Learning About DBT

Dialectical behavior therapy (DBT) is a structured program of psychotherapy with a strong educational component designed to provide skills for managing intense emotions and negotiating social relationships. Originally developed to curb the self-destructive impulses of chronic suicidal patients, it is also the treatment of choice for borderline personality disorder, emotion dysregulation, and a growing array of psychiatric conditions. It consists of group instruction and individual therapy sessions, both conducted weekly for six months to a year.

The “dialectic” in dialectical behavior therapy is an acknowledgment that real life is complex, and health is not a static thing, but an ongoing process hammered out through a continuous Socratic dialogue with the self and others. It is continually aimed at balancing opposing forces and investigating the truth of powerful negative emotions.

DBT acknowledges the need for change in a context of acceptance of situations and recognizes the constant flux of feelings—many of them contradictory—without having to get caught up in them. Therapists help clients understand and accept that thought is an inherently messy process. DBT is itself an interplay of science and practice.

Clients participating in a DBT counseling can expect a course of treatment that typically consists of weekly group, skill-focused instructional meetings as well as individual therapy sessions. Individual sessions usually last an hour; group meetings, usually consisting of four to 10 people, are designed to run for an hour and a half to two hours. DBT is present-oriented and skills-based, and patients are asked to practice their skills between sessions. Patients can expect homework assignments, which might, for example, focus on taking specific, concrete steps to master relationship challenges.

DBT specifically focuses on providing therapeutic skills in four key areas.

• Mindfulness enables individuals to accept and be present in the current moment by noting the fleeting nature of emotions, which diminishes the power of emotions to direct their actions.

• DBT also inculcates distress tolerance, the ability to tolerate negative emotion rather than needing to escape from it or acting in ways that make difficult situations worse.

• Emotion regulation strategies give individuals the power to manage and change intense emotions that are causing problems in their life.

• Last but not least, DBT teaches techniques of interpersonal effectiveness, allowing a person to communicate with others in a way that is assertive, maintains self-respect, and strengthens relationships; a core principle is that learning how to ask directly for what you want diminishes resentment and hurt feelings.

DBT incorporates many of the techniques of cognitive behavioral therapy (CBT). It helps patients recognize and challenge the varieties of distorted thinking that underlie negative feelings and prompt unproductive behavior. For example, clients learn to identify when they are catastrophizing—assuming the worst will happen—in order to avoid acting as if it were the case. They review their own past and present experience for instances of all-or-nothing thinking, seeing everything in extremes of black or white, devoid of the nuance that is more generally the nature of life.

Mindfulness training is an important part of DBT. In addition to keeping clients present-focused, it slows down emotional reactivity, affording people time to summon healthy coping skills in the midst of distressing situations.

Clients are asked to keep a diary tracking their emotions and impulses, a tool that helps them gain awareness of their feelings, understand which situations are especially problematic for them, and use the information to gain control over their own behavior. In individual sessions, patients review difficult situations and feelings they faced the prior week and engage in problem-solving by actively discussing ways of behaving that might have delivered a positive outcome. In addition, patients typically have access to therapists between sessions for skills coaching if they are in a crisis.

This information was found on the Psychology Today website in a post on “Dialectical Behavior Therapy.”

Recap of Topic: Learning About DBT

DBT is a skills-based modality that utilizes CBT techniques and addresses emotional regulation. The primary goal of DBT is to teach clients how to monitor their thought processes, reframe all-or-none thinking, and reduce emotional dysregulation through acceptance, assertiveness and self-soothing.

Understanding What DBT Treats

With its strong emphasis on emotion regulation skills, DBT is finding application as a treatment for a wide range of mental health conditions. They include but are not limited to:

• Personality disorders, including borderline personality disorder

• Self-harm

• Post-traumatic stress disorder

• Bulimia

• Binge-eating disorder

• Depression

• Anxiety

• Substance use disorder

• Bipolar disorder

It is important to note that the reason DBT has proved effective in treating these conditions is that each of these conditions is thought to be associated with issues that result from unhealthy or problematic efforts to control intense, negative emotions. Rather than depending on efforts that cause problems for the person, DBT helps people learn healthier ways to cope.

Recap of Topic: Understanding What DBT Treats

DBT is indicated for clients suffering from mental health and substance abuse issues who struggle to regulate powerful, negative emotion. DBT offers a structured approach for teaching these clients how to identify emotions and their triggers. Clients are then taught skills that they can use outside of session to help themselves.

Practicing DBT Skills

DBT addresses skills in four primary areas: mindfulness, interpersonal effectiveness, distress tolerance, and emotional regulation. This information was found on Psych Central in an article titled, “4 DBT Skills for Everyday Challenges.”

1. Mindfulness is a foundational DBT skill that can help you better cope with stressors. Mindfulness is about the intentional observance of the here and now. It helps you stay away from worrying about the past and the future. In DBT, mindfulness skills help you discover who you are, what you want, and how you can control your emotions and mind. There are two types of mindfulness DBT skills: the what and the how skills.

   The what skills refer to the things you do to cope. These include:

   • observing: seeing what happens without labeling it

   • describing: putting in words what you observe

   • participating: involving yourself

   The how skills are about the way you do those things you do to cope. These include:

   • non-judgmentally: challenging negative self-talk and thoughts

   • one-mindfully: doing one thing at a time

   • effectively: doing what actually works for you and not what you think is right

2. Interpersonal effectiveness refers to a set of DBT skills that aim to help you establish and maintain healthy relationships with yourself and others. These skills teach you to speak up for your own needs, set boundaries, and respect yourself. For example, saying no is an interpersonal effectiveness skill that helps you care for yourself and let other know what you really want.

   Interpersonal effectiveness skills have three main goals:

   • objective effectiveness: getting what you want

   • connection effectiveness: improving and maintaining your relationships

   • self-respect effectiveness: cultivating self-respect

3. Distress tolerance is another foundational DBT skill that helps you cope with painful situations. The idea is to use helpful coping mechanisms when you’re facing emotional pain. Distress tolerance skills involve doing things that can help you stay away from intense pain so you can deal with it once you’re prepared. For example, grounding techniques like taking a cold shower or engaging in intense physical activity are distress tolerance skills in DBT. Radical acceptance is another DBT skill that can help you learn to tolerate distress. Radical acceptance helps you move toward a place of acceptance of your situations, thoughts, and emotions that are unchangeable. With this DBT skill, you notice and act intentionally to accept things as they are without trying to change them. Radical acceptance doesn’t mean you approve of the situation but rather that you accept it as it is so you can move on.

4. Emotional regulation, the fourth of the core DBT skills, teaches you how to gain control over your emotions rather than letting your emotions control you.

   Emotion regulation skills involve:

   • reality checking

   • acceptance of emotions

   • learning opposite actions of behaviors associated with specific emotions

   In opposite action, for instance, you do the opposite of what your emotion tells you to do. For example, if you feeling very sad and self-critical, your emotions may be telling you to lie down in a dark room. Opposite action would be getting out of the house, getting sunlight, and watching the sunset. When you practice opposite action, you’re not letting your emotions have the reins. Instead, you’re cultivating awareness of your feelings (“I know how I feel”) and being intentional about taking an action that allows you to walk a different path.

Recap of Topic: Practicing DBT Skills

Dialectical behavioral therapy is a psychotherapy approach that aims to help you cope with every day and extraordinary challenges by developing specific skills. The main DBT skills are mindfulness, interpersonal effectiveness, distress tolerance, and emotion regulation. Anyone can use these for any type of challenge. If you find it difficult to form stable interpersonal relationships, stay in the here and now, or regulate your emotions, DBT skills may help get to a place of greater peace and acceptance.

^{Recommended Product of the Week}

This week’s recommended product(s) is the book, "DBT skills training handouts and worksheets” by Marsha Linehan. All the handouts and worksheets discussed in the book are provided together with brief introductions to each module written expressly for clients.