Could DBT really solve crisis pregnancies?
Most people have never heard of the therapy a TD prescribed for pregnant women
Lucinda Creighton has suggested that dialectical behaviour therapy, or DBT, could be used to treat women who are pregnant and feeling suicidal.Photograph: Laura Hutton
This relatively new form of therapy is a development of cognitive behaviour therapy (CBT) and is used in some parts of the State to treat personality disorders or phobias, or for those who have a history of self-harming.
Ms Creighton’s suggestion that DBT may be suitable for pregnant women feeling suicidal drew a strong response from Dr Anthony McCarthy, perinatal psychiatrist at The National Maternity Hospital at Holles Street, who said he was amazed at the number of politicians and obstetricians who seemed to hold vast understanding of suicide, pregnancy and the risks “as if they understand these issues and can then come up with proposals”.
Specifically, in relation to DBT, he said he was surprised at the suggestion that it should be written into legislation when “most people have never heard of it”.
Dr McCarthy also said that suggesting such a therapy hinted that society’s “views of women” were related to emotional instability because dialectical behaviour therapy was specific for those with an emotionally unstable personality disorder.
So what exactly is dialectical behaviour therapy? How does it differ from the better-known cognitive behaviour therapy and when is it appropriate as a treatment?
Dr Brendan Kelly, who is senior lecturer in psychiatry and consultant psychiatrist at the department of adult psychiatry, University College Dublin, explained the main differences between CBT and DBT.
“Cognitive behaviour therapy is about your cognition, such as your thoughts and your behaviours. It helps, for example, in dealing with catastrophising, as well as magnification and minimisation, and teaches us how we can learn ways to deal with these things.
“It is about training your mind, and has its roots ultimately in lots of Buddhist meditation practices. For some who have, say, depression, CBT can be helpful. For those who have severe depression, sometimes their mental state is such they can’t engage in this initially and anti-depressant medication can be helpful in getting them to a place where they can start problem solving.
“For mild depression, CBT is the treatment of choice.”
Often with CBT, the therapist will try to understand the sequence of events or thoughts that might lead up to, for example, a panic attack and then the therapy involves learning to interrupt that pattern.
The form of therapy Deputy Creighton suggested, which is DBT, is a development of CBT.
“What DBT does is it takes the CBT approach and applies it to situations where a person’s emotions are running haywire,” said Dr Kelly. “DBT is often focused on the self-harm element of behaviour and in making people aware of what is going on in their minds and realising that labelling these mood fluctuations is often enough to make us change them.”