What is DBT ?
(Dialectical Behavioral Therapy)
The goal of DBT is to help clients build a life that they experience as manageable and worth living. DBT focuses on building on a person’s strengths and teaching specific skills to help manage emotional responses and interactions. In DBT, the client and the therapist work together to set goals that are meaningful to the client. Dialectical behavior therapy (DBT) is a specific type of cognitive-behavioral psychotherapy developed in the late 1980s by psychologist Marsha M. Linehan to help treat borderline personality disorder. Since its development, it is effective in managing anxiety, depression, urges to self-harm or use substances, and more. These skills can be used by anyone anywhere at anytime.
The theory behind the approach is that some people are prone to intense or strong emotional reactions in some situations, primarily those found in romantic, family, and friend relationships. DBT theory suggests that some people’s arousal levels in certain situations can increase far more quickly than the average person’s and take a significant amount of time to return to baseline arousal levels.
Dialectical behavior therapy emphasizes the psychosocial aspects of treatment. It blends methods from various practices including Eastern mindfulness techniques. The benefits of DBT is that it offers practical skills that can help manage intense emotions and improve your ability to communicate. It can have a positive impact on relationships with others, professional and personal. Below is a summary of skills that can be used to manage depression, anxiety, increase self-awareness, improve self-talk, and improve communication.
Overview of DBT Skills
DBT skills focus on teaching 4 areas of skills to improve relationships and emotions.
- Mindfulness: The practice of being fully aware and present in this one moment
- Distress Tolerance: How to tolerate pain in difficult situations, not change it
- Interpersonal Effectiveness: How to ask for what you want and say no while maintaining self-respect and relationships with others
- Emotion Regulation: How to change emotions that you want to change
Mindfulness is the act of being strongly aware of what you’re sensing and feeling — without interpretation or judgment. It is being deliberate about where you put your thoughts and your mind. By increasing this skill, you can learn to live more in tune with your feelings and your activities.
Instructions: Focus on the facts. If your emotional mind begins to
wander toward sad thoughts or other associations, gently recognize what
you are doing, and without judgment start the exercise again.
What are 5 objects you can see?
What are 5 sounds you can hear?
What are 5 things you can taste?
Name 2 things you can taste.
(Use a glass of water or cup of tea with this portion if needed)
*Name one thing you can smell.
*Note: Smells can have strong emotional connections.
For individuals who have a trauma history or strong triggers,
use a guided scent that you know will not bring up sad or negative memories.
Recommendations for guided mindfulness for taste and smell
A cup of tea
(cinnamon, chamomile, or orange spice)
Twix candy bar
Snickers candy bar
2) Distress Tolerance
It is possible to learn specific skills to help manage distressing emotions. The reality is that pain and distress are inevitable part of life. At times refusing to accept this reality can cause and increase a person’s suffering. Distress tolerance teaches techniques intended to help someone endure a crisis without using self-harming behaviors, such as self-harm, attempting suicide, drugs, or alcohol, or even engaging in destructive relationship patterns. The goal is to help us get through situations without making them worse.
Improving the moment
Identify pros and cons
Make a list of 3 activities that are calming and relaxing
Get involved in a repetitive activity (color by number, crochet, knit, take a walk, etc)
Improve the moment. Focus on one thing in a stressful situation can provide a means to settle down. It can have a calming effect. The only pain one has to survive is “just this moment.”
Let go of the future and the past. When feeling discomfort, irritation, or anxiety, tell yourself to focus on “just this moment.”
3) Interpersonal Effectiveness
In DBT, this refers to skills that help us tend to our relationships, balance priorities versus demands, balance “wants” and “should,” and build a sense of mastery and self-respect. The goal of therapy is to help individuals become more aware of their behavior affects relationship, and then make positive changes when appropriate.
DEARMAN – Skills for communicating with others in a clear and effective manner.
Describe– Describe your needs in a clear and direct manner.
Express – Let others know how a situation makes you feel by clearly expressing your feelings. Don’t expect others to read your mind. Try using this line: “I feel ___ because ___.”
Assert – Don’t beat around the bush—say what you need to say. Don’t say: “Oh, well, I don’t know if I can cook tonight or not.” Do say: “I won’t be able to cook because I’m working late.”
Reinforce – Reward people who respond well, and reinforce why your desired outcome is positive. This can be as simple as a smile and a “thank you”.
Mindful – Don’t forget the objective of the interaction. It can be easy to get sidetracked into harmful arguments and lose focus.
Appear – Appear confident. Consider your posture, tone, eye contact, and body language
Negotiate – No one can have everything they want out of an interaction all the time. Be open to negotiation. Do say: “If you wash the dishes, I’ll put them away.”
Self-Respect Effectiveness (F.A.S.T.)
Sometimes in relationships you might find yourself betraying your own values and beliefs to receive approval or to get what you want. The acronym F.A.S.T. will help you achieve self-respect effectiveness.
Fair – Be fair. Not only to others, but also to yourself.
Apologies – Don’t apologize unless it’s warranted. Don’t apologize for making a request, having an opinion, or disagreeing.
Stick to Values – Don’t compromise your values just to be liked or to get what you want. Stand up for what you believe in.
Truthful – Avoid dishonesty such as exaggeration, acting helpless as a form of manipulation, or outright lying.
4) Emotional Regulation Skills
Emotional regulation skills help you recognize the role emotions play in your decision-making and often on your actions. Learning ways to manage emotions can have a positive impact on how you change or adapt to a situation so that the outcome can be more favorable. It is possible to learn new ways to respond to situations and learn to new perspectives. Even with severe trauma and abandonment experiences, these skills can help change perspectives and attitudes that can lead to improved emotions and experiences.
- Learn to identify and label emotions without judgment
- Identify obstacles to changing emotions, practice redirecting thoughts
- Reduce vulnerability to emotional mind, self-care methods
- Increase positive emotional events
- Increase mindfulness to current emotions
- Take opposite action
- Apply distress tolerance techniques or practice mindfulness activities.
- Deep breathing
THREE PRIMARY STATES OF MIND
A person is in a Reasonable Mind when they approach things intellectually or logically. This can include planning behavior, paying attention to empirical facts (facts that can be observed or measured or counted), focusing attention, and not being driven by an emotional state of mind.
Planning for an event
Studying for a test
Budgeting for an item you wish to buy
Writing a grocery list out prior to going shopping
A person uses Emotional Mind when their actions are a result of emotions, reactive and unplanned. It can be impulsive. Often these reactions are formed early in life as a result of our life experiences. We can be vulnerable to any experience that we interpret as “invalidating.” These experiences form our instinctive emotional and behavioral where we do not think, we react.
You are in your Emotional Mind when your emotions are in control, when emotions influence and control your thinking and your behavior.
Problems with Emotion Mind occur when the results are positive in the short term but negative in the long term, or when the experience itself is very painful, or leads to other painful states and events (e.g., anxiety and depression can be painful in themselves).
Emotional Mind is aggravated by: Illness, Sleep deprivation, tiredness, Drugs and alcohol, Hunger, bloating, overeating, poor nutrition, Environmental stress (too many demands), Environmental threat.
The wise mind is a delicate balance of reason and emotion acting together in a way that promotes healthy responses to situations. This is when reason and emotion come together. It is our ability to make better and more balanced choices. Some examples of Wise Mind include taking space during an argument, following your gut and your intuition when something does not feel right, or finding time to meditate during a stressful workday and taking care of yourself. DBT believes that people have the ability to make healthy choices. DBT assumes that people have the ability to access this inner wisdom.
These are only brief reviews of skills that individuals can learn to manage uncomfortable and intense emotions. It takes practice and time to learn new responses to people and scenarios. Remember that when experiencing stress, anxiety, sadness, or other intense emotions, we can learn additional tools to reduce our suffering and improve our own experience.