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Above the Clouds


Dialectical Behaviour Therapy

Dialectical Behaviour Therapy (DBT) is a cognitive behaviour therapy  first developed by Marsha Linehan to treat Borderline Personality Disorder (Linehan, 1993). Since this time, there is a growing body of research to show its effectiveness in treating adolescents with complex problems, self harming behaviour, substance use, post traumatic stress disorder and eating disorders. Dr Linehan has direct personal experience and developed DBT when traditional treatments were not working and incorporated eastern philosophies and practice into her treatment.


DBT rests on the foundation of a dialectical philosophy that two opposing views can both be true. It takes an “AND” approach rather than an “EITHER/BUT” / black or white thinking approach. It is through this dialectic that the strategies of acceptance and change are applied.


DBT is applied when the core presenting issue is emotions and emotion regulation. Linehan’s research shows that some people experience emotions more intensely and are more reactive. This could be due to the person’s make up or related to adverse/ traumatic experiences. While emotions may be experienced intensely, if these feelings are invalidated, dismissed or ignored, the skills to label, respond and manage them are not developed. Over time, you no longer trust your emotions leading to feelings of disconnection and / or isolation and punishing behaviours. These behaviours develop in response to being confused, overwhelmed and not in control.


DBT focuses on understanding, labelling and building skills to respond to our emotions.  It aims to develop awareness of patterns of destructive behaviour to identify opportunities for change. Understanding Emotion Mind and Rational Mind helps us to learn when to use Wise Mind.


The DBT skills:

1. Mindfulness – to be in the moment, increase awareness and acceptance to make wise choices

2. Emotion Regulation - labelling, learning and managing a range of difficult, intense emotions

3. Distress Tolerance - sitting with discomfort and learning different ways to respond to difficult, painful, intense emotions in an nonjudgemental way

4. Interpersonal Effectiveness - how to get your needs met to maintain relationships and self respect


The role of validation is a critical component in DBT. When we are invalidating or are in an invalidating environment, we receive messages that our emotional experience does not make sense which adds to our distress. Conversely, validation seeks to soothe our internal system. This has particular resonance if you have experienced adverse early childhood experiences and learned that the world is not safe. 


Through DBT we learn ways to soothe and validate our emotional experiences as it is through validation that we learn to label, respond and manage our emotions to live a life worth living.

DBT has been demonstrated to be effective in treating...

  1. Binge Eating Disorder

  2. Bulimia Nervosa

If you would you like to talk to us more about DBT for Eating Disorders and whether this approach fits you, please contact us on 02 9555 4810 or email us at

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