Copyright © 2014 Dr Alex Fowke. All Rights Reserved.
Developed in the 1990s by Professor Marsha Linehan at the University of Washington for the treatment of chronically suicidal and self-injurious clients, DBT focuses on teaching clients to use specific behavioural
techniques and strategies that are effective in tackling problems associated with strong and uncontrolled
emotions ('emotional dysregulation'). DBT is a therapy based on teaching clients new skills, and was
designed for people who experience difficulties in managing their emotions and have developed
maladaptive and dysfunctional ways of coping, or patterns of behaviour that are self-defeating or impulsive, affecting their everyday lives and their relationships.
Failures in emotion regulation can lead to inhibition or truncating of emotions, which in turn can lead to
increasing emotional avoidance, an increasing inability to cope with emotions when they do arise, and
increases in dysfunctional behaviour to avoid or block painful emotions. Whilst these 'strategies' can
seemingly 'solve' the problem in the short-term, they ultimately maintain psychological, behavioural and
social difficulties in the longer-term. Consequently, DBT aims to teach the skills to help solve some of these
difficulties in a more adaptive way.
There is a wealth of research that evidences the efficacy of DBT as a psychological intervention in the
treatment of Borderline Personality Disorder (or Emotionally Unstable Personality Disorder), as well as
anger difficulties and deliberate self-harm, depression, impulsivity and dissociation. It has also been
shown to have had a positive impact on global functioning, interpersonal functioning, well-being and
I am accredited as a DBT therapist in the UK through the Society for DBT. For this accreditation, I have demonstrated my extensive training and significant clinical experience in teaching clients to use DBT skills, both as part of standard DBT services in specialist mental health services, the REFRAMED research project, and as a part of my clinical work with individual clients in conjunction with other therapy skills, including traditional CBT strategies.
In my private work I incorporate some of the key principles and elements of the DBT model to help clients to develop a greater awareness and understanding of painful emotions and - ultimately - learn the skills to cope with distress in a safer and more effective way.
The therapy skills that are taught in DBT fall into four separate areas or 'modules':
Mindfulness: helping you to focus and concetrate on one thing at a time, effectively and without judgement, rather than getting caught up in thoughts from the past or about the future.
Emotion Regulation: helping you to understand and accept painful emotions and become more confident in your ability to regulate and manage these strong feelings in a way that is more effective and less disruptive.
Distress Tolerance: helping you to tolerate and accept some level of distress or emotional pain so that you can deal with difficult situations in a way that is more effective, functional and safe.
Interpersonal Effectiveness: helping you to improve your personal relationships, by teaching you skills to help you get your needs met in a more effective way without sacrificing your self-respect or putting the relationship at risk.