who can utilize DBT principles, consider online therapy. As a flexible and convenient form of care, online therapy can provide you with the tools to regulate your emotions and address life challenges. With an online therapy platform like BetterHelp, you can participate in DBT or other forms of therapy remotely through video calls, voice calls, or in-app messaging. Your therapist can also connect you with useful resources, such as at-home exercises geared toward emotional regulation. 

A growing number of studies suggest that online therapy is an effective method of conducting dialectical behavior therapy. In a study on the effects of online therapy, researchers found that a DBT-based programme improved emotional regulation—as well as executive functioning—in participants. 

Takeaway

Emotional regulation plays a key role in one’s ability to pursue goals, form relationships, and function on a daily basis. Dialectical behavior therapy is a widely utilized modality that can help participants understand and accept strong emotions that may be underlying mental health challenges. To practice DBT-related skills or other therapeutic techniques, consider getting matched with a professional online or contacting a provider in your area. Connecting with a therapist can be a constructive next step on your mental health journey.